臨床泌尿器科69巻1号

2015年01月発行

特集 LOH症候群診療—最近の進歩

日本人におけるテストステロン測定結果—日・欧米ガイドラインを踏まえて

著者： 高栄哲¹ 田谷正樹² 並木幹夫²

所属機関： ¹昭和伊南総合病院泌尿器科 ²金沢大学大学院医学系研究科集学的治療分野（泌尿器科学）

ページ範囲：P.12 - P.19

文献概要

要旨　加齢男性性腺機能低下症候群（LOH症候群）の生化学的診断基準値はテストステロン値による。欧米は総テストステロンであり，本邦では遊離型テストステロンである。日本人総テストステロンは加齢によって漸減しないが，欧米では漸減する。本稿では，本邦で行われた3つの大規模テストステロン測定プロジェクトの結果を総括するとともに，LOH症候群の診断基準について総覧する。さらに，日米間の住民ベースのテストステロンレベルを比較するために，米国の同一ラボで測定したテストステロン分画値と加齢との関係について報告する。また，アナログ遊離型テストステロンの測定中止に伴う代替測定法についても考察した。

参考文献

1）日本泌尿器科学会，日本men's health学会（編）：加齢男性性腺機能低下症候群診療の手引き，じほう，東京，2006

2）Namiki M, Akaza H, Shimazui T, et al：Clinical practice manual for late-onset hypogonadism syndrome. Int J Urol 15：377-388, 2008

3）Nieschlag E, Swerdloff R, Behre HM, et al：Investigation, treatment and monitoring of late-onset hypogonadism in males：ISA, ISSAM, and EAU recommendations. Eur Urol 48：1-4, 2005

4）Morales A, Schulman CC, Tostain J, et al：Testosterone Deficiency Syndrome（TDS）Needs to be Named Appropriately—The Importance of Accurate Terminology. European urology 50：407-409, 2006

5）岩本晃明，柳瀬敏彦，高　栄哲，他：日本人成人男子の総テストステロン，遊離テストステロンの基準値の設定．日泌会誌95：751-760，2005

6）Iwamoto T, Yanase T, Horie H, et al：Late-onset hypogonadism（LOH）and androgens：validity of the measurement of free testosterone levels in the diagnostic criteria in Japan Int J Urol 16：168-174, 2009

7）Adachi K, Yasuda K, Fuwa Y, et al：Measurement of plasma free steroids by direct radioimmunoassay of ultrafiltrate in association with the monitoring of free components with[14C]glucose. Clin Chim Acta 200：13-22, 1991

8）Krasnoff JB, Basaria S, Pencina MJ, et al：Free testosterone levels are associated with mobility limitation and physical performance in community-dwelling men：the Framingham Offspring Study. J Clin Endocrinol Metab 95：2790-2799, 2010

9）Deslypere JP and Vermeulen A：Leydig cell function in normal men：effect of age, life-style, residence, diet, and activity. J Clin Endocrinol Metab 59：955-962, 1984

10）Muller M, den Tonkelaar I, Thijssen JH, et al：Endogenous sex hormones in men aged 40-80 years. Eur J Endocrinol 149：583-589, 2003

11）Vermeulen A, Kaufman JM and Giagulli VA：Influence of some biological indexes on sex hormone-binding globulin and androgen levels in aging or obese males. J Clin Endocrinol Metab 81：1821-1826, 1996

12）Rosner W, Auchus RJ, Azziz R, et al：POSITION STATEMENT：Utility, Limitations, and Pitfalls in Measuring Testosterone：An Endocrine Society Position Statement. J Clin Endocrinol Metab 92：405-413, 2007

13）Moreno SA, Shyam A and Morgentaler A：Comparison of free testosterone results by analog radioimmunoassay and calculated free testosterone in an ambulatory clinical population. J Sex Med 7：1948-1953, 2010

14）Rosner W：Errors in the measurement of plasma free testosterone. J Clin Endocrinol Metab 82：2014-2015, 1997

15）Yamamoto K, Koh K, Matsui M, et al：Measurement-specific bioavailable testosterone using concanavalin A precipitation：comparison of calculated and assayed bioavailable testosterone. Int J Urol 16：894-901, 2009

16）Ho CK, Stoddart M, Walton M, et al：Calculated free testosterone in men：comparison of four equations and with free androgen index. Ann Clin Biochem 43：389-97, 2006

17）Fritz KS, McKean AJ, Nelson JC, et al：Analog-based free testosteronetest results linked to total testosterone concentrations, not free testosterone concentrations. Clin. Chem 54：512-516, 2008

18）de Ronde W, van der Schouw YT, Pols HA, et al：Calculation of bioavailable and free testosterone in men：a comparison of 5 published algorithms. Clin Chem 52：1777-1784, 2006

19）Okamura K, Ando F and Shimokata H：Serum total and free testosterone level of Japanese men：a population-based study. Int J Urol 12：810-814, 2005

20）Taya M, Koh E, Izumi K, et al：Comparison of testosterone fractions between Framingham Heart Study participants and Japanese participants Int J Urol 21：689-695, 2014

21）Feldman HA, Longcope C, Derby CA, et al：Age trends in the level of serum testosterone and other hormones in middle-aged men：longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab 87：589-598, 2002

22）Araujo AB, O'Donnell AB, Brambilla DJ, et al：Prevalence and incidence of androgen deficiency in middle-aged and older men：estimates from the Massachusetts Male Aging Study. J Clin Endocrinol Metab 89：5920-5926, 2004

23）Harman SM, Metter EM, Tobin JD, et al：Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J clin Endocrineol Metab 86：724-731, 2001

24）Wang C, Nieschlag E, Swerdloff RS, et al：ISA, ISSAM, EAU, EAA and ASA recommendations：investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male 12：5-12, 2009

25）Haring R, Teng Z, Xanthakis V, et al：Association of sex steroids, gonadotrophins, and their trajectories with clinical cardiovascular disease and all-cause mortality in elderly men from the Framingham Heart Study. Clin Endocrinol 78：629-634, 2013

26）Bhasin S, Pencina M, Jasuja GK, et al：Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the Framingham Heart Study and applied to three geographically distinct cohorts. J Clin Endocrinol Metab 96：2430-2439, 2011

27）Vermeulen A：Hormonal cut-offs of partial androgen deficiency：a survey of androgen assays. J Endocrinol Invest 28：28-31, 2005

28）Matsui F, Koh E, Yamamoto K, et al：Liquid chromatography-tandem mass spectrometry（LC-MS/MS）assay for simultaneous measurement of salivary testosterone and cortisol in healthy men for utilization in the diagnosis of late-onset hypogonadism in males. Endocrine journal 56：1083-1093, 2009