{"id":52537,"date":"2023-10-28T14:45:20","date_gmt":"2023-10-28T07:45:20","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=52537"},"modified":"2024-05-06T11:07:17","modified_gmt":"2024-05-06T04:07:17","slug":"suy-sinh-duc-anh-huong-nhu-the-nao-den-chuc-nang-tinh-duc-nam","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/suy-sinh-duc-anh-huong-nhu-the-nao-den-chuc-nang-tinh-duc-nam\/","title":{"rendered":"Suy sinh d\u1ee5c \u1ea3nh h\u01b0\u1edfng nh\u01b0 th\u1ebf n\u00e0o \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam?"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh \u0111\u1ee5c \u1edf nam gi\u1edbi c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Trong \u0111\u00f3 suy sinh duc l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n \u00edt g\u1eb7p v\u1edbi t\u1ef7 l\u1ec7 trung b\u00ecnh trong qu\u1ea7n th\u1ec3 nam gi\u1edbi \u1edf \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n l\u00e0 t\u1eeb 3- 3%. H\u1ed9i ch\u1ee9ng suy sinh d\u1ee5c hay c\u00f2n g\u1ecdi l\u00e0 s\u1ef1 suy gi\u1ea3m testosterone l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea7n thi\u1ebft \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 ch\u1ea9n \u0111o\u00e1n tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n nam gi\u1edbi m\u1eafc r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, d\u1ec5 c\u00f3 h\u01b0\u1edbng ti\u1ebfp c\u1eadn v\u00e0 can thi\u1ec7p h\u1ee3p l\u00fd.<\/b>
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T\u1ea3i b\u1ea3n PDF<\/span> T\u1ea0I \u0110\u00c2Y\u00a0\u00a0<\/span><\/a><\/p>\n

Ngu\u1ed3n: S\u00e1ch \u0110\u1ea1i c\u01b0\u01a1ng s\u1ee9c kh\u1ecfe t\u00ecnh d\u1ee5c – Ch\u01b0\u01a1ng 3: R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam<\/span><\/p>\n

Suy sinh d\u1ee5c v\u00e0 ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c nam<\/span><\/p>\n

Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc<\/span><\/p>\n

Ch\u1ee7 bi\u00ean: PGS.TS.BS. L\u00ea Minh T\u00e2m<\/span><\/p>\n

Bi\u00ean so\u1ea1n<\/span><\/p>\n

PGS.TS.BS. T\u00f4n N\u1eef V\u00e2n Anh<\/span><\/p>\n

ThS.BS. H\u1ed3 Tr\u1ea7n Tu\u1ea5n H\u00f9ng<\/span><\/p>\n

ThS.BS. Nguy\u1ec5n \u0110\u1eafc Nguy\u00ean<\/span><\/p>\n

ThS.BS. Tr\u1ea7n Th\u1ecb Nh\u01b0 Qu\u1ef3nh<\/span><\/p>\n

GI\u1edaI THI\u1ec6U<\/span><\/h2>\n
Sinh l\u00fd<\/span><\/h3>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 16.1. Ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd tr\u1ee5c d\u01b0\u1edbi \u0111\u1ed3i – tuy\u1ebfn y\u00ean – tuy\u1ebfn sinh d\u1ee5c<\/figcaption><\/figure>\n
Tuy\u1ebfn y\u00ean \u0111i\u1ec1u ch\u1ec9nh ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tinh ho\u00e0n th\u00f4ng qua vi\u1ec7c ti\u1ebft hormone LH, hormone n\u00e0y \u0111i\u1ec1u ch\u1ec9nh qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t testosterone trong t\u1ebf b\u00e0o Leydig; v\u00e0 hormone FSH, ch\u1ee7 y\u1ebfu ki\u1ec3m so\u00e1t qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t t\u1ec9nh tr\u00f9ng trong \u1ed1ng sinh tinh. Vi\u1ec7c s\u1ea3n xu\u1ea5t v\u00e0 b\u00e0i ti\u1ebft gonadotropin \u0111\u01b0\u1ee3c k\u00edch th\u00edch b\u1edfi hormone gi\u1ea3i ph\u00f3ng gonadotropin v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i v\u00e0 b\u1ecb \u1ee9c ch\u1ebf b\u1edfi ph\u1ea3n h\u00f3i \u1ee9c ch\u1ebf qua trung gian l\u00e0 ho\u1ea1t \u0111\u1ed9ng trung t\u00e2m c\u1ee7a steroid sinh d\u1ee5c v\u00e0 inhibin B (H\u00ecnh 16.1).Hormone gonadotropin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng theo xung c\u1ee9 sau 60-90 ph\u00fat k\u00edch th\u00edch gi\u1ea3i ph\u00f3ng theo nh\u1ecbp LH v\u00e0 FSH v\u00e0o m\u00e1u. Gonadotropin \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1edfi ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i, bao g\u1ed3m c\u1ea3 hormone gi\u1ea3i ph\u00f3ng corticotropin (CRF) v\u00e0 t\u1ebf b\u00e0o th\u1ea7n kinh B endorphin. LH k\u00edch th\u00edch t\u1ebf b\u00e0o Leydig s\u1ea3n xu\u1ea5t <\/span>testosterone, FSH k\u1ebft h\u1ee3p v\u1edbi testosterone trong tinh ho\u00e0n t\u00e1c \u0111\u1ed9ng l\u00ean t\u1ebf b\u00e0o Sertoli v\u00e0 \u1ed0ng sinh t\u1ec9nh \u0111\u1ec3 k\u00edch th\u00edch sinh tinh. T\u1ec9nh ho\u00e0n s\u1ea3n xu\u1ea5t 3-10 mg testosterone m\u1ed7i ng\u00e0y, gin t\u01b0\u01a1ng \u1ee9ng v\u1edbi n\u1ed3ng \u0111\u1ed9 10,4-34,7 nmol\/L trong huy\u1ebft thanh \u0111\u1ea1t \u0111\u1ecbnh \u0111i\u1ec3m v\u00e0o bu\u1ed5i s\u00e1ng. Testosterone t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp th\u00f4ng qua c\u00e1c th\u1ee5 th\u1ec3 androgen v\u00e0 th\u00f4ng qua qu\u00e1 tr\u00ecnh chuy\u1ec3n \u0111\u1ed5i th\u00e0nh hai ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh, dihydrotestosterone nh\u1edd enzyme 5-a reductase ho\u1eb7c oestradiol nh\u1edd enzyme protease. Testosterone v\u00e0 oestrogen ph\u1ea3n h\u1ed3i ti\u00eau c\u1ef1c \u0111\u1ebfn v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i v\u00e0 tuy\u1ebfn y\u00ean d\u00e9 \u1ee9c ch\u1ebf ti\u1ebft gonadotropin. T\u1ebf b\u00e0o th\u1ea7n kinh Kisspeptin-1 (Kiss-1), neurokinin-B v\u00e0 tachykinin-3 c\u00f3 li\u00ean quan \u0111\u1ebfn k\u00edch th\u00edch GnRH. Leptin c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c k\u00edch ho\u1ea1t t\u00edn hi\u1ec7u Kiss-1. Kho\u1ea3ng 25 mg testosterone c\u00f3 trong tinh ho\u00e0n b\u00ecnh th\u01b0\u1eddng v\u00e0 trung b\u00ecnh 5-10 mg testosterone \u0111\u01b0\u1ee3c ti\u1ebft ra h\u00e0ng ng\u00e0y.<\/span><\/p>\n
B\u1ea5t k\u1ef3 c\u00e1c r\u1ed1i lo\u1ea1n n\u00e0o trong ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd k\u1ec3 tr\u00ean c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng s\u1ee5t gi\u1ea3m n\u1ed3ng \u0111\u1ed9 testosterone, t\u1eeb \u0111\u00f3 g\u00e2y n\u00ean nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng v\u1ec1 ch\u1ee9c n\u0103ng sinh l\u00fd t\u00ecnh d\u1ee5c \u1edf nam gi\u1edbi.<\/span><\/p>\n
Ph\u00e2n lo\u1ea1i<\/span><\/h3>\n
M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn thi\u1ec3u n\u0103ng sinh d\u1ee5c v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh c\u00e1c nh\u00f3m ch\u00ednh sau:<\/span><\/p>\n
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Suy sinh d\u1ee5c nguy\u00ean ph\u00e1t<\/b> l\u00e0 do c\u00e1c nguy\u00ean nh\u00e2n t\u1ea1i t\u1ec9nh ho\u00e0n kh\u00e1c nhau: b\u1ec7nh l\u00fd nhi\u1ec5m s\u1eafc th\u1ec3 (h\u1ed9i ch\u1ee9ng Klinefelter l\u00e0 b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p nh\u1ea5t). H\u1ed9i ch\u1ee9ng Klinefelter l\u00e0 nguy\u00ean nh\u00e2n di truy\u1ec1n ph\u1ed1 bi\u1ebfn nh\u1ea5t c\u1ee7a thi\u1ebfu n\u0103ng sinh d\u1ee5c v\u00e0 x\u1ea3y ra v\u1edbi t\u1ef7 l\u1ec7 1\/600 ca sinh s\u1ed1ng. C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00e1c nhau v\u00e0 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c th\u1eeba m\u1ed9t nhi\u1ec5m s\u1eafc th\u1ec3 X do kh\u00f4ng ph\u00e2n t\u00e1ch nhi\u1ec5m s\u1eafc th\u1ec3 gi\u1edbi t\u00ednh trong qu\u00e1 tr\u00ecnh gi\u1ea3m ph\u00e2n. Ki\u1ec3u gen ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 47, XXY, nh\u01b0ng th\u1ec3 kh\u1ea3m 46, XY\/47, XXY th\u01b0\u1eddng th\u1ea5y.<\/span><\/li>\n<\/ul>\n
B\u1ec7nh nh\u00e2n c\u00f3 tinh ho\u00e0n nh\u1ecf v\u00e0 c\u1ee9ng v\u00e0 th\u01b0\u1eddng v\u00f4 sinh do t\u1ed5n th\u01b0\u01a1ng \u1ed1ng sinh tinh. N\u1ed3ng \u0111\u1ed9 testosterone trong huy\u1ebft thanh r\u1ea5t th\u1ea5p, nh\u01b0ng m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 n\u1ed3ng \u0111\u1ed9 \u1edf m\u1ee9c th\u1ea5p h\u01a1n m\u1ee9c b\u00ecnh th\u01b0\u1eddng v\u00e0 c\u00f3 ki\u1ec3u h\u00ecnh nam gi\u1edbi b\u00ecnh th\u01b0\u1eddng. M\u1ed9t s\u1ed1 nam gi\u1edbi m\u1eafc th\u1ec3 kh\u1ea3m c\u00f3 k\u00edch th\u01b0\u1edbc tinh ho\u00e0n v\u00e0 kh\u1ea3 n\u0103ng sinh tinh b\u00ecnh th\u01b0\u1eddng \u1edf tu\u1ed5i d\u1eady th\u00ec, nh\u01b0ng c\u00e1c t\u1ebf b\u00e0o m\u00e1u b\u1ecb mit din theo th\u1eddi gian. Ngo\u00e0i ra, c\u00e1c kh\u1ed1i u t\u1ea1i tinh ho\u00e0n v\u1edbi s\u1ef1 thi\u1ebfu h\u1ee5t testosterone sau khi \u0111i\u1ec1u tr\u1ecb ho\u00e1 x\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y suy sinh d\u1ee5c. Vi\u00eam tinh ho\u00e0n, teo tinh ho\u00e0n v\u00f4 c\u0103n, thi\u1ec3u s\u1ea3n \u1ed1ng d\u1eabn tinh b\u1ea9m sinh, r\u1ed1i lo\u1ea1n ph\u00e1t tri\u1ec3n gi\u1edbi t\u00ednh b\u1ed9 NST 46 XY, h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n di truy\u1ec1n tuy\u1ebfn sinh d\u1ee5c, h\u1ed9i ch\u1ee9ng Noonan ho\u1eb7c \u0111\u1ed9t bi\u1ebfn th\u1ee5 th\u1ec3 LH l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p h\u01a1n.<\/span><\/p>\n
M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p x\u1ea3y ra t\u00ecnh tr\u1ea1ng ch\u1ea5n th\u01b0\u01a1ng tinh ho\u00e0n v\u00e0 xo\u1eafn tinh ho\u00e0n. S\u1ef1 gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u1ea5p t\u00ednh c\u00f3 th\u1ebf g\u00e2y hu\u1ef7 ho\u1ea1i ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c \u1ed1ng sinh tinh. Ngo\u00e0i ra, m\u1eb7c d\u00f9 l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n quan tr\u1ecdng c\u1ee7a suy sinh duc th\u1ee9 ph\u00e1t, glucocorticoid \u1edf li\u1ec1u si\u00eau sinh l\u00fd \u0111\u00f4i khi g\u00e2y ra suy sinh d\u1ee5c nguy\u00ean ph\u00e1t \u0111\u1ea3o ng\u01b0\u1ee3c. Ketoconazole c\u0169ng c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp v\u00e0 \u0111\u1ea3o ng\u01b0\u1ee3c qu\u00e1 tr\u00ecnh t\u1ea1o steroid \u1edf t\u1ec9nh ho\u00e0n.\u00a0<\/span><\/p>\n
M\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y gi\u00e3n t\u0129nh m\u1ea1ch th\u1eebng tinh \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn qu\u00e1 tr\u00ecnh sinh t\u1ec9nh v\u00e0 s\u1ea3n xu\u1ea5t testosterone. Nh\u1eefng c\u1ea3i thi\u1ec7n v\u1ec1 n\u1ed3ng \u0111\u1ed9 testosterone v\u00e0 kh\u1ea3 n\u0103ng sinh s\u1ea3n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o sau khi c\u1eaft b\u1ecf t\u0129nh m\u1ea1ch th\u1eebng tinh.<\/span><\/p>\n
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\u00a0Suy sinh d\u1ee5c th\u1ee9 ph\u00e1t<\/b> l\u00e0 do c\u00e1c nguy\u00ean nh\u00e2n trung \u01b0\u01a1ng \u1edf v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i ho\u1eb7c tuy\u1ebfn y\u00ean:<\/span><\/li>\n<\/ul>\n
t\u0103ng prolactin m\u00e1u do kh\u1ed1i u ho\u1eb7c c\u01a1 n\u0103ng, h\u1ed9i ch\u1ee9ng Kallmann, thi\u1ebfu h\u1ee5t LH \u0111\u01a1n \u0111\u1ed9c, u tuy\u1ebfn y\u00ean, vi\u00eam tuy\u1ebfn y\u00ean t\u1ef1 mi\u1ec5n, suy tuy\u1ebfn y\u00ean do \u0111i\u1ec1u tr\u1ecb (ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb), kh\u1ed1i u th\u1ea7n kinh trung \u01b0\u01a1ng, h\u1ed9i ch\u1ee9ng Prader-Willi t\u0103ng s\u1ea3n th\u01b0\u1ee3ng th\u1eadn b\u1ea9m sinh.<\/span><\/p>\n
T\u0103ng prolactin m\u00e1u din \u0111\u1ebfn suy sinh d\u1ee5c th\u1ee9 ph\u00e1t th\u00f4ng qua \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p v\u00e0 b\u00e0i ti\u1ebft GnRH. Tr\u1eeb khi tuy\u1ebfn sinh d\u1ee5c b\u1ecb t\u1ed5n th\u01b0\u01a1ng do hi\u1ec7u \u1ee9ng \u1ee9c ch\u1ebf t\u1eeb u tuy\u1ebfn y\u00ean, tr\u1ef1c tuy\u1ebfn sinh d\u1ee5c th\u01b0\u1eddng ph\u1ee5c h\u1ed3i sau khi b\u00ecnh th\u01b0\u1eddng h\u00f3a n\u1ed3ng \u0111\u1ed9 prolactin. Thu\u1ed1c ch\u1ee7 v\u1eadn dopamine \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u00e9 \u0111i\u1ec1u tr\u1ecb u ti\u1ebft prolactin v\u00e0 ch\u1ee9ng t\u0103ng prolactin m\u00e1u v\u00f4 c\u0103n.<\/span><\/p>\n
Glucocorticoid \u1edf li\u1ec1u si\u00eau sinh l\u00fd din \u0111\u1ebfn thi\u1ebfu h\u1ee5t androgen do \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p Lobe<\/span><\/p>\n
Prednisone v\u1edbi li\u1ec1u h\u00e0ng ng\u00e0y t\u1eeb 15 mg tr\u1edf l\u00e9n c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf n\u1ed3ng \u0111\u1ed9 testosterone trong huy\u1ebft thanh trong v\u00f2ng 3 ng\u00e0y, v\u1edbi m\u1ee9c \u0111\u1ed9 \u1ee9c ch\u1ebf li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn li\u1ec1u glucocorticoid. Thu\u1ed1c gi\u1ea3m \u0111au opioid c\u0169ng \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p GnRH v\u00e0 n\u00f3ng d\u00e9 testosterone, doi khi l\u00e0m gi\u1ea3m n\u00f3ng \u0111\u1ed9 ay trong 59<\/span><\/p>\n
th\u00e9. C\u00e1c t\u00e1c nh\u00e2n l\u00e0 ch\u1ea5t ch\u1ee7 v\u1eadn c\u1ee7a thu th\u00e9 u-opioid (v\u00ed du: methadone v\u00e0 morphine) c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf tr\u1ee5c d\u01b0\u1edbi \u0111\u1ed3i – sinh d\u1ee5c. Nh\u1eefng t\u00e1c d\u1ee5ng nh\u01b0 v\u1eady hi\u1ebfm khi x\u1ea3y ra v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c ch\u00e0 b\u00f4ng th\u1ee5 th\u1ec3 mu-opioid v\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng c\u1ee7a th\u1ee5 th\u1ebf x-opioid (v\u00ed d\u1ee5, buprenorphine). C\u00e1c in c\u1ee9u kh\u00f4ng ki\u1ec3m so\u00e1t v\u00e9 li\u1ec7u ph\u00e1p thay th\u1ebf testosterone \u0111\u00e3 cho th\u1ea5y ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n \u1edf nam gi\u1edbi b\u1ecb suy gi\u1ea3m n\u1ed9i ti\u1ebft t\u1ed1 g\u00e2y ra b\u1edfi s\u1eed d\u1ee5ng opioid.<\/span><\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 16.2. H\u00ecnh \u1ea3nh suy sinh d\u1ee5c nguy\u00ean ph\u00e1t v\u00e0 suy sinh d\u1ee5c th\u1ee9 ph\u00e1t<\/figcaption><\/figure>\n
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Suy tuy\u1ebfn sinh d\u1ee5c v\u00e0 v\u00f9ng d\u01b0\u1edbi \u0111\u00f3<\/b>i (kh\u1edfi ph\u00e1t mu\u1ed9n): suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n do l\u00e3o h\u00f3a ho\u1eb7c th\u1eeba cin ho\u1eb7c c\u1ea3 hai l\u00e0 m\u1ed9t c\u01a1 ch\u1ebf \u0111i\u1ec3n h\u00ecnh \u0111\u01b0\u1ee3c thay trong suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n.<\/span><\/li>\n<\/ul>\n
S\u1ef1 ti\u1ebft hormone gi\u1ea3i ph\u00f3ng gonadotropin theo cung ch\u1ebf ti\u1ebft c\u1ee7a v\u00f9ng d\u01b0\u1edbi \u0111\u00f3i b\u1ecb gi\u1ea3m s\u00fat, do t\u0103ng \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a v\u00f9ng d\u01b0\u1edbi \u0111\u00f3i \u0111\u1ed1i v\u1edbi t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u1eeb c\u00e1c androgen ngo\u1ea1i vi. T\u1ea1i t\u0129nh ho\u00e0n, th\u1ec3 t\u00edch tinh ho\u00e0n c\u0169ng nh\u01b0 kh\u00f3i l\u01b0\u1ee3ng t\u1ebf b\u00e0o Leydig v\u00e0 ch\u1ee9c n\u0103ng d\u1ef1 tr\u1eef b\u1ecb gi\u1ea3m s\u00fat. C\u00f3 s\u1ef1 gi\u1ea3m b\u00e0i ti\u1ebft testosterone \u0111i k\u00e8m v\u1edbi ng\u1eebng ti\u1ebft ho\u00e0n to\u00e0n v\u00e0o ban \u0111\u00eam. C\u00e1c r\u1ed1i lo\u1ea1n k\u1ebft h\u1ee3p n\u00e0y l\u00e0 nguy\u00ean nh\u00e2n l\u00e0m gi\u1ea3m d\u1ea7n m\u1ee9c testosterone v\u1edbi t\u1ef7 l\u1ec7 trung b\u00ecnh l\u00e0 1-2% m\u1ecfi nam. Nam gi\u1edbi m\u1eafc b\u1ec7nh m\u00e3n t\u00ednh, b\u00e9o ph\u00ec v\u00e0 h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a c\u0169ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u1ef7 l\u1ec7 thi\u1ebfu h\u1ee5t testosterone cao v\u1edbi thay \u0111\u1ed5i t\u1eeb 25% \u0111\u1ebfn 50%. 20% nam gi\u1edbi tr\u00ean 60 tu\u1ed5i c\u00f3 m\u1ee9c testosterone s\u1ee5t gi\u1ea3m m\u1ed9t c\u00e1ch \u0111\u00e1ng k\u1ec3.<\/span><\/p>\n
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\u00a0Kh\u00f4ng nh\u1ea1y c\u1ea3m\/kh\u00e1ng th\u1ee5 th\u1ec3 androgen<\/b> l\u00e0 m\u1ed9t d\u1ea1ng thi\u1ebfu n\u0103ng sinh d\u1ee5c r\u1ea5t hi\u1ebfm g\u1eb7p, do kh\u00f4ng nh\u1ea1y c\u1ea3m ho\u00e0n to\u00e0n ho\u1eb7c m\u1ed9t ph\u1ea7n v\u1edbi th\u1ee5 th\u1ec3 androgen ho\u1eb7c thi\u1ebfu h\u1ee5t S-alpha reductase.<\/span><\/li>\n<\/ul>\n
D\u1ecbch t\u1ebf h\u1ecdc<\/span><\/h3>\n
T\u1ef7 l\u1ec7 m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 suy sinh d\u1ee5c nam trong d\u00e2n s\u1ed1 n\u00f3i chung vin ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft, m\u1eb7c d\u00f9 \u01b0\u1edbc t\u00ednh s\u01a1 b\u1ed9 t\u1ef7 l\u1ec7 n\u00e0y da c\u00f3 s\u1eb5n t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc. C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 d\u00e2n s\u1ed1 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n cho \u0111\u1ebfn nay c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf: d\u00e2n s\u1ed1 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u ch\u1ee7 y\u1ebfu l\u00e0 nam gi\u1edbi trung ni\u00ean tr\u1edf l\u00ean; nhi\u1ec1u \u0111\u1ecbnh ngh\u0129a kh\u00e1c nhau v\u1ec1 thi\u1ec3u n\u0103ng sinh d\u1ee5c \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng; v\u00e0 x\u00e9t nghi\u1ec7m testosterone ti\u00eau chu\u1ea9n ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. M\u1eb7c d\u00f9 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, gi\u1ea3m s\u1ee9c s\u1ed1ng v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ec3 ch\u1ea5t c\u00f3 li\u00ean quan \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 testosterone th\u1ea5p trong huy\u1ebft thanh, nh\u01b0ng nhi\u1ec1u nam gi\u1edbi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 m\u1ed9t s\u1ed1 nam gi\u1edbi c\u00f3 tri\u1ec7u ch\u1ee9ng l\u1ea1i c\u00f3 n\u1ed3ng \u0111\u1ed9 testosterone b\u00ecnh th\u01b0\u1eddng. T\u1ef7 l\u1ec7 th\u1ecf thi\u1ebfu h\u1ee5t androgen \u1edf Hoa K\u1ef3 l\u00e0 kho\u1ea3ng 6%. M\u1ed9t cu\u1ed9c kh\u1ea3o s\u00e1t t\u1ea1i ph\u00f2ng kh\u00e1m ngo\u1ea1i tr\u00fa cho th\u1ea5y t\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc l\u00e0 38.7% tr\u00ean c\u01a1 s\u1edf n\u00f2ng \u0111\u1ed9 testosterone th\u00e1p h\u01a1n 10,4 nmol\/L (nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng). Kho\u1ea3ng 500.000 nam gi\u1edbi \u1edf Hoa K\u1ef3 \u0111\u01b0\u1ee3c chin doin l\u00e0 thi\u1ebfu h\u1ee5t n\u1ed9i ti\u1ebft t\u1ed1 nam v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh cao h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc c\u00e1c b\u1ec7nh k\u00e8m theo c\u1ee5 th\u1ebf, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u00e9o ph\u00ec, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 HIV.<\/span><\/p>\n
CH\u1ea8N \u0110O\u00c1N L\u00c2M S\u00c0NG<\/span><\/h2>\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng<\/span><\/h3>\n
\u0110\u1ed1i v\u1edbi b\u1ea5t k\u1ec3 lo\u1ea1i suy sinh d\u1ee5c n\u00e0o, b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u suy sinh d\u1ee5c:<\/span><\/p>\n
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S\u1ef1 Thi\u1ebfu h\u1ee5t testosterone<\/b> tr\u01b0\u1edbc khi sinh s\u1ebd l\u00e0m thay \u0111\u1ed5i s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ed9 ph\u1eadn sinh d\u1ee5c g\u00e2y ra t\u1ea5t c\u1ea3 nh\u1eefng thay \u0111\u1ed5i c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u1ed1i v\u1edbi c\u00e1c kh\u00eda c\u1ea1nh v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh b\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i: nh\u01b0 l\u1ed7 ti\u1ec3u th\u1ea5p, t\u1eadt tinh ho\u00e0n kh\u00f4ng xu\u1ed1ng, v\u00e0 b\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i h\u00ecnh th\u00e1i c\u1ee7a ph\u1ee5 n\u1eef. Nh\u1eefng thay \u0111\u1ed5i v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu n\u00e0y s\u1ebd l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng sinh d\u1ee5c trong t\u01b0\u01a1ng lai. Nh\u1eefng r\u1ed1i lo\u1ea1n n\u00e0y kh\u00f4ng th\u1ee9 t\u1ef1 ph\u1ee5c h\u1ed3i v\u00e0 c\u00e1ch \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh. Quy t\u1eafc ph\u1eabu thu\u1eadt chung l\u00e0 ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t v\u00e0 x\u00e1c \u0111\u1ecbnh l\u1ef1a ch\u1ecdn gi\u1edbi t\u00ednh, \u0111i\u1ec1u n\u00e0y s\u1ebd d\u1ec5 \u0111\u1ea1t \u0111\u01b0\u1ee3c h\u01a1n khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt \u0111i\u1ec1u tr\u1ecb t\u00e1i t\u1ea1o \u1edf th\u1eddi \u0111i\u1ec3m s\u1edbm. M\u1ee5c ti\u00eau l\u00e0 ho\u00e0n th\u00e0nh vi\u1ec7c ch\u1ec9nh s\u1eeda phiu thu\u1eadt cho \u0111\u1ebfn khi 2 tu\u1ed5i. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c tuy\u1ebfn sinh d\u1ee5c kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng\/lo\u1ea1n h\u1ec7 gen, d\u00e9 ph\u00e1t hi\u1ec7n s\u1edbm kh\u1ea3 n\u0103ng \u00e1c t\u00ednh v\u00e0 \u0111\u01b0a ra l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p. C\u00e1c v\u00e1n d\u00e9 ch\u00ednh trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p l\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft v\u00e0 ch\u1ecdn \u0111o\u00e1n t\u1eeb khi m\u1edbi sinh, v\u00e0 r\u1ea5t kh\u00f3 \u0111i\u1ec1u tr\u1ecb sau 2 tu\u1ed5i do c\u00e1c nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3 kh\u00e1c v\u00e0 do b\u1ea3n d\u1ea1ng gi\u1edbi, vai tr\u00f2 gi\u1edbi v\u00e0 xu h\u01b0\u1edbng t\u00ednh d\u1ee5c \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp. \u0110i\u1ec1u tr\u1ecb thay th\u1ebf testosterone l\u00e0 bit bu\u1ed9c, sau th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t sinh l\u00fd<\/span><\/li>\n
\u00a0Tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu h\u1ee5t testosterone tr\u01b0\u1edbc tu\u1ed5i d\u1eady th<\/b>\u00ec, s\u1ebd lu\u00f4n quan s\u00e1t th\u1ea5y hi\u1ec7n t\u01b0\u1ee3ng d\u1eady th\u00ec mu\u1ed9n, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a \u1edf tr\u1ebb trai l\u00e0 kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m sinh d\u1ee5c th\u1ee9 c\u1ea5p (t\u0103ng k\u00edch th\u01b0\u1edbc tinh ho\u00e0n ) tr\u01b0\u1edbc 14 tu\u1ed5i. H\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh: t\u00ednh ho\u00e0n nh\u1ecf, t\u00ecnh ho\u00e0n l\u1ea1c ch\u1ed7, b\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i gi\u1ed1ng n\u1eef gi\u1edbi, gi\u1ecdng n\u00f3i the th\u00e9, c\u01a1 th\u1ebf v\u00e0 l\u1ecfng m\u1eb7t th\u01b0a th\u1edbt, gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng v\u00e0 c\u01a1. T\u1eeb \u0111\u1eb7c \u0111i\u1ec3m t\u00ecnh d\u1ee5c, nh\u1eefng c\u1eadu b\u00e9 n\u00e0y kh\u00f4ng th\u1ec3 hi\u1ec7n h\u1ee9ng th\u00fa t\u00ecnh d\u1ee5c, gi\u1ea3m xu h\u01b0\u1edbng t\u1ef1 k\u00edch th\u00edch v\u00e0 gi\u1ea3m \u1ea3o t\u01b0\u1edfng, m\u1ecfng t\u1ec9nh. Suy sinh d\u1ee5c kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1ebd \u1ea3nh h\u01b0\u1edfng n\u1eb7ng n\u00e9 \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c c\u1ee7a nam gi\u1edbi sau n\u00e0y, ngo\u00e0i ra c\u00f2n g\u00e2y ra lo\u1ea1n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng tinh tr\u00f9ng c\u1ee7a b\u1ec7nh nh\u00e2n. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 s\u1ef1 b\u1ed5 sung androgen b\u00ecnh th\u01b0\u1eddng, s\u1ebd kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng, thay \u0111\u1ed5i h\u00e0nh vi t\u00ecnh d\u1ee5c, ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c b\u1ecb \u1ea3nh h\u01b0\u1edfng m\u1ed9t c\u00e1ch to\u00e0n \u0111i\u1ec7n. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3, s\u1ebd kh\u00f4ng c\u00f3 s\u1ef1 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng v\u1ec1 ki\u1ec3u h\u00ecnh nam gi\u1edbi tr\u01b0\u1edfng th\u00e0nh, k\u00e8m theo \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c b\u1ecb suy gi\u1ea3m nghi\u00eam tr\u1ecdng.<\/span><\/li>\n
Thi\u1ebfu h\u1ee5t testosterone \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh s\u1ebd g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c so v\u1edbi c\u00e1c d\u1ea1ng suy sinh d\u1ee5c da d\u1ebb c\u1eadp tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ed9 ph\u1eadn sinh d\u1ee5c ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng, c\u00e1c \u0111\u1eb7c t\u00ednh sinh d\u1ee5c ph\u1ee5 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng, ch\u1ee9c n\u0103ng v\u00e0 h\u00e0nh vi t\u00ecnh d\u1ee5c b\u00ecnh th\u01b0\u1eddng cho \u0111\u1ebfn khi b\u1eaft \u0111\u1ea7u suy sinh d\u1ee5c. B\u1ee9c tranh l\u00e2m s\u00e0ng th\u01b0\u1eddng th\u1ea5y c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 r\u1ed1i lo\u1ea1n t\u00ecnh d\u1ee5c. C\u00e1c tri\u1ec7u ch\u1ee9ng t\u00ecnh duc bao gom m\u1ea5t ham mu\u1ed1n t\u00ecnh d\u1ee5c, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c, r\u1ee5ng l\u00f4ng tr\u00ean c\u01a1 th\u1ec3 v\u00e0 b\u1ed1c h\u1ecfa C\u00e1c bi\u1ebfn ch\u1ee9ng chuy\u1ec3n h\u00f3a l\u00e0 m\u00e1t kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng, thi\u1ebfu c\u01a1, t\u0103ng c\u00e2n, t\u0103ng m\u1ee1 c\u01a1 th\u1ebf v\u00e0 t\u0103ng nguy c\u01a1 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u.<\/span><\/li>\n<\/ul>\n
T\u00f3m l\u1ea1i, ki\u1ec3u h\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n thi\u1ebfu n\u0103ng sinh d\u1ee5c xu\u1ea5t hi\u1ec7n \u0111\u1ed9c l\u1eadp v\u1edbi nguy\u00ean nh\u00e2n g\u00e2y ra v\u1ea5n \u0111\u1ec1, nh\u01b0ng th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u h\u01a1n b\u1edfi t\u00f4i b\u1eaft \u0111\u1ea7u suy sinh d\u1ee5c. Khi s\u1ef1 thi\u1ebfu h\u1ee5t androgen ho\u00e0n to\u00e0n v\u00e0 ph\u00e1t tri\u1ec3n trong th\u1eddi k\u1ef3 b\u00e0o thai, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ebf rit nghi\u00eam tr\u1ecdng, tr\u1ea3i d\u00e0i t\u1eeb ki\u1ebfu h\u00ecnh n\u1eef g\u1eafn nh\u01b0 ho\u00e0n to\u00e0n (khong nh\u1ea1y c\u1ea3m ho\u00e0n to\u00e0n v\u1edbi androgen ho\u1eb7c khi\u1ebfm khuy\u1ebft enzyme ng\u0103n ch\u1eb7n qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p androgen) \u0111\u1ebfn c\u00e1c khi\u1ebfm khuy\u1ebft kh\u00e1c nhau trong qu\u00e1 tr\u00ecnh nam h\u00f3a v\u00e0 c\u01a1 quan sinh d\u1ee5c kh\u00f4ng r\u00f5 r\u00e0ng (\u0111\u01b0\u01a1ng vit nh\u1ecf, 16 ti\u00e9u th\u00e1p v\u00e0 tinh ho\u00e0n \u00e1n). Khi suy sinh d\u1ee5c x\u1ea3y ra \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 suy sinh d\u1ee5c ch\u1ee9c n\u0103ng, c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng nh\u1eb9, kh\u00f3 nh\u1eadn bi\u1ebft v\u00e0 th\u01b0\u1eddng b\u1ecb nh\u1ea7m l\u1eabn v\u1edbi qu\u00e1 tr\u00ecnh l\u00e3o h\u00f3a ho\u1eb7c v\u1edbi b\u1ec7nh m\u1ea1n t\u00ednh \u0111i k\u00e8m. M\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, ch\u1eb3ng h\u1ea1n nh\u01b0 m\u1ec7t m\u1ecfi, suy nh\u01b0\u1ee3c v\u00e0 gi\u1ea3m n\u0103ng l\u01b0\u1ee3ng, c\u0169ng nh\u01b0 suy gi\u1ea3m kh\u1ea3 n\u0103ng t\u00ecnh duc c\u00f3 th\u1ebf l\u00e0 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng. C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y b\u1ed9 ba tri\u1ec7u ch\u1ee9ng t\u00ecnh d\u1ee5c, bao g\u1ed3m ham mu\u1ed1n t\u00ecnh d\u1ee5c th\u00e1p, gi\u1ea3m kh\u1ea3 n\u0103ng c\u01b0\u01a1ng c\u1ee9ng t\u1ef1 ph\u00e1t v\u00e0 r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m n\u1ed3ng \u0111\u1ed9 testosterone trong huy\u1ebft thanh.<\/span><\/p>\n
.Ch\u1ea9n \u0111o\u00e1n<\/span><\/h3>\n
C\u01a1 s\u1edf ch\u00ednh c\u1ee7a chin \u0111o\u00e1n bao g\u1ed3m c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p v\u1edbi suy sinh duc, c\u00f9ng v\u1edbi b\u1eb1ng ch\u1ee9ng sinh h\u00f3a v\u1ec1 n\u1ed3ng \u0111\u1ed9 testosterone to\u00e0n ph\u1ea7n trong huy\u1ebft thanh th\u1ea5p v\u00e0o bu\u1ed5i s\u00e1ng trong hai l\u1ea7n tr\u1edf l\u00ean, \u0111\u01b0\u1ee3c do b\u1eb1ng x\u00e9t nghi\u1ec7m \u0111\u00e1ng tin c\u1eady. L\u01b0\u1ee3ng testosterone c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi l\u01b0\u1ee3ng th\u1ee9c \u0103n \u0103n v\u00e0o; do \u0111\u00f3, testosterone to\u00e0n ph\u1ea7n trong huy\u1ebft thanh n\u00e9n \u0111\u01b0\u1ee3c do trong \u0111i\u1ec1u ki\u1ec7n l\u00fac \u0111\u00f3i v\u00e0 v\u00e0o bu\u1ed5i s\u00e1ng (tir 07:00 \u0111\u1ebfn 11:00 gi\u1edd). Lu\u00f4n lu\u00f4n ph\u1ea3i th\u1ef1c hi\u1ec7n ph\u00e9p \u0111o x\u00e1c nh\u1eadn trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 gi\u00e1 tr\u1ecb b\u1ec7nh l\u00fd v\u00e0 ch\u1eafc ch\u1eafn l\u00e0 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u b\u1eaft k\u1ef3 li\u1ec7u ph\u00e1p testosterone n\u00e0o. Ng\u01b0\u1ee1ng tham kh\u1ea3o ch\u1ea5n \u0111o\u00e1n l\u00e0 \u0111\u01b0\u1edbi 8 nmol\/L.<\/span><\/p>\n
Vi\u1ec7c x\u00e1c \u0111\u1ecbnh LH ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00f9ng v\u1edbi prolactin (PRL) khi ph\u00e1t hi\u1ec7n n\u1ed3ng \u0111\u1ed9 testosterone to\u00e0n ph\u1ea7n b\u1ec7nh l\u00fd, d\u00e9 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c c\u00e1c t\u00ecnh tr\u1ea1ng c\u01a1 b\u1ea3n v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ebf x\u1ea3y ra.<\/span><\/p>\n
Do \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c c\u1ee7a prolactin \u0111\u1ed1i v\u1edbi ham mu\u1ed1n t\u00ecnh d\u1ee5c, PRL c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c coi l\u00e0 s\u00e0ng l\u1ecdc \u0111\u1ea7u tay \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m ham mu\u1ed1n t\u00ecnh d\u1ee5c.<\/span><\/p>\n
Ngo\u00e0i ra, ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tuy\u1ebfn y\u00ean (MRI), c\u0169ng nh\u01b0 c\u00e1c \u0111\u00e1nh gi\u00e1 hormon tuy\u1ebfn y\u00ean kh\u00e1c, l\u00e0 c\u1ea7n thi\u1ebft khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ebf nh\u01b0 r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c, \u0111au \u0111\u1ea7u ho\u1eb7c khi x\u00e1c nh\u1eadn t\u0103ng prolactin m\u00e1u<\/span><\/p>\n
$\"S\u01a1$ <\/a>
S\u01a1 \u0111\u1ed3 16.1. C\u00e1c b\u01b0\u1edbc th\u0103m d\u00f2 \u0111\u1ea7u tay nh\u1eb1m ch\u1ea9n \u0111o\u00e1n suy sinh d\u1ee5c<\/figcaption><\/figure>\n
<\/p>\n
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Khai th\u00e1c ti\u1ec1n s\u1eed, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng: c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ec3 li\u00ean quan \u0111\u1ebfn suy sinh d\u1ee5c \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong b\u1ea3ng 16.1. Ti\u1ec1n s\u1eed can thi\u1ec7p ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi tinh ho\u00e0n \u00e1n ho\u1eb7c 16 ti\u1ec3u l\u1ec7ch ph\u1ea3i \u0111\u01b0\u1ee3c khai th\u00e1c. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, c\u00e1c b\u1ec7nh \u0111i k\u00e8m m\u1ea1n t\u00ednh v\u00e0 to\u00e0n th\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m to\u00e0n di\u1ec7n \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n. N\u00ean lo\u1ea1i tr\u1eeb vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng can thi\u1ec7p v\u00e0o ho\u1ea1t \u0111\u1ed9ng tr\u1ee5c d\u01b0\u1edbi \u0111\u1ed3i-tuy\u1ebfn y\u00ean-tuy\u1ebfn sinh d\u1ee5c. C\u00e1c b\u1ec7nh c\u1ea5p t\u00ednh din \u0111\u1ebfn suy sinh d\u1ee5c ch\u1ee9c n\u0103ng c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m r\u00f5 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u.<\/span><\/li>\n
Ph\u1eebng m\u1eb7t<\/span><\/li>\n<\/ul>\n
M\u1ed9t s\u1ed1 b\u1ea3ng c\u00e2u h\u1ecfi t\u1ef1 \u0111\u00e1nh gi\u00e1 ho\u1eb7c m\u1ed9t s\u1ed1 m\u00f4 h\u00ecnh c\u00e1c cu\u1ed9c ph\u00f3ng vi\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 s\u00e0ng l\u1ecdc suy sinh d\u1ee5c. M\u1eb7c d\u00f9 c\u00e1c c\u00f4ng c\u1ee5 khai th\u00e1c b\u1ec7nh s\u1eed n\u00e0y \u0111\u00e3 ch\u1ee9ng minh t\u00ednh h\u1eefu \u00edch l\u00e2m s\u00e0ng trong vi\u1ec7c hd tr\u1ee3 tr\u00e1n \u0111o\u00e1n c\u1ee7a suy sinh d\u1ee5c ho\u1eb7c trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tri bing testosterone, t\u00edn hi\u1ec7u c\u1ee7a ch\u00fang vin c\u00f2n k\u00e9m v\u00e0 kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u00e9 s\u00e0ng l\u1ecdc c\u00f3 h\u1ec7 th\u1ed1ng nh\u1eefng ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng b\u1ecb suy sinh d\u1ee5c.<\/span><\/p>\n
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Khai th\u00e1c c\u00e1c d\u1ea5u hi\u1ec7u th\u1ec3 ch\u1ea5t<\/b>: v\u00ec b\u00e9o ph\u00ec th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn thi\u1ec3u n\u0103ng sinh d\u1ee5c (h\u1ea7u h\u1ebft l\u00e0 ch\u1ee9c n\u0103ng), n\u00ean vi\u1ec7c x\u00e1c \u0111\u1ecbnh ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 (BMI) v\u00e0 do chu vi v\u00f2ng eo \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb th\u1ef1c hi\u1ec7n \u1edf t\u1ea5t c\u1ea3 c\u00e1c c\u00e1 nh\u00e2n. K\u00edch th\u01b0\u1edbc tinh ho\u00e0n v\u00e0 d\u01b0\u01a1ng v\u1eadt, c\u0169ng nh\u01b0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sinh d\u1ee5c ph\u1ee5 c\u00f3 th\u1ebf cung c\u1ea5p th\u00f4ng tin h\u1eefu \u00edch v\u1ec1 t\u00ecnh tr\u1ea1ng n\u1ed9i ti\u1ebft t\u1ed1 nam t\u1ed1ng th\u1ebf. Ngo\u00e0i ra, t\u1ef7 l\u1ec7 ph\u00e2n kh\u00fac tr\u00ean\/ph\u00e2n kh\u00fac d\u01b0\u1edbi c\u1edd th\u1ebf (> 0,92) v\u00e0 t\u1ef7 l\u1ec7 sii tay tr\u00ean chi\u1ec1u cao (< 1,0) c\u00f3 th\u1ec3 h\u1eefu \u00edch d\u00e9 x\u00e1c \u0111\u1ecbnh h\u00ecnh d\u1ea1ng c\u01a1 th\u1ec3 \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ecb thi\u1ec3u n\u0103ng sinh d\u1ee5c tr\u01b0\u1edbc tu\u1ed5i d\u1eady th\u00ec ho\u1eb7c d\u1eady th\u00ec mu\u1ed9n.<\/span><\/li>\n
C\u00e1c b\u1eb1ng ch\u1ee9ng khuy\u1ebfn c\u00e1o<\/span><\/li>\n
C\u00e1c tri\u1ec7u ch\u1ee9ng t\u00ecnh d\u1ee5c l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ec3 nh\u1ea5t li\u00ean quan \u0111\u1ebfn suy sinh d\u1ee5c.<\/span><\/li>\n
Chin \u0111o\u00e1n suy sinh d\u1ee5c n\u00ean d\u1ef1a tr\u00ean c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ec3 c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t androgen, c\u00f9ng v\u1edbi n\u1ed3ng \u0111\u1ed9 testosterone huy\u1ebft thanh th\u1ea5p li\u00ean t\u1ee5c.<\/span><\/li>\n
Ch\u1ea9n \u0111o\u00e1n suy sinh d\u1ee5c ch\u1ee9c n\u0103ng l\u00e0 ch\u00e1n \u0111o\u00e1n lo\u1ea1i tr\u1eeb, sau khi lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n th\u1ef1c th\u1ebf c\u1ee7a suy sinh d\u1ee5c.<\/span><\/li>\n
S\u00e0ng l\u1ecdc thi\u1ebfu n\u0103ng sinh d\u1ee5c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb v\u00ec hi\u1ec7u qu\u1ea3 chi ph\u00ed v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng l\u00e0 kh\u1ecfng r\u00f5 r\u00e0ng. C\u00e1c c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc \u0111ang \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n, nh\u01b0ng c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m hi\u1ec7u su\u1ea5t vin ch\u01b0a \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp m\u1ed9t c\u00e1ch ch\u1eb7t ch\u1ebd. Ng\u01b0\u1ee3c l\u1ea1i, ph\u00e1t hi\u1ec7n tr\u01b0\u1eddng h\u1ee3p b\u1ea3ng c\u00e1ch \u0111o n\u1ed3ng \u0111\u1ed9 testosterone c\u00f3 th\u1ebf ph\u00f9 h\u1ee3p \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u00e0n \u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng nghi ng\u1edd suy sinh d\u1ee5c, ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n t\u00ecnh d\u1ee5c, g\u00e3y x\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9, v\u00e0 nh\u1eefng ng\u01b0\u1eddi d\u00f9ng glucocorticoid ho\u1eb7c opioid. Nam gi\u1edbi c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1eafc c\u00e1c b\u1ec7nh nh\u01b0 HIV, b\u1ec7nh phoi tac ngh\u1ebdn m\u1ea1n t\u00ednh, b\u1ec7nh th\u1eadn, v\u00e0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng type 11, c\u00f3 li\u00ean quan \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 testosterone th\u1ea5p, c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m.<\/span><\/li>\n<\/ul>\n
M\u1ed9t s\u1ed1 khuy\u1ebfn c\u00e1o:<\/strong><\/p>\n
\n
\u00a0\u0110\u00e1nh Gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng, s\u1eed d\u1ee5ng thu\u1ed1c v\u00e0 c\u00e1c ch\u1ea5t c\u00f3 th\u1ebf c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t\/ho\u1ea1t \u0111\u1ed9ng c\u1ee7a testosterone (M\u1ea1nh).<\/span><\/li>\n
T\u1ed5ng testosterone ph\u1ea3i \u0111\u01b0\u1ee3c \u0111o v\u00e0o bu\u1ed5i s\u00e1ng (07:00 v\u00e0 11:00 gi\u1edd) v\u00e0 \u1edf tr\u1ea1ng th\u00e1i \u0111\u1ed1i, v\u1edbi x\u00e9t nghi\u1ec7m \u0111\u00e1ng tin c\u1eady trong ph\u00f2ng th\u00ed nghi\u1ec7m (M\u1ea1nh).<\/span><\/li>\n
L\u1eadp l\u1ea1i t\u1ed5ng l\u01b0\u1ee3ng testosterone \u00edt nh\u1ea5t hai l\u1ea7n ri\u00eang bi\u1ec7t khi < 12 nmol\/L v\u00e0 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng testosterone (M\u1ea1nh).<\/span><\/li>\n
Testosterone to\u00e0n ph\u1ea7n ng\u01b0\u1ee1ng 12 nmol\/L (3,5 ng\/mL) l\u00e0 ng\u01b0\u1ee1ng \u0111\u00e1ng tin c\u1eady d\u00e9 ch\u1ea9n \u0111o\u00e1n suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n (M\u1ea1nh).<\/span><\/li>\n
Xin th\u0103m do SHBG v\u00e0 testosterone t\u1ef1 do kh\u00ed c\u00e1n thi\u1ebft (M\u1ea1nh).<\/span><\/li>\n
Testosteron t\u1ef1 do t\u00ednh to\u00e1n \u0111\u01b0\u1ee3c < 225 pmol\/L \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00e9 xu\u1ea5t nh\u01b0 m\u1ed9t ng\u01b0\u1ee1ng c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n suy sinh d\u1ee5c (Y\u1ebfu).<\/span><\/li>\n
Ph\u00e2n t\u00edch n\u1ed3ng \u0111\u1ed9 LH va FSH \u0111\u1ebf ph\u00e2n bi\u1ec7t gi\u1eefa suy sinh d\u1ee5c nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t (M\u1ea1nh).<\/span><\/li>\n
C\u00e2n nh\u1eafc do prolactin (PRL) n\u1ebfu ham mu\u1ed1n t\u00ecnh d\u1ee5c th\u00e1p (ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u\/ tri\u1ec7u ch\u1ee9ng<\/span><\/li>\n
g\u1ee3i \u00fd kh\u00e1c) v\u00e0 c\u00f3 l\u01b0\u1ee3ng testosterone th\u1ea5p ho\u1eb7c th\u1ea5p \u1edf m\u1ee9c b\u00ecnh th\u01b0\u1eddng (M\u1ea1nh).<\/span><\/li>\n
Th\u1ef1c hi\u1ec7n ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tuy\u1ebfn y\u00ean (MRI) trong suy sinh d\u1ee5c th\u1ee9 ph\u00e1t, v\u1edbi PRL t\u0103ng cao ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee5 th\u1ec3 c\u1ee7a kh\u1ed1i u tuy\u1ebfn y\u00ean v\u00e0\/ho\u1eb7c s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c thi\u1ebfu h\u1ee5t hormone thu\u1ef3 tr\u01b0\u1edbc tuy\u1ebfn y\u00ean kh\u00e1c (M\u1ea1nh).<\/span><\/li>\n<\/ul>\n
$\"S\u01a1$ <\/a>
S\u01a1 \u0111\u1ed3 16.2. C\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n chi ti\u1ebft suy sinh d\u1ee5c nam gi\u1edbi<\/figcaption><\/figure>\n
\u0110I\u1ec0U TR\u1eca<\/span><\/h2>\n
Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/span><\/h3>\n
Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng ch\u1ec9 quan tr\u1ecdng \u0111\u1ed1i v\u1edbi suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n<\/b>: gi\u1ea3m c\u00e2n, gi\u1ea3m m\u1ee1 trong c\u01a1 th\u1ebf v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ebf l\u00e0m t\u0103ng m\u1ee9c testosterone n\u1ed9i sinh. Thay \u0111\u00f3i l\u1ed3i s\u00f3ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n s\u1ef1 c\u00e2n b\u1eb1ng testosterone, trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111i\u1ec1u tr\u1ecb thay th\u1ebf n\u1ed9i ti\u1ebft t\u1ed1 t\u00edch c\u1ef1c, tuy v\u1eady, vi\u1ec7c gi\u1ea3m c\u00e2n \u0111\u00e1ng k\u1ec3 h\u01a1n 10% r\u00edt kh\u00f3 duy tr\u00ec th\u01b0\u1eddng xuy\u00ean \u1edf b\u1ec7nh nh\u00e2n. V\u00ec v\u1eady, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung l\u00e0 c\u1ea7n thi\u1ebft trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y. Ngay c\u1ea3 khi k\u1ebft qu\u1ea3 c\u00f3 th\u1ec3 nh\u1eadn th\u1ea5y s\u1ef1 dip \u1ee9ng, vi\u1ec7c tu\u1ea7n thai gi\u1ea3m c\u00e2n b\u1ec1n v\u1eefng trong th\u1eddi gian d\u00e0i l\u00e0 th\u1ea5p, do \u0111\u00f3, kh\u1ea3 n\u00e0ng testosterone gi\u1ea3m s\u1ebd xu\u1ea5t hi\u1ec7n tr\u1edf l\u1ea1i b\u1ea5t c\u1ee9 khi n\u00e0o con n\u1eb7ng t\u0103ng l\u00ean.<\/span><\/p>\n
Ph\u00f2ng ng\u1eeba thi\u1ebfu h\u1ee5t testosterone v\u1eabn l\u00e0 m\u1ee5c ti\u00eau h\u00e0ng \u0111\u1ea7u <\/b>b\u1eb1ng vi\u1ec7c qu\u1ea3n l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 thay \u0111\u00f3i \u0111\u01b0\u1ee3c, ching h\u1ea1n nh\u01b0 ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng, ho\u1ea1t \u0111\u1ed9ng th\u1ec3 thao th\u01b0\u1eddng xuy\u00ean v\u00e0 gi\u1ea3m u\u1ed1ng r\u01b0\u1ee3u, nh\u01b0ng trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p, rit kh\u00f3 d\u00e9 duy tr\u00ec l\u00e2u d\u00e0i.<\/span><\/p>\n
Li\u1ec7u ph\u00e1p testosterone thay th\u1ebf<\/span><\/h3>\n
Hi\u1ec7n t\u1ea1i, li\u1ec7u ph\u00e1p b\u1ed5 sung testosterone l\u00e0 ph\u01b0\u01a1ng ph\u00e1p duy nh\u1ea5t gi\u00fap ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a thi\u1ebfu h\u1ee5t testosterone, b\u00e1t k\u1ebf \u0111\u1ed1i v\u1edbi l\u0129nh v\u1ef1c thu\u1ebf ch\u00e1t, t\u00e2m l\u00fd hay t\u00ecnh duc.<\/span><\/p>\n
Kh\u00f4ng c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn r\u00f5 r\u00e0ng v\u1ec1 ng\u01b0\u1ee1ng b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng testosterone. Hi\u1ec7n c\u00f3 nhi\u1ec1u h\u01b0\u1edbng d\u1eabn kh\u00e1c nhau d\u00e9 chin \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb suy sinh d\u1ee5c: suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n (t\u1ed1ng testosterone < 8 nmol\/L) n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p testosterone, nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u1ed5ng m\u1ee9c testosterone t\u1eeb 8-12 nmol\/L k\u00e8m c\u00e1c tri\u1ec7u ch\u1ee9ng suy sinh d\u1ee5c n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. C\u00e1c h\u01b0\u1edbng din kh\u00e1c khuy\u1ebfn ngh\u1ecb ch\u1ec9 \u0111i\u1ec1u tr\u1ecb c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 testosterone d\u01b0\u1edbi 8 nmol\/L k\u00e8m theo tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3.<\/span><\/p>\n
M\u1ed1i quan t\u00e2m ch\u00ednh trong li\u1ec7u ph\u00e1p thay th\u1ebf testosterone \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb l\u00e0 s\u1ef1 an to\u00e0n m\u1ea1ch m\u00e1u v\u00ec g\u1ee3i \u00fd v\u1ec1 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 t\u0103ng l\u00ean, m\u1eb7c d\u00f9 \u0111\u00e3 gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch nghi\u00eam tr\u1ecdng nh\u01b0 t\u1eed vong, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng t\u1eed vong v\u00e0 \u0111\u1ed9t qu\u1ef5. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i c\u1ee7a testosterone \u0111\u1ed1i v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch.<\/span><\/p>\n
Tuy v\u1eady, c\u00e1c nghi\u00ean c\u1ee9u gin \u0111\u00e2y cho th\u1ea5y c\u00e1c k\u1ebft qu\u1ea3 kh\u00e1c nhau cho th\u1ea5y s\u1ef1 gia t\u0103ng c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u khi c\u00f3 li\u1ec7u ph\u00e1p b\u1ed5 sung testosterone. Do d\u1eef li\u1ec7u tr\u00e1i ng\u01b0\u1ee3c n\u00e0y, FDA (C\u1ee5c Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m) vin khuy\u1ebfn ngh\u1ecb r\u1eb1ng c\u1ea7n c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u can thi\u1ec7p l\u1edbn h\u01a1n \u0111\u1ebf c\u00f3 k\u1ebft lu\u1eadn ch\u1eafc ch\u1eafn v\u1ec1 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng testosterone c\u00f3 an to\u00e0n cho tim m\u1ea1ch hay khong. EMA (C\u01a1 quan D\u01b0\u1ee3c ph\u1ea9m ch\u00e2u \u00c2u) da nh\u1ea5t tr\u00ed r\u1eb1ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng nh\u1ea5t qu\u00e1n v\u1ec1 vi\u1ec7c t\u0103ng nguy c\u01a1 m\u1eafc c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 tim khi thay th\u1ebf testosterone \u1edf nam gi\u1edbi thi\u1ebfu hormone.<\/span><\/p>\n
Nh\u00ecn chung, li\u1ec7u ph\u00e1p n\u00e0y c\u00f3 nh\u1eefng l\u1ee3i \u00edch r\u00f5 r\u00e0ng \u0111\u1ed1i v\u1edbi ch\u1ee9c n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng, v\u1edbi c\u00e1c cu\u1ed9c giao h\u1ee3p th\u1ecfa m\u00e3n sau \u00edt nh\u1ea5t 3 th\u00e1ng b\u1ed5 sung testosterone. Ngo\u00e0i ra, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng testosterone \u1edf nam gi\u1edbi suy sinh d\u1ee5c gi\u00fap c\u1ea3i thi\u1ec7n \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf phosphodiesterase-5. Nh\u00ecn chung b\u1ed5 sung testosterone c\u00f3 t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ef1c kho\u00e1i v\u00e0 xu\u1ea5t tinh. H\u1ee9ng th\u00fa t\u00ecnh d\u1ee5c xu\u1ea5t hi\u1ec7n sau 3 tu\u1ea7n \u0111\u1ea7u ti\u00ean s\u1eed d\u1ee5ng v\u00e0 \u0111\u1eb7t m\u1ee9c 6n dinh sau 6 tu\u1ea7n.<\/span><\/p>\n
N\u1ed3ng \u0111\u1ed9 testosterone n\u00ean \u0111\u01b0\u1ee3c do \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 c\u00f3 li\u1ec7u ph\u00e1p b\u1ed5 sung ch\u00ednh x\u00e1c v\u00e0o th\u1eddi \u0111i\u1ec3m 3, 6 v\u00e0 12 th\u00e1ng sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n
C\u00f3 m\u1ed9t s\u1ed1 khuy\u1ebfn ngh\u1ecb v\u1ec1 s\u00e0ng l\u1ecdc testosterone t\u00edch c\u1ef1c trong c\u00e1c nh\u00f3m nguy c\u01a1 \u0111\u1eb7c bi\u1ec7t c\u1ee7a nam gi\u1edbi:<\/span><\/p>\n
\n
Ti\u1ec3u \u0111\u01b0\u1eddng type 2.<\/span><\/li>\n
Hai ch\u1ee9ng chuy\u1ec3n h\u00f3a.<\/span><\/li>\n
B\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh v\u1eeba \u0111\u1ebfn n\u1eb7ng,- Lo\u00e3ng x\u01b0\u01a1ng. Ti\u1ec1n s\u1eed v\u00f5 sinh.<\/span><\/li>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng steroid, thu\u1ed1c phi\u1ec7n v\u00e0 thu\u1ed1c ch\u1ed1ng co gi\u1eadt.<\/span><\/li>\n
L\u1ea1m d\u1ee5ng r\u01b0\u1ee3u.<\/span><\/li>\n
R\u1ed1i lo\u1ea1n c\u01b0\u01a1ng ho\u1eb7c m\u1ea5t kh\u1ea3 n\u0103ng c\u01b0\u01a1ng c\u1ee9ng t\u1ef1 ph\u00e1t.<\/span><\/li>\n
M\u1ea5t ham mu\u1ed1n t\u00ecnh d\u1ee5c.<\/span><\/li>\n
M\u1ed9t s\u1ed1 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a li\u1ec7u ph\u00e1p testosterone thay th\u1ebf:<\/span><\/li>\n
Ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/span><\/li>\n
Ung Th\u01b0 v\u00fa.<\/span><\/li>\n
Ph\u00e1t hi\u1ec7n h\u1ea1ch x\u01a1 c\u1ee9ng khi kh\u00e1m ti\u1ec1n li\u1ec7t tuy\u1ebfn.<\/span><\/li>\n
N\u1ed3ng \u0111\u1ed9 kh\u00e1ng nguy\u00ean \u0111\u1eb7c hi\u1ec7u tuy\u1ebfn ti\u1ec1n li\u1ec7t > 4 pg\/L, ho\u1eb7c > 3 ug\/ L \u1edf nam gi\u1edbi c\u00f3 nguy c\u01a1 cao (v\u00ed d\u1ee5: ng\u01b0\u1eddi ch\u00e2u Phi, h\u1ecd h\u00e0ng th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t c\u1ee7a nam gi\u1edbi b\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t)..<\/span><\/li>\n
Ng\u01b0ng th\u1edf nghi\u00eam tr\u1ecdng l\u00fac ng\u1ee7 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c.<\/span><\/li>\n
Suy tim sung huy\u1ebft kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/span><\/li>\n<\/ul>\n
T\u00f3m l\u1ea1i, khi \u0111\u00e1nh gi\u00e1 suy sinh d\u1ee5c, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 kh\u00f4ng ch\u1ec9 n\u00ean t\u1eadp trung v\u00e0o c\u00e1c lo\u1ea1i suy sinh d\u1ee5c c\u01a1 b\u1ea3n do t\u1ea1i t\u1ec9nh ho\u00e0n hay trung \u01b0\u01a1ng, v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i v\u00e0 tuy\u1ebfn y\u00ean; m\u00e0 s\u1ef1 thi\u1ebfu h\u1ee5t m\u1ed9t ph\u1ea7n testosterone c\u00f3 th\u1ebf x\u1ea3y ra do t\u0103ng \u0111\u1ed9 tu\u1ed5i (suy sinh d\u1ee5c kh\u1edfi ph\u00e1t mu\u1ed9n), ho\u1eb7c th\u1ee9 ph\u00e1t do t\u0103ng c\u00e2n (l\u00ean \u0111\u1ebfn 30% nam gi\u1edbi m\u1eafc h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a v\u00e0 50% nam gi\u1edbi m\u1eafc b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng), ho\u1eb7c suy sinh d\u1ee5c th\u1ee9 ph\u00e1t \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n sau khi s\u1eed d\u1ee5ng steroid m\u1ea1n t\u00ednh ho\u1eb7c sau khi ti\u1ebfp x\u00fac l\u00e2u v\u1edbi c\u0103ng th\u1eb3ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nam gi\u1edbi tr\u1ebb tu\u1ed5i. T\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i suy sinh d\u1ee5c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nam gi\u1edbi tr\u1ebb, trung ni\u00ean ho\u1eb7c gi\u00e0 c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m v\u00e0 c\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau. Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e9n \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a cho t\u1eebng Lo\u1ea1i thi\u1ebfu n\u0103ng sinh d\u1ee5c v\u00e0 n\u00ean xem x\u00e9t c\u00e1c t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c v\u00e0 ti\u00eau c\u1ef1c c\u00f3 th\u1ebf x\u1ea3y ra. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u00f3 th\u1ebf c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u01b0: thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, gi\u1ea3n c\u00e2n b\u1ec1n v\u1eefng t\u0103ng c\u01b0\u1eddng t\u1eadp th\u1ec3 d\u1ee5c, li\u1ec7u ph\u00e1p b\u1ed5 sung testosterone v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 sinh s\u1ea3n.<\/span><\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/span><\/h2>\n
\n
Bhasin S, Cunningham GR, Hayes FJ, et al, and the Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95: 2536-59.<\/span><\/li>\n
Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007.<\/span><\/li>\n
Rosen RC, Araujo AB, Connor MK, et al. The NERI Hypogonadism Screener: psychometric validation in male patients and controls. Clin Endocrinol (Oxf) 2011; 74: 248-56.<\/span><\/li>\n<\/ol>\n
4.Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl] Med 2010; 363: 109-22.<\/span><\/p>\n
\n
Spitzer M, Basaria S, Travison TG, et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med 2012;157: 681-91.<\/span><\/li>\n
Wikstrom AM, Dunkel L. Klinefelter syndrome. Best Pract Res Clin Endocrinol Metab 2011; 25: 239-50.<\/span><\/li>\n<\/ol>\n
C\u00c2U H\u1eceI L\u01af\u1ee2NG GI\u00c1<\/span><\/h2>\n
C\u00e2u 1. \u0110\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 testosterone trong huy\u1ebft thanh n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o th\u1eddi \u0111i\u1ec3m n\u00e0o trong ng\u00e0y:<\/i><\/b><\/p>\n
\n
\u00a04-7h.<\/span><\/li>\n
7-11h.<\/span><\/li>\n
11h- 16h.<\/span><\/li>\n
16h-22h.<\/span><\/li>\n<\/ol>\n
Cau 2. C\u00e1c nguy\u00ean nh\u00e2n sau g\u00e2y suy sinh duc nguy\u00ean ph\u00e1t, ngo\u1ea1i tr\u1eeb:<\/i><\/b><\/p>\n
\n
Suy tuy\u1ebfn y\u00ean.<\/span><\/li>\n
H\u1ed9i ch\u1ee9ng Klinefelter.<\/span><\/li>\n
Vi\u00eam tinh ho\u00e0n.<\/span><\/li>\n
\u0110\u1ed9t bi\u1ebfn th\u1ee5 th\u1ebf LH.<\/span><\/li>\n<\/ol>\n
C\u00e2u 3. M\u1ed9t tr\u1ebb trai, 15 tu\u1ed5i, kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n d\u1eady th\u00ec, th\u1ea5p h\u01a1n so v\u1edbi tu\u1ed5i, tinh ho\u00e0n kh\u00f4ng t\u0103ng k\u00edch th\u01b0\u1edbc, n\u1ed3ng \u0111\u1ed9 testosterone trong huy\u1ebft thanh th\u1ea5p v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng nh\u1eadn bi\u1ebft m\u00f9i. Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 \u0111\u1eb7t ra \u1edf tr\u1ebb n\u00e0y l\u00e0:<\/i><\/b><\/p>\n
A H\u1ed9i ch\u1ee9ng Klinefelter.<\/span><\/p>\n
\n
H\u1ed9i ch\u1ee9ng Noonan.<\/span><\/li>\n
H\u1ed9i ch\u1ee9ng Kallmann.<\/span><\/li>\n
H\u1ed9i ch\u1ee9ng Prader Willi.<\/span><\/li>\n<\/ol>\n
C\u00e2u 4. C\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a li\u1ec7u ph\u00e1p testosterone thay th\u1ebf:<\/i><\/b><\/p>\n
\n
Ung thu v\u00fa.<\/span><\/li>\n
Hct > 50%,<\/span><\/li>\n
PSA > 4 pg\/L.<\/span><\/li>\n
T\u1ea5t c\u1ea3 \u0111\u00fang,<\/span><\/li>\n<\/ol>\n
C\u00e2u 5. Th\u1eddi \u0111i\u1ec3m c\u1ea7n ho\u00e0n th\u00e0nh vi\u1ec7c ch\u00ednh s\u1eeda ph\u1eabu thu\u1eadt \u0111\u1ed1i v\u1edbi c\u00e1c thay \u0111\u1ed5i v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng sinh d\u1ee5c:<\/i><\/b><\/p>\n
\n
6 th\u00e1ng tu\u1ed5i.<\/span><\/li>\n
1 tu\u1ed5i.<\/span><\/li>\n
2 tu\u1ed5i.<\/span><\/li>\n
Tr\u01b0\u1edbc tu\u1ed5i d\u1eady th\u00ec.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh \u0111\u1ee5c \u1edf nam gi\u1edbi c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Trong \u0111\u00f3 suy sinh duc l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n \u00edt g\u1eb7p v\u1edbi t\u1ef7 l\u1ec7 trung b\u00ecnh trong qu\u1ea7n th\u1ec3 nam gi\u1edbi \u1edf \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n l\u00e0 t\u1eeb 3- 3%. H\u1ed9i ch\u1ee9ng suy sinh d\u1ee5c hay c\u00f2n g\u1ecdi […]\n","protected":false},"author":1,"featured_media":52708,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[150],"tags":[],"class_list":["post-52537","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sinh-ly-nam-nu"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52537","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=52537"}],"version-history":[{"count":1,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52537\/revisions"}],"predecessor-version":[{"id":72472,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52537\/revisions\/72472"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/52708"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=52537"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=52537"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=52537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}