男性更年期綜合徵（Male Menopause Syndrome）的中醫療法

Treatment of Male Menopause Syndrome by Chinese Medicine

鄧振華(Zhen-Hua Deng)

《傳統醫學雜誌》 18卷1期 (2007/04) Pp. 73-85

https://doi.org/10.30038/JTM.200704.0010

摘要

根據世界衛生組織的研究調查，男性30歲以後，體內的雄性激素開始下降，平均每年下降約1%～2%。經激素代謝檢測，中老年男性雄激素隨年齡的增長，其清除率及產生速度均下降，不但有代謝活性的游離雄激素含量下降，而且在組織中濃度也降低。該研究測定25～70歲各年齡階段的男性，結果發現70歲男性體內的雄性激素水準僅為25歲男性激素的10%，估計75歲以上的男性其雄激素水準，約與9歲男孩的水準相當。男性在40～90歲期間，體內的睪固酮水準每年平均下降1%～2%，總下降程度高達30%～50%。與女性更年期比較，男性更年期發生時間較早，一般40～45歲即開始發生，而且經歷時間較長，可持續到60～65歲，甚至更老，而且幾乎所有的男性都會被影響，但程度不同。研究統計，約40% 的40～70歲男性會出現更年期症狀，大部分男性可終身沒有明顯的更年期症狀。睪丸酮水平的下降，主要是睪丸間質細胞功能減退引起的。睪丸酮水平低於300ng/dl時，男性開始出現性慾減退、乏力、精神萎靡、勃起次數減少、性生活減少的表現。男性更年期是老化現象，也是一個新的生理階段的開始。女性更年期大多症狀明顯，男性更年期除症狀不明顯外，常因正值事業衝刺期，被認為是因事業不順或家庭因素而不予注意，而容易被忽略。臨床表現為：性功能減退、情緒變化、神經和血管症狀及男性化體徵的減退等問題出現。臨床上常見男性病患將部份更年期症狀如易怒、沮喪、失眠…等，解讀為專業不順所致；而將情緒不穩定、易倦怠及性功能障礙歸因於家庭因素，甚至直接忽略而未即時就診，也因此困擾許多中老年男性。1994年Morales及Lunenfeld提出“男性更年期綜合徵（症候群）－中老年男性部份雄激素缺乏綜合徵（patients with partial androgen deficiency of the aging male (PADAM)）”的概念及定義，其認為PADAM定義：因為老化導致男性性腺功能不足，造成性賀爾蒙分泌缺乏，所引起的臨床上生理及心理的症候。由於人口老齡化趨勢及各相關因素的影響，男性更年期綜合徵正逐漸及廣泛影響許多中老年男性，自公共衛生及預防醫學的觀點看，目前男性更年期綜合徵遠不及女性更年期綜合徵受到人們普遍的認知與重視，但隨著男性醫學的發展，醫療工作者和人們應當對男性更年期綜合徵給予足夠的認識和重視，並且使其能得到及時、有效的診治與預防；同時，如何使男性順利度過更年期更是當前男性醫學的一大研究主題。

關鍵字

男性更年期綜合徵 ； 中老年男性部份雄激素缺乏綜合徵

並列摘要

According to the research and investigation of the World Health Organization, male older than 30 years old would decrease androgen by an average of about 1%-2% per year. Measured by the metabolism of hormone exam, it is found that its clearance rate and production velocity are decreased with the increasing of age in the middle aged and senior age male. The amount and concentration of androgen are decreased in the tissue. After investigating on male around 25-70 year old it is found that the level of androgen in 70 year old men is only 10% compared with 25 year old men. It is estimated that the level of androgen in above 75 year old men is about equivalent to 9 year old boys. As for 40-90 year old men, the level of testosterone drops by an average of about 1%-2% per year, and total reduction is up to 30%-50%.Compared with the menopause in women, the occurrence lime of male climacterium is relatively earlier which , generally begins at 40 - 50 years old, and lasts longer until 60 - 65 years old, even older. Almost all men can be influenced with variant degree. According to the research statistics, about 40% of 40 - 70 years old men will have the symptoms of climacterium. Most of all men will not have significant symptoms of climacterium throughout the life. The declination for the level of androgen is mainly caused by the functional decay of Leydig cell. When the level of androgen in lower than 300 ng/dl, the men will start to appear the depletion of sexual desire, fatigue, dispirited, lessening of erection times, and degradation of sexual life.The male climacterium is an aging phenomenon, which is also a new beginning of physiological stage. Most symptoms are obvious in female menopause, but it is not distinct in male climacterium. It is often neglected due to the dash development of male career is often occurred in this stage, therefore it is often considered to be caused by troublesome in career or family factor. The clinical symptoms are the degradation of sexual function, mood alteration, neural and vascular symptoms and the reduction of virilescence sign etc. Clinically male patients often interpret the climacteric symptoms, such as irritation, depression, and insomnia, etc are caused by troublesome career, and the instability, fatigue, and the reduction of sexual function are caused by family factor. Patients even neglected the symptoms directly and failed to see the doctor, so it bothers many aging male. In 1994, Morales and Lunenfeld proposed the concept and definition of ”Male climacteric syndrome - patients with Partial Androgen Deficiency of the Aging Male (PADAM)”. The PADAM is defined as the clinical physiological and psychological symptoms caused by the deficiency of androgen due to aging.Because the influence of aging population trend and various corresponding factors, the male climacteric syndrome affects many aging male gradually and extensively. From the viewpoint of public health and preventive medicine, people do not pay attention to the male climacteric syndrome like the female menopausal syndrome. But with the development of male medical science, the medical workers and people should seek and pay enough understanding and attention to the male menopause syndrome, and enable it to get prompt, effective treatment and prevention. Meanwhile, how to help the men to pass through the male climacteric syndrome is one of the major research topic of male medical science at current time.

並列關鍵字

Male climacteric syndrome ； patients with Partial Androgen Deficiency of the Aging Male ； PADAM