Оценка влияния коррекции углеводного обмена и массы тела на эндогенную продукцию тестостерона у мужчин с сахарным диабетом 2 типа, ожирением и синдромом гипогонадизма

Синдром гипогонадизма и сахарный диабет 2 типа (СД2) у мужчин нередко сочетаются и взаимно отягощают друг друга. Учитывая патогенетическую взаимосвязь с компонентами метаболического синдрома (гипергликемия, инсулинорезистентность, ожирение) и потенциальную обратимость дефицита тестостерона, а также настороженность врачей и пациентов в отношении заместительной терапии тестостероном, интересным является изучения влияния различных методик коррекции углеводного обмена и ожирения на эндогенную продукцию тестостерона. При анализе влияния коррекции образа жизни, медикаментозной терапии СД2 и ожирения, а также метаболической хирургии на выработку тестостерона, обнадеживающие результаты получены в отношении методик, обеспечивающих, в первую очередь, значимое снижение массы тела (препараты из группы агонистов рецепторов глюкагоноподобного пептида-1 и бариатрическая хирургия). Что касается иных классов новых противодиабетических препаратов, вполне вероятно, что все они могут оказывать прямое или косвенное благотворное воздействие на мужскую половую функцию, главным образом за счет снижения глюкозотоксичности и воспаления. Однако данная гипотеза требует проведения исследований на больших по объему выборках пациентов. Кроме того, до сих пор нет убедительных данных о значимости коррекции углеводного обмена вне зависимости от снижения массы тела в отношении эндогенной продукции тестостерона, а также отсутствуют данные о степени улучшения гликемического контроля, необходимой для клинически значимого повышения уровня тестостерона сыворотки крови.

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