肥胖男性功能性性腺功能減退症的治療策略：系統評價與網絡薈萃分析

Treatment Strategies for Functional Hypogonadism in Obese Men: A Systematic Review and Network Meta-Analysis

——《性醫學雜誌》，第23卷第9期，2026年9月——

<The Journal of Sexual Medicine>, Volume 23, Issue 9, September 2026

【摘要】引言：肥胖相關的功能性性腺功能減退症（FH）是一種潛在可逆的病症，與性功能障礙、代謝紊亂、身體成分改變及生活質量受損相關。儘管已有多種治療策略，但其相對療效和安全性尚不明確。本系統評價與網絡薈萃分析旨在明確針對肥胖相關FH成年男性的各類治療在特定結局指標上的效應，並評估比較性證據的可信度。方法：檢索PubMed、Embase、Web of Science和Cochrane Library數據庫（建庫至2026年4月），納入評估結構化生活方式干預（SLT）、睾酮替代療法（TRT）、內源性睾酮恢復（ETR）療法、基於胰高血糖素樣肽-1受體激動劑（GLP-1 RA）的療法，或TRT聯合SLT的隨機對照試驗。採用頻率學派方法進行網狀薈萃分析。使用RoB 2評估偏倚風險，使用CINeMA評估證據可信度。通過敏感性分析和直接證據分析檢驗主要結果的穩健性。結果：共納入23項隨機對照試驗，涉及1899名受試者。與常規護理/安慰劑相比，TRT聯合SLT在提高總睾酮水平方面的估計增幅最大（MD 7.19，95% CI：1.18-13.21），其次是ETR療法（MD 4.14，95% CI：0.74-7.54）和TRT（MD 2.53，95% CI：0.26-4.81）。TRT聯合SLT顯著改善了國際勃起功能指數（IIEF）評分（MD 1.29，95% CI：0.07-2.50）。與常規護理/安慰劑相比，沒有任何干預措施能顯著降低糖化血紅蛋白水平。TRT降低了腰圍並增加了瘦體重，但也導致紅細胞比容升高；ETR療法和TRT聯合SLT也增加了瘦體重。未發現各組間不良事件存在顯著差異。敏感性分析和直接證據分析的結果總體上支持主要發現的趨勢。討論：現有治療方法在不同結局指標上顯示出各異的效應，但沒有單一策略在所有結局指標上均表現出持續的優越性。在多項比較中，證據的置信度為低或極低；納入的試驗在受試者特徵、治療方案及隨訪時長方面存在差異。這些結果應作為制定個體化治療決策的參考，而非確立治療方案優劣排名的依據，且尚需通過更長期的頭對頭試驗加以證實。

【關鍵詞】功能性性腺功能減退症；肥胖；睾酮替代療法；GLP-1受體激動劑；網狀薈萃分析

[Abstract] Introduction: Obesity-related functional hypogonadism (FH) is a potentially reversible condition associated with sexual dysfunction, metabolic disorders, altered body composition, and impaired quality of life. Although several treatment strategies are available, their comparative benefits and safety remain uncertain. This systematic review and network meta-analysis aimed to characterize their outcome-specific effects and the confidence of the comparative evidence in adult men with obesity-related FH. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to April 2026 for randomized controlled trials evaluating structured lifestyle therapy (SLT), testosterone replacement therapy (TRT), endogenous testosterone restoration (ETR) therapy, glucagon-like peptide-1 receptor agonist–based therapy, or TRT plus SLT. Frequentist network meta-analyses were performed. Risk of bias was assessed using RoB 2, and confidence in the evidence was evaluated using CINeMA. Sensitivity and direct-evidence analyses were conducted to examine the robustness of the principal findings. Results: Twenty-three randomized controlled trials involving 1899 participants were included. Compared with usual care/placebo, TRT plus SLT showed the largest estimated increase in total testosterone (MD 7.19, 95% CI, 1.18-13.21), followed by ETR therapy (MD 4.14, 95% CI, 0.74-7.54) and TRT (MD 2.53, 95% CI, 0.26-4.81). Testosterone replacement therapy plus SLT significantly improved International Index of Erectile Function scores (MD 1.29, 95% CI, 0.07-2.50). No intervention significantly reduced glycated hemoglobin compared with usual care/placebo. Testosterone replacement therapy reduced waist circumference and increased lean mass but also increased hematocrit; ETR therapy and TRT plus SLT also increased lean mass. No significant differences in adverse events were detected. Sensitivity and direct-evidence analyses generally supported the direction of the principal findings. Discussion: Available treatments showed distinct outcome-specific effects, but no single strategy was consistently superior across all outcomes. Confidence in many comparisons was low or very low, and the included trials differed in participant characteristics, treatment protocols, and follow-up duration. These findings should inform individualized treatment decisions rather than a definitive treatment ranking, and require confirmation in longer-term head-to-head trials.

[Key words] unctional hypogonadism, obesity, testosterone replacement therapy, GLP-1 receptor agonist, network meta-analysis

論文原文：Treatment strategies for functional hypogonadism in obese men: a systematic review and network meta-analysis. Liangliang Yang, Xinlei He, Shize Wang, et al. (2026). The Journal of Sexual Medicine, Volume 23, Issue 9, September 2026.

https://doi.org/10.1093/jsxmed/qdag272

（翻譯兼責任編輯：MARY）

（需要英文原文的朋友，請聯繫微信：millerdeng95或iacmsp）