當血糖超過腎臟再吸收糖的極限(一般為180 mg/dl)時，糖分會從小便中排出，使得尿液滲透壓升高，伴隨大量水分和電解質的流失，使細胞脫水，故出現三多(多尿，多渴，多吃)，疲倦，體重減輕等典型症狀。其他症狀還包括手腳麻，視覺模糊，皮膚傷口不易癒合，女性會陰發癢等。但也有50%病人 (血糖多為180 mg/dl以下)沒有任何症狀。
1 糖尿病最明顯的症狀為以下三多:
1.1 多喝(不正常的口渴)
1.2 多吃(容易肌餓、百口大開)
1.3 多尿
1.4 所以通稱”三多”症。
2 其他症狀還有:
2.1 易疲倦、四肢無力、四肢麻木、體重減輕。
2.2 女性外陰部搔疾。
2.3 視力減退、視覺模糊。
2.4 皮膚多病變、傷口不易癒合。
2.5 對細菌抵抗力減低，容易患肺結核症、 葡萄球菌感染症。
2.6 有以上症狀不一定是糖尿病，但看看醫生是必須的。
Erectile dysfunction is when men can’t get a penile erection or can’t keep an erection long enough to finish having sex. Erectile dysfunction is sometimes called “impotence,” although that’s an older term that doctors aren’t using as much these days.
Erectile dysfunction is a highly common problem. Ten to 20 million men in the United States have erectile dysfunction to some degree. The chance of having problems with erection increases as men age, but many older men have no problems at all.
在罹患精神疾病的病患當中，由於疾病本身而讓病患受到許多的痛苦，且治療需要持續一段時間，然後慢慢在罹患疾病症狀的控制穩定下，原來日常生活的功能和品質才能夠逐漸恢復。典型的代表就是現在被社會相當注意的憂鬱症。憂鬱症的主要症狀當中，除了憂鬱的情緒，睡眠、體重改變、思考速度減慢等等症狀之外，核心的症狀還包括對於日常生活興趣和快感全面的下降，所以在罹患疾病的過程當中，除了食慾和日常活動的興趣下降之外，當然也包含性功能的下降。男性可能出現的是對性行為提不起勁，陽萎、早洩、延遲射精，在女性也可能出現接受性刺激的時候沒有興趣，陰道分泌物減少，導致對於性行為無法愉快地享受。這些性功能障礙的症狀，在急性憂鬱期間，往往被忽略，而被當成是憂鬱症狀的一部份，但是隨著憂鬱症的症狀減輕之後，性功能障礙的問題常常沒有後續的處理，認為性功能障礙其實是憂鬱症的一部分，這對於憂鬱症的完整恢復，留下了一部份的遺憾。
在憂鬱症的治療當中，常常使用抗憂鬱劑的藥物，藥物對於憂鬱症的恢復是不可或缺的，但是，由於藥物本身也可能造成性功能障礙。治療憂鬱症主要的抗憂鬱劑，對於男性以及女性的性功能障礙，也造成相當大的影響。如果本來已經出現性功能障礙，抗憂鬱劑也可能讓性反應的強度降低。憂鬱症或者是藥物造成性功能障礙的影響，需要詳細的評估，甚至需要和泌尿科及婦產科共同合作，協助病患恢復良好的生活品質。
根據門診的追蹤研究當中，和性功能障礙有關的主要影響因素包括了：生理的疾病(例如高血壓、糖尿病)、服用藥物的作用和副作用、個案原來的人際適應程度(和家人關係的親密程度、人際溝通的意願和主動性)、以及原來精神症狀或症狀本身的嚴重性。在國外的研究當中，發現如果以憂鬱症為例，憂鬱症狀在中到重度的時候，精神症狀對於性功能障礙的影響最大。在我們的門診追蹤當中，發現如果在憂鬱症狀治療已經穩定，症狀處於輕到中度的時候，就必須要考慮原來個案的人際適應程度，這些症狀的嚴重度、人際適應的程度，都可以經由門診評估。
精神疾病和憂鬱的症狀，都是可以經由治療而讓症狀減輕，在功能逐漸恢復的過程當中，性生活的品質，和病患整體生活品質的提升，有相當大的關連性。如果出現性功能方面的障礙，除了要先排除泌尿科和婦產科的疾病之外，可以從精神科的評估和協助當中，增加生活的滿意度。而提升性功能首要的步驟，就是開始要去覺察到性生活的滿意度以及對於性功能障礙能夠具有初步的了解。
There are three different categories of hypogonadism, depending on the organs or organ systems responsible:
Primary hypogonadism, where the defect lies in the testes – The testes may be malfunctioning as a result of an accident or surgery. Inflammation of the testes and a number of other diseases can also lead to impaired testosterone production in the testes.
Secondary hypogonadism, where the defect lies in the hypothalamic-pituitary system – Hormones produced by the hypothalamus and the pituitary stimulate testosterone production by the testes. If insufficient amounts of these hormones are present the testes are unable to function properly. The hypothalamus-pituitary-testes system can be impaired by being underweight, a pituitary tumour and certain diseases, drugs and toxins.
Age-related testosterone deficiency, also known as late-onset hypogonadism (LOH) – In men, there is a slow but steady decline in blood levels of testosterone with increasing age. This often results in a vicious circle. On one hand complex ageing processes lead to the development of a testosterone deficiency. A general age-related deterioration in health as a result of disease is often an additional factor in this development. On the other hand, the developing testosterone deficiency itself has a negative effect on health and contributes to ageing processes.
estosterone deficiency has serious health consequences. It can put men at higher risk of:
Metabolic syndrome and diabetes
The increase in visceral fat in the man’s abdomen is linked to a decline in testosterone levels. This extra fat increases the risk of not only diabetes, but also metabolic syndrome (increased levels of total and ‘bad’ cholesterol, insulin resistance and high blood glucose).
Cardiovascular disease
Studies have shown that the lower the levels of testosterone, the higher the risk of cardiovascular disease and promotes a number of cardiovascular risk factors. Lower levels of testosterone can also lead to a decrease in elasticity in the walls of the arteries; this is associated with an increase in blood pressure. Healthy levels of testosterone have been linked to lower risk of heart attacks and healthier cholesterol levels.
Contraindications are conditions or circumstances (e.g. history of previous illness) in which the use of a certain drug or medical procedure is not allowed or only with special medical supervision.
Testosterone treatment is contraindicated in patients with diagnosed cancer of the prostate. Testosterone therapy does not lead to the development of prostate cancer. However, as prostate cancer is sex-hormone dependent, testosterone could stimulate the growth of an already existing tumor.
Breast cancer, which is very rare in men, is also a contraindication for testosterone therapy
The efficacy of testosterone therapy has been proven in testosterone deficiency.
Effects of treatment:
• Improvement in libido and erections
• Mental and physical wellbeing and performance are considerably increased. Many patients report positive effects on general mood, self-esteem and vitality
• has a virilising (masculinising) effect on the secondary sex characteristics (body and pubic hair, beard growth)
• Body shape and proportions become masculine again. Muscle mass and muscle strength increase, fat decreases
• Long-term therapy leads to an increase in bone density. The risk of osteoporosis-related fractures is reduced
• Improved production of red blood cells
• There is preliminary evidence that testosterone therapy may prevent the development of cardiovascular disease.
Testosterone has a wide margin of safety. Even after prolonged use of high doses, serious side-effects are rare. In some cases, testosterone therapy cannot be used due to pre-existing medical conditions. This is what doctors refer to as contraindications.
Treatment with testosterone must be individually tailored to the patient’s age and current needs. Monitoring of the treatment is carried out regularly to assess progress.
The aim of testosterone therapy is to achieve blood testosterone levels appropriate for the patient’s age. The only case in which other forms of treatment may be necessary is if there is a desire for fertility. These treatments are performed in centres specialising in reproductive medicine.
由於會影響到勃起功能的因素很多，因而往往會造成很多男性的心中之痛，尤其是到了中年以後，寡人有疾者比比皆是。至於女性的勃起問題，它和男性是相類似的，只不過女性比較佔便宜，不會因而不能做愛。不過，女性如果有勃起功能障礙，它會導致性腺分泌不足，性交疼痛不舒適以及性冷感症、無高潮等等。
由此可知，勃起功能不管是男是女都不能忽視，它影響到男女關係、夫妻性生活、生活品質…..等等。很多人甚至認為不能勃起表示身體健康亮起紅燈，生命受到嚴重威脅以至於坐立不安。的確，勃起和身體的狀況有密切的關係。然而，它並不會影響到健康問題，只有大大地影響到生活的品質，有些人會因而造成心理上的打擊。所以，醫學上認為它是一個重要的公共衛生問題。
性刺激有來自於大腦中樞神經的刺激和來自於泌尿生殖器官末梢神經的刺激。前者包括視覺、聽覺、嗅覺、情緒、性幻想以及性激素等等的刺激（見圖）。這些刺激的強度和勃起的品質成正比的關係，也和心理性勃起功能障礙息息相關。後者最重要的部位是在陰莖龜頭，因為它有高度分化的性感覺神經末梢，可以把特別的性感覺訊息傳到中樞神經系統。
另外，對肛門上皮組織、陰囊、會陰部等部位的刺激也會把這種性感覺傳入脊髓而造成勃起。此外，刺激尿道、膀胱、前列腺、貯精囊、睪丸以及輸精管，甚至於性器官充滿分泌物或感染發炎等等都會造成性衝動。這些末梢刺激引起的勃起現象主要表現在夜間的勃起，這種男性從三歲開始就會出現的勃起現象，每天都會在睡夢中持續上演，除非身體有什麼病痛，否則它是不會消失的。這一點可以用夜間陰莖勃起掃瞄器來証明。所以，末梢神經刺激的障礙和器質性的性功能障礙有密切的關係。
不過，性功能的問很複雜，很多問題至今仍然是一團謎。一旦性功能出了問題，如何診斷？如何治療？更是對現代醫學的一大挑戰。因為到目前為止，還沒有一種確切的診斷方法，而仍然需要患者自己的主觀評估。原因何在？主要的原因是因為有一半以上性功能障礙與心理因素有關。
| Treatment | Advantages | Side-effects & disadvantages |
| Testosterone injection | Testosterone enanthate:
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Testosterone undecanoate:
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| Testosterone patch |
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| Testosterone implants |
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| Oral testosterone capsules |
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| Testosterone gel |
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If a testosterone deficiency is established, testosterone therapy can considerably improve mental and physical wellbeing, sexual satisfaction and quality of life. Diseases resulting from a testosterone deficiency (e.g. osteoporosis) can be prevented. Below are some treatment options available for treating testosterone deficiency.
Testosterone injection
Intramuscular injection of testosterone is one of the standard forms of therapy.
Injections of testosterone enanthate have been used for more than 50 years and are therefore well established. The injections are given at intervals of two to three weeks. They are generally well tolerated. The disadvantage of these conventional injections are that they produce high blood concentrations of active hormone shortly after the injection and that levels then fall again rapidly. Patients often find that this can lead to fluctuations of mood (feeling of energy and wellbeing shortly after the injection – increasing tiredness as the testosterone levels decline).
A newly developed injectable preparation with testosterone undecanoate overcomes the shortcomings of conventional testosterone injections. Only four injections are required per year. Testosterone levels remain constant. Patients value the consistent, reliable efficacy and the long duration of effect, which mean they are not dependent on having frequent injections. Consequently, testosterone undecanoate is believed to become the standard preparation for long-term treatment.
Testosterone patch
Testosterone patches were the first preparations in which testosterone was delivered to the bloodstream via the skin (transdermally). Two of these patches are affixed to the upper arms, abdomen, shoulders or back every evening. They must be left in place for 24 hours. The disadvantage is the visibility and particularly the limited skin tolerability. In some patients the skin can become irritated (redness, itching).
Testosterone implants
Implants (also called pellets) are amongst the oldest testosterone preparations. They are implanted under the skin of the abdomen in a minor surgical procedure under local anesthesia. Implantation of 3 to 6 pellets ensures gradually declining testosterone levels within the normal range for four to six months. Then new pellets have to be implanted.
Oral testosterone capsules
Testosterone capsules have a very short duration of action (only a few hours). Therefore several capsules have to be taken in the course of the day. In addition, uptake and utilization of the testosterone are influenced by the diet, so the action is not very reliable. Testosterone capsules have to be taken with a high-fat meal for optimal absorption. This poses a problem for obese men since the additional intake of fat will only worsen their obesity and increase related health risks.
Testosterone gel
The patient applies the clear, colourless gel to the skin of the upper arms, shoulders or abdomen himself every morning. The gel is absorbed within a few minutes. After this, the testosterone concentration remains very reliably within the normal range for 24 hours. Most patients tolerate the gel well.
