Different Testosterone Levels Are Associated with Ejaculatory Dysfunction

Abstract

Introduction The role of testosterone (T) in pathogenesis of ejaculatory symptoms has not been completely clarified. Aim To evaluate the possible contribution of T and hypogonadism in the control of the ejaculatory reflex, comparing subjects with premature ejaculation (PE) or delayed ejaculation (DE) to those without ejaculatory dysfunction. Methods A consecutive series of 2,437 (mean age 51.9 ± 13.0 years) male patients with sexual dysfunction was studied. Main Outcome Measure Several hormonal and biochemical parameters were studied, along with the structured interview on erectile dysfunction (SIEDY) structured interview. Hypogonadism were defined when total testosterone (TT) was lower than 10.4 nmol/L. Results Among the patients studied, 714 (25.9%) and 121 (4.4%) reported PE and DE, respectively. In the youngest age band (25–40 years), subjects with PE reported higher TT and free testosterone (FT) levels when compared to the other groups (subjects with DE or those without PE and DE; P < 0.05 for both). Conversely, in the oldest age band (55–70 years), lower TT and FT levels were observed in DE subjects. Accordingly, patients with PE showed the lowest (12%) and subjects with DE the highest (26%) prevalence of hypogonadism. These differences were confirmed even after adjustment for confounders such as age and libido (HR = 0.75 [0.57–0.99] and 1.83 [1.14–3.94] for PE and DE, respectively; both P < 0.05). Conclusion Our data seem to suggest that T plays a facilitatory role in the control of ejaculatory reflex. Both central and peripheral mechanisms have been advocated to explain this association. Clinical studies are currently in progress to further establish the role of T in the ejaculatory dysfunction, attempting to revert DE by androgen administration.

Insight on pathogenesis of lifelong premature ejaculation: inverse relationship between lifelong premature ejaculation and obesity

“…13 Keleta et al 14 showed that the chronic treatment with T in rats significantly decreased serotonin (5-hydroxytryptamine (5-HT)) in brain. Serotonin is the most important central monoamine neurotransmitter that is involved in delaying ejaculation.…”

Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015

“…Few investigators have reported on the prevalence of DE. 17,23,37,41,58 Rates for this disorder vary from 1% to 10%. It is speculated that the prevalence of DE or anejaculation in elderly men, many of whom are no longer sexually active, could be much higher.…”

Evidence for a genetic etiology to ejaculatory dysfunction

“…1 Prevalence estimates of PE vary widely between studies, with reports ranging from around 3% 2 to around 30% 3 depending on definition and diagnostic criteria. For its etiology, psychological, environmental and contextual factors are all still being considered, 4,5 whereas recent research has focused on neurobiological, 6 endocrine 7,8 and genetic explanatory frameworks. 9,10 In recent years, researchers have tended to favor theoretical approaches that incorporate several different etiological factors to PE.…”