Endocrine Aspects of Male Sexual Dysfunctions

Abstract

Introduction Endocrine disorders may adversely affect men’s sexual function. Aim To provide recommendations based on best evidence for diagnosis and treatment of endocrine-related male sexual dysfunctions. Methods The Endocrine Aspects of Male Sexual Dysfunctions Committee, including 11 members from eight countries and four continents, collaborated with the Endocrine subcommittee of the Standards Committee of the International Society for Sexual Medicine. Medical literature was reviewed in detail, followed by extensive internal committee discussion over 2 years, then public presentation and discussion with the other experts before finalizing the report. Main Outcome Measure Recommendations based on grading of evidence-base medical literature and interactive discussion. Results From animal studies, it is derived that testosterone modulates mechanisms involved in erectile machinery, including expression of enzymes that both initiate and terminate erection. In addition, testosterone is essential for sexual motivation. Whether these findings could be extrapolated to human erections is unclear. Testosterone plays a broad role in men’s overall health. Recent studies have established strong associations between low testosterone and metabolic and cardiovascular imbalances. In some studies, low testosterone decreased longevity; however, longitudinal studies do not support the predictive value of low testosterone for further cardiovascular events. The article proposes a standardized process for diagnosis and treatment of endocrine-related male sexual dysfunctions, updating the knowledge on testosterone and prostate safety. There is no compelling evidence that testosterone treatment causes prostate cancer or its progression in men without severe testosterone deficiency (TD). The possible roles of prolactin and thyroid hormones are also examined. Conclusions Men with erectile dysfunction, hypoactive sexual desire and retarded ejaculation, as well as those with visceral obesity and metabolic diseases, should be screened for TD and treated. Prospective interventional studies are required before screening for TD in more conditions, including cardiovascular diseases, and considering correction as preventive medicine as much data suggests.

Antiinflammatory effect of androgen receptor activation in human benign prostatic hyperplasia cells

“…However, it could be hypothesized that intraprostatic level of DHT could be more important than the level of serum testosterone for the growth of the prostate (Isaacs et al 1983), thus explaining this lack of association between serum testosterone level and prostate overgrowth. In contrast, some uncontrolled studies have reported a gradual improvement in the International Prostate Symptom Score (IPSS) following long-term testosterone therapy in men with hypogonadism and/or metabolic syndrome (MetS) (see review in Buvat et al (2010)). A small randomized controlled trial with testosterone enanthate in 23 men with BPH tends to support these findings, with a significant decrease in the IPSS score, maximum flow rate, and voided volume in the testosterone group but not in the 23 untreated controls (Shigehara et al 2011).…”

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…Beyond 6 months, TRT should be continued only in cases of clinical benefit. 77 Caution is warranted in men with a history of congestive heart failure (risk of fluid retention); repletion goals should be in the middle range (ie, 350-600 ng/dL) for this group. In patients older than 70 years and those with chronic illness, the consensus panel suggests use of an easily titratable testosterone formulation (eg, gel, spray, or patch) rather than intermediate and long-acting injectable formulations.…”

How to recognize late-onset hypogonadism in men with sexual dysfunction

“…In addition, signs and symptoms of hypogonadism are quite similar, irrespective of the disease origin; in other words, the clinical phenotype can be identical for primary or secondary hypogonadism. [2][3][4] However, the clinical phenotype is very different according to the age of hypogonadism onset, which can be used as an alternative classification. Table 1 reports the new age-ofonset-based classification of male hypogonadism.…”

“…5,19,20 Although they differ in their proposed T thresholds for the biochemical definition of hypogonadism, [2][3][4] all the Andrology Society guidelines recognize that the presence of hypogonadism-related symptoms is the cornerstone to defining a clinically relevant hypogonadism. It has been universally recognized that diagnosis of androgen deficiency should be made only in symptomatic men with unequivocally low serum T levels, as neither marker is consistently reliable alone.…”