Hormonal Causes of Male Sexual Dysfunctions and Their Management (Hyperprolactinemia, Thyroid Disorders, GH Disorders, and DHEA)

Abstract

Introduction Besides hypogonadism, other endocrine disorders have been associated with male sexual dysfunction (MSD). Aim To review the role of the pituitary hormone prolactin (PRL), growth hormone (GH), thyroid hormones, and adrenal androgens in MSD. Methods A systematic search of published evidence was performed using Medline (1969 to September 2011). Oxford Centre for Evidence-Based Medicine—Levels of Evidence (March 2009) was applied when possible. Main Outcome Measures The most important evidence regarding the role played by PRL, GH, thyroid, and adrenal hormone was reviewed and discussed. Results Only severe hyperprolactinemia (>35 ng/mL or 735 mU/L), often related to a pituitary tumor, has a negative impact on sexual function, impairing sexual desire, testosterone production, and, through the latter, erectile function due to a dual effect: mass effect and PRL-induced suppression on gonadotropin secretion. The latter is PRL-level dependent. Emerging evidence indicates that hyperthyroidism is associated with an increased risk of premature ejaculation and might also be associated with erectile dysfunction (ED), whereas hypothyroidism mainly affects sexual desire and impairs the ejaculatory reflex. However, the real incidence of thyroid dysfunction in subjects with sexual problems needs to be evaluated. Prevalence of ED and decreased libido increase in acromegalic patients; however, it is still a matter of debate whether GH excess (acromegaly) may create effects due to a direct overproduction of GH/insulin-like growth factor 1 or because of the pituitary mass effects on gonadotropic cells, resulting in hypogonadism. Finally, although dehydroepiandrosterone (DHEA) and its sulfate have been implicated in a broad range of biological derangements, controlled trials have shown that DHEA administration is not useful for improving male sexual function. Conclusions While the association between hyperprolactinemia and hypoactive sexual desire is well defined, more studies are needed to completely understand the role of other hormones in regulating male sexual functioning.

Funkcjonowanie seksualne i objawy depresyjne u młodych mężczyzn z niedoczynnością tarczycy leczonych terapią skojarzoną z zastosowaniem lewotyroksyny i liotyroniny

“…Erectile dysfunction has been reported more frequently in men with either hypothyroidism or hyperthyroidism than in men with normal thyroid function [1,2], but after adjusting for potential confounders only frank hyperthyroidism was found to be associated with erectile dysfunction [3]. Unlike erectile function, libido was more disturbed in men with hypofunction than in men with hyperfunction of the thyroid gland [1,4]. Moreover, hypothyroidism often results in delayed ejaculation, while elevated thyroid hormone levels are frequently accompanied by premature ejaculation [1,5,6].…”

Sexual Abstinence and Sperm Quality

“…Since they have an infertility issue, they need to ejaculate more often to increase the quality of sperm they produce per a single ejaculation. The time taken by two different individuals to produce a new batch of quality sperms differs (66). This is due to the fact that a fertile man and infertile man take different time for their tester ones to produce semen.…”

Treatment of Hypogonadism: Current and Future Therapies

“…It competes with estrogen for binding at the estrogen receptor and increases GnRH secretion, thereby increasing LH secretion 27 and consequently serum testosterone concentrations. For this reason, it works only in individuals with hypogonadotropic hypogonadism with an otherwise intact hypothalamic-pituitary-gonadal axis.…”