Hyperprolactinemia and Sexual Function in Men

Abstract

Male hyperprolactinemia (HPRL) is known to induce different types of sexual dysfunctions. In order to determine the incidence of HPRL among patients referred for sexual dysfunction, serum prolactin (PRL) was assayed in 1053 clinically idiopathic cases. Among 850 cases complaining of erectile impotence, 10 with marked HPRL (1.1%, PRL above 35 ng/ml) were found, of whom 6 cases were associated with a pituitary adenoma. 17 mild HPRL (2%, PRL 20–35 ng/ml) were also found. Among 124 cases with premature ejaculation, 13 (10%) mild HPRL were found. Serum PRL was normal in 51 cases complaining of anejaculation without orgasm, and 27 patients exclusively complaining of reduced sexual desire. Our results lay stress on the fact that serum PRL must be assayed in every case of clinically idiopathic erectile impotence. Indeed, 5 of the 10 marked HPRL patients would have been misdiagnosed if we had only assayed this hormone when plasma testosterone was below the normal range. Moreover, in order to shed some light on the mechanisms by which HPRL disturbs male sexual function, the sexual behaviour of 17 markedly HPRL males was compared to their serum levels of PRL and testosterone, first before treatment, then at regular intervals during treatment. Our main conclusion is that impotence cannot be totally explained by a decrease in plasma testosterone, because this steroid hormone was within the normal range in 7 of the 16 impotent patients. Moreover, when serum PRL was lowered by bromocriptine, 6 patients recovered their potency before plasma testosterone clearly increased, and in 3 of those patients before it reached the normal range. The other mechanisms able to explain the impotence of HPRL males are discussed. Our study suggests that psychological factors play an important additional role in the impotence of some HPRL patients.

Hyperprolactinemia and sexual function in men: a short review

“…2,18 We found no HPRL in the two former sexual dysfunctions. However, the size of samples was limited and Schwartz et al 20 reported on some male HPRLs revealed by isolated low sexual desire or anorgasmia.…”

“…2 It was in the low normal range (3-4 ng/ml) in four of the seven others and over 4 ng/ml in three. Many other ED patients with normal serum testosterone despite marked HPRL have been reported, including some with pituitary tumors, unlikely to be macroprolactinemias.…”

“…Many other ED patients with normal serum testosterone despite marked HPRL have been reported, including some with pituitary tumors, unlikely to be macroprolactinemias. 2 Determining serum PRL only in case of low testosterone would have led to neglect 50% of the 12 marked HPRL and three of the seven pituitary tumors that we detected in ED patients. 16 Likewise, sexual desire may be normal, or may seem normal to the patient, in ED patients with HPRL.…”

“…During treatment of hyperprolactinemic men with the prolactinlowering agent bromocriptin, sexual improvement correlates better with serum PRL's decrease than with testosterone's increase. 2 Also, erections can return prior to any increase in testosterone. A study by Bancroft et al, 5 who compared bromocriptin with a placebo in a single man according to a doubleblind design, also tends to support a direct, testosterone-independent effect of HPRL on men's sexual behavior.…”

Levosulpiride: a new solution for premature ejaculation?

“…In every patient an assay for prolactin was performed before starting the trial, as the hyperprolactinemic effect of the drug in many subjects is well known and we wanted to evaluate the size of it in everyone and the possible relationship with the therapeutic effect of the drug. 5 After 60 days the patients were followed-up. None of the patients were lost to follow-up.…”