Increased estradiol levels in venous occlusive disorder: a possible functional mechanism of venous leakage

Mancini, Antonio; Milardi, Domenico; Bianchi, Antonio; Summaria, Vincenzo; Marinis, Laura De

doi:10.1038/sj.ijir.3901287

Cited by 38 publications

(28 citation statements)

References 23 publications

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“…High estradiol values are considered detrimental to male sexual function. Estradiol values have been noted to be significantly higher in ED patients with venous leak than in controls, supporting the hypothesis that estradiol level can adversely influence penile smooth muscle function [120].…”

Section: Estradiolmentioning

confidence: 59%

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

2007

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Objectives-Androgens are essential for the development and growth of the penis, and they regulate erectile physiology by multiple mechanisms. Our goal is to provide a concise overview of the basic research and how this knowledge can be translated into a new clinical paradigm for patient management. In addition, this new paradigm may serve as a basis for stimulating constructive debate regarding the use of testosterone in men, and to promote new, innovative basic and clinical research to further understand the underlying mechanisms of androgen action in restoring erectile physiology. Methods-A literature review was performed utilizing the US National Library of Medicine's PubMed database.Results-On the basis of evidence derived from laboratory animal studies and clinical data, we postulate that androgen insufficiency disrupts cellular-signaling pathways and produces pathologic alterations in penile tissues, leading to erectile dysfunction. In this review, we discuss androgendependent cellular, molecular, and physiologic mechanisms modulating erectile function in the animal model, and the implication of this knowledge in testosterone use in the clinical setting to treat erectile dysfunction. The new clinical paradigm incorporates many of the consensed points of view discussed in traditional consensed algorithms exclusively designed for men with androgen insufficiency. There are, however, novel and innovative differences with this new clinical paradigm. This paradigm represents a fresh effort to provide mandatory and optional management strategies for men with both androgen insufficiency and erectile dysfunction. Conclusions-The new clinical paradigm is evidence-based and represents one of the first attempts to address a logical management plan for men with concomitant hormonal and sexual health concerns.

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Section: Estradiolmentioning

confidence: 59%

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

2007

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“…Early detumescence, clinically called venous leakage, is a common presenting symptom in ED, especially when androgen deficiency is present, but Mancini et al. [110] suggested that increased estradiol levels may also contribute to ED. The authors pointed out that both ED and estradiol levels appear to increase with age.…”

Section: What Is the Evidence For A Role Of Androgens In Human Penilementioning

confidence: 99%

Are Androgens Critical for Penile Erections in Humans? Examining the Clinical and Preclinical Evidence

Traish

Guay

2006

The Journal of Sexual Medicine

170

121

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Androgens are deemed critical for penile-tissue development, growth, and maintenance of erectile function, however, their role in erection, especially in humans, remains controversial. In this review, we summarize information from clinical and animal model studies to provide a comprehensive and rational argument for the role of androgens, or lack thereof, on penile erection ability in humans. The goal of this review is to present the clinical and preclinical evidence available in the literature with regard to testosterone and erectile physiology and engage the reader in this discussion. Ultimately, each reader will have to form his or her own conclusions based on the existing evidence. In humans, androgen-deficiency manifestations are noted in clinical situations such as: (i) inadequate development of the penis; and (ii) loss of erectile function in prostate cancer and benign prostatic hyperplasia patients managed with medical or surgical castration or antiandrogen therapy. Androgen treatment causes: (i) improvement in sexual function in hypogonadal patients treated with androgen supplementation; (ii) improvement in nocturnal penile tumescence in hypogonadal patients treated with androgens; (iii) improvement in erectile function with androgen supplementation in patients who did not respond to phosphodiesterase type 5 inhibitor therapy initially; and (iv) improvement in the well-being, mood, energy, and sexual function in aging men who have testosterone deficiency treated with androgen therapy. In contrast to animals, especially rodents in which the adrenal cortex does not synthesize androgens, the human adrenal is a source of peripherally circulating androgen precursors, thus, complete androgen insufficiency may not be observed in men at a younger age. Furthermore, in light of the concept that a threshold of androgen levels exists in animals and humans below which sexual function is diminished, further contributes to the complexity of understanding androgens role in erections, especially in humans. Nevertheless, based on the preclinical and clinical data available in the literature, to date, we infer that androgens play a critical role in maintaining erectile physiology in humans.

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“…However, even in this setting, the absence of estradiol effect on LH secretion is still puzzling. Thus, taking into account that high estradiol levels have already been described as the only abnormality in a subset of patients with ED, the hypothesis that the later might not only be caused by androgen deficiency is becoming increasingly evident [8, 20]. Furthermore, it has been reported that the chronic exposure to phosphodiesterase type 5 inhibitors (PDE5i), widely used for the treatment of ED, may influence serum estradiol levels [33, 34].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most plausible mechanisms by which obesity contributes to T levels decline is the adipose tissue dependent aromatization of T to estradiol [15]. In line with these remarks, hormonal ED etiology might not be confined to androgen deficiency, as isolated high estradiol levels have been reported in some ED patients [8, 20]. …”

Section: Introductionmentioning

confidence: 98%

Hormonal Modulation in Aging Patients with Erectile Dysfunction and Metabolic Syndrome

Costa

Carvalho

Pacheco‐Figueiredo

et al. 2013

International Journal of Endocrinology

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Erectile dysfunction (ED), metabolic syndrome (MetS), and hypogonadism are closely related, often coexisting in the aging male. Obesity was shown to raise the risk of ED and hypogonadism, as well as other endocrinological disturbances with impact on erectile function. We selected 179 patients referred for ED to our andrology unit, aiming to evaluate gonadotropins and estradiol interplay in context of ED, MetS, and hypogonadism. Patients were stratified into groups in accordance with the presence (or not) of MetS and/or hypogonadism. Noticeable differences in total testosterone (TT) and free testosterone (FT) levels were found between patients with and without MetS. Men with MetS evidenced lower TT circulating levels with an increasing number of MetS parameters, for which hypertriglyceridemia and waist circumference strongly contributed. Regarding the hypothalamic-pituitary-gonadal axis, patients with hypogonadism did not exhibit raised LH levels. Interestingly, among those with higher LH levels, estradiol values were also increased. Possible explanations for this unexpected profile of estradiol may be the age-related adiposity, other estrogen-raising pathways, or even unknown mechanisms. Estradiol is possibly a molecule with further interactions beyond the currently described. Our results further enlighten this still unclear multidisciplinary and complex subject, raising new investigational opportunities.

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Increased estradiol levels in venous occlusive disorder: a possible functional mechanism of venous leakage

Cited by 38 publications

References 23 publications

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction

Are Androgens Critical for Penile Erections in Humans? Examining the Clinical and Preclinical Evidence

Hormonal Modulation in Aging Patients with Erectile Dysfunction and Metabolic Syndrome

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