Testosterone and Sleep-Related Erections: An Overview*

Abstract

Montorsi F, Oettel M. Testosterone and sleep-related erections: an overview.J Sex Med 2005;2:771–784 Sleep-related erections have been reported to occur from the intrauterine life to senescence. It has been speculated that the main function of nocturnal erections is to provide adequate engorgement of the corpora cavernosa, which then leads to increased tissue oxygenation. This is in turn to prevent cavernous fibrosis, the histopathological basis for corporeal venoocclusive dysfunction, which probably is the most common cause of organic erectile dysfunction. It has been suggested that sleep-related erections are triggered by the release of nitric oxide by the nitrergic nerve fibers within the cavernous nerves. Androgens regulate this mechanism as well as some other non-nitrergic processes within the corpora cavernosa and within the central nervous system. By contrast, the erectile response to tactile or visual erotic stimuli in wakefulness predominantly involves an androgen-independent system, although it may, at least to a certain degree, also be influenced by androgen-sensitive mechanisms. No doubt, androgens are key players in the physiology of nocturnal erections, and the availability of new, user-friendly testosterone preparations such as transdermal gel and intramuscularly administered testosterone undecanoate stimulates further investigations on this field. The prospect that the quality of sleep may also be improved by an androgen therapy administered to improve sleep-related erections in hypogonadal men needs further basic research and appropriate clinical studies.

An Evidence-Based Perspective to Commonly Performed Erectile Dysfunction Investigations

“…Furthermore, Carani et al., through their testosterone replacement study, demonstrated a strong involvement of androgens in regulation of SREs/NPT [40]. Finally, because SREs are closely correlated with REM sleep, therefore they are also related to a man's state of health and well‐being [36].…”

Impact of androgen deprivation therapy on sexual function

“…59 Some authors have suggested that the testosterone threshold value below which erectile function is affected is about 10% of the normal range of testosterone and that below this threshold value, erectile function would be affected in a dose-dependent fashion. 59,66 Some have suggested that it is free testosterone and not total testosterone that is associated with erectile function. 54,55,67,68 As highlighted by Incidence of CVOD 6 months after surgery: 60% in NAAD1RP vs. 20% in the RP alone patients (P,0.001) IIEFo24, 18 months after surgery: 22% in the NAAD1RP group vs. 50% in the RP alone patients (P,0.01) Kratzik et al The 5-year actuarial potency rate was:…”

Idiopathic stuttering priapism treated with salbutamol orally: a case report

“…Various human and animal studies have shown that androgens play a key role in the regulation of SRE (Montorsi & Oettel, 2005), and it has been reported that libido and the frequency of nocturnal erections can be suppressed by reducing testosterone levels to 10% of normal physiological levels (Bain, 2007).…”