The relationship between hypogonadism and erectile dysfunction

Abstract

It is well known that testosterone enhances sexual interest leading to an increased frequency of sexual acts and an increase in the frequency of sleep-related erections. However, it has little effect on fantasy-or visually induced erections. Exact contribution to erection from testosterone in men remains unclear. Animal studies have well demonstrated that testosterone plays critical physiological (activity of nitric oxide synthases and phosphodiesterases), biochemical (through an endothelial-independent pathway and adrenergic tonicity) and structural (change of fibroelasticity and hollow cell accumulation) roles in erectile function. The supplementation of testosterone to castrated animals can restore erectile function. Clinically, reports of patients with erectile dysfunction (ED) combined with hypogonadism who receive testosterone therapy have inconsistent results. However, testosterone may ameliorate the expression of the phosphodiesterase-5 (PDE5) inhibitor, and the use of testosterone in conjunction with the PDE5 inhibitor revealed convincing results. Because of potential risks in clinical use, testosterone therapy should be individualized, carefully considered and closely monitored, especially, in patients with possible occult prostate cancer, and large benign prostatic hyperplasia. Lower urinary tract symptoms might be worsened by this treatment, since the prostate is an androgen-dependent tissue.

Quality of life, self‐esteem, fatigue, and sexual function in young men after cancer

“…Our findings are consistent with previous observations in testicular cancer survivors who have been reported to have impaired sexual functioning 10. Capacity for erection is known to be linked to testosterone levels,25 although erectile dysfunction is not always corrected by testosterone replacement 26‐28. In the Derogatis Interview for Sexual Functioning domain, arousal is a signal for ED.…”

Lack of direct androgen regulation of PDE5 expression

“…In addition, 5 recent review articles cited these studies as evidence for androgen regulation of PDE5 [17; 18; 19; 20; 21]. However, if indeed androgens upregulate PDE5 expression, wouldn’t they undermine the effectiveness of PDE5 inhibitors?…”

Androgens are Fundamental in the Maintenance of Male Sexual Health

“…Over the past three decades, the effect of androgens on erectile function has been extensively investigated at the basic [19][20][21] and clinical levels [22][23][24]. The need for sufficient androgen levels to maintain an appropriate erectile function is beyond question, but their actions in the neurovascular structures modulating erectile mechanisms remain controversial.…”