Abstract
Testosterone is the most defining of male hormones. Having low testosterone affects many aspects of male sexuality; however,the effects of low testosterone are variable. Data regarding treatment of low testosterone and its effects on sexual dysfunction are highly variable in quality and,in many areas,show conflicting results. In this review,we will review the hypothalamic-pituitary-gonadal axis as well as discuss animal and human data regarding the link between testosterone and erectile function. Furthermore, we discuss testosterone replacement and its effects on treatments for erectile dysfunction as well as present the limited data available regarding the possible association of Peyronie’s disease and low testosterone. Finally, we discuss the effects of testosterone on libido and orgasmic function.
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Abbreviations
- ADT:
-
Androgen deprivation therapy
- BAT:
-
Bioavailable testosterone
- CaP:
-
Carcinoma of the prostate
- DHEA:
-
Dehydoepiandrosterone
- DHEA-S:
-
Dehydroepiandrosterone sulfate
- ED:
-
Erectile dysfunction
- FT:
-
Free testosterone
- HSD:
-
Hypoactive sexual desire
- IIEF:
-
International Index of Erectile Function
- IM:
-
Intramuscular
- MPOA:
-
Medial preoptic area
- NAAD:
-
Neoadjuvant androgen deprivation
- NOS:
-
Nitric oxide synthase
- PD:
-
Peyronie’s disease
- PDE5:
-
Phosphodiesterase-5
- PSV:
-
Peak systolic velocity
- RP:
-
Radical Prostatectomy
- SEP:
-
Sexual encounter profile
- TRT:
-
Testosterone replacement therapy
- TT:
-
Total testosterone
References
Bhasin S, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabol. 2010;95(6):2536–59.
Wang C, et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male. 2009;12(1):5–12.
Swaab DF. Sexual differentiation of the brain and behavior. Best practice & research. Clin Endocrinol Metabol. 2007;21(3):431–44.
Suzuki N, et al. Effect of testosterone on intracavernous pressure elicited with electrical stimulation of the medial preoptic area and cavernous nerve in male rats. J Androl. 2007;28(2):218–22.
Wagner G, Mulhall J. Pathophysiology and diagnosis of male erectile dysfunction. BJU Int. 2001;88 Suppl 3:3–10.
Lugg J, et al. Cavernosal nerve stimulation in the rat reverses castration-induced decrease in penile NOS activity. Am J Physiol. 1996;271(2 Pt 1):E354–61.
Mills TM, Reilly CM, Lewis RW. Androgens and penile erection: a review. J Androl. 1996;17(6):633–8.
Morelli A, et al. Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology. 2004;145(5):2253–63.
Chamness SL, et al. The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat. Fertil Steril. 1995;63(5):1101–7.
Lugg JA, Rajfer J, Gonzalez-Cadavid NF. Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat. Endocrinology. 1995;136(4):1495–501.
Park KH, et al. Effects of androgens on the expression of nitric oxide synthase mRNAs in rat corpus cavernosum. BJU Int. 1999;83(3):327–33.
Wingard CJ, et al. Improved erectile function after Rho-kinase inhibition in a rat castrate model of erectile dysfunction. Am J Physiol Regul Integr Comp Physiol. 2003;284(6):R1572–9.
Vignozzi L, et al. Testosterone regulates RhoA/Rho-kinase signaling in two distinct animal models of chemical diabetes. J Sex Med. 2007;4(3):620–30; discussion 631–32.
Filippi S, et al. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in an animal model of male metabolic syndrome. J Sex Med. 2009;6(12):3274–88.
Zhang XH, et al. Testosterone restores diabetes-induced erectile dysfunction and sildenafil responsiveness in two distinct animal models of chemical diabetes. J Sex Med. 2006;3(2):253–64; discussion 264–5, author reply 265–6.
Zhang XH, et al. Testosterone regulates PDE5 expression and in vivo responsiveness to tadalafil in rat corpus cavernosum. Eur Urol. 2005;47(3):409–16; discussion 416.
Traish AM, et al. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology. 1999;140(4):1861–8.
Davila HH, Rajfer J, Gonzalez-Cadavid NF. Corporal veno-occlusive dysfunction in aging rats: evaluation by cavernosometry and cavernosography. Urology. 2004;64(6):1261–6.
Kang SM, et al. Effect of oral administration of testosterone on brachial arterial vasoreactivity in men with coronary artery disease. Am J Cardiol. 2002;89(7):862–4.
Liu D, Dillon JS. Dehydroepiandrosterone activates endothelial cell nitric-oxide synthase by a specific plasma membrane receptor coupled to Galpha(i2,3). J Biol Chem. 2002;277(24):21379–88.
Murphy JG, Khalil RA. Decreased [Ca(2+)](i) during inhibition of coronary smooth muscle contraction by 17beta-estradiol, progesterone, and testosterone. J Pharmacol Exp Ther. 1999;291(1):44–52.
Aversa A, et al. Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf). 2000;53(4):517–22.
Kumar RJ, Barqawi A, Crawford ED. Adverse events associated with hormonal therapy for prostate cancer. Rev Urol. 2005;7 Suppl 5:S37–43.
Potters L, et al. Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2001;50(5):1235–42.
Mazzola CR, et al. Androgen deprivation therapy before radical prostatectomy is associated with poorer postoperative erectile function outcomes. BJU Int. 2012;110(1):112–6.
Potosky AL, et al. Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. J Clin Oncol. 2001;19(17):3750–7.
Hoffman RM, et al. Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study. Cancer. 2003;97(7):1653–62.
Potosky AL, et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst. 2002;94(6):430–7.
Hatzimouratidis K, Hatzichristou D. Testosterone and erectile function: an unresolved enigma. Eur Urol. 2007;52(1):26–8.
Montorsi F, Oettel M. Testosterone and sleep-related erections: an overview*. J Sex Med. 2005;2(6):771–84.
Martinez-Jabaloyas JM, et al. Testosterone levels in men with erectile dysfunction. BJU Int. 2006;97(6):1278–83.
Ahn HS, Park CM, Lee SW. The clinical relevance of sex hormone levels and sexual activity in the ageing male. BJU Int. 2002;89(6):526–30.
Kim YC. Testosterone supplementation in the aging male. Int J Impot Res. 1999;11(6):343–52.
Kim YC. Hormonal replacement therapy and aging: Asian practical recommendations on testosterone supplementation. Asian J Androl. 2003;5(4):339–44.
Jain P, Rademaker AW, McVary KT. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol. 2000;164(2):371–5.
Isidori AM, et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf). 2005;63(4):381–94.
Ebert T, et al. The current status of therapy for symptomatic late-onset hypogonadism with transdermal testosterone gel. Eur Urol. 2005;47(2):137–46.
Hwang TI, Lin YC. The relationship between hypogonadism and erectile dysfunction. Int J Impot Res. 2008;20(3):231–5.
Buvat J, Bou Jaoude G. Significance of hypogonadism in erectile dysfunction. World J Urol. 2006;24(6):657–67.
Bolona ER, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82(1):20–8.
Bhasin S, et al. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007;369(9561):597–611.
Mulhall JP, et al. Effect of testosterone supplementation on sexual function in hypogonadal men with erectile dysfunction. Urology. 2004;63(2):348–52; discussion 352–3.
Kalinchenko SY, et al. Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone. Aging Male. 2003;6(2):94–9.
Foresta C, et al. Role of androgens in erectile function. J Urol. 2004;171(6 Pt 1):2358–62, quiz 2435.
Shamloul R, et al. Testosterone therapy can enhance erectile function response to sildenafil in patients with PADAM: a pilot study. J Sex Med. 2005;2(4):559–64.
Greenstein A, et al. Does sildenafil combined with testosterone gel improve erectile dysfunction in hypogonadal men in whom testosterone supplement therapy alone failed? J Urol. 2005;173(2):530–2.
Tas A, et al. Efficacy of sildenafil in male dialysis patients with erectile dysfunction unresponsive to erythropoietin and/or testosterone treatments. Int J Impot Res. 2006;18(1):61–8.
Hwang TI, et al. Combined use of androgen and sildenafil for hypogonadal patients unresponsive to sildenafil alone. Int J Impot Res. 2006;18(4):400–4.
Rosenthal BD, et al. Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone. Urology. 2006;67(3):571–4.
Yassin AA, Saad F, Diede HE. Testosterone and erectile function in hypogonadal men unresponsive to tadalafil: results from an open-label uncontrolled study. Andrologia. 2006;38(2):61–8.
Aversa A, et al. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol (Oxf). 2003;58(5):632–8.
Shabsigh R, et al. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol. 2004;172(2):658–63.
Rochira V, et al. Sildenafil improves sleep-related erections in hypogonadal men: evidence from a randomized, placebo-controlled, crossover study of a synergic role for both testosterone and sildenafil on penile erections. J Androl. 2006;27(2):165–75.
Garcia JA, et al. Testosterone undecanoate improves erectile dysfunction in hypogonadal men with the metabolic syndrome refractory to treatment with phosphodiesterase type 5 inhibitors alone. Andrologia. 2011;43(5):293–6.
Buvat J, et al. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1 % hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med. 2011;8(1):284–93.
Yassin AA, Saad F, Traish A. Testosterone undecanoate restores erectile function in a subset of patients with venous leakage: a series of case reports. J Sex Med. 2006;3(4):727–35.
Kurbatov D, Kuznetsky J, Traish A. Testosterone improves erectile function in hypogonadal patients with venous leakage. J Androl. 2008;29(6):630–7.
El-Sakka AI. Prevalence of Peyronie’s disease among patients with erectile dysfunction. Eur Urol. 2006;49(3):564–9.
Moreno SA, Morgentaler A. Testosterone deficiency and Peyronie’s disease: pilot data suggesting a significant relationship. J Sex Med. 2009;6(6):1729–35.
Rhoden EL, et al. A cross-sectional study for the analysis of clinical, sexual and laboratory conditions associated to Peyronie’s disease. J Sex Med. 2010;7(4 Pt 1):1529–37.
Karavitakis M, et al. The relationship between androgens, regulators of collagen metabolism, and Peyronie’s disease: a case control study. J Sex Med. 2010;7(12):4011–7.
Cavallini G, Biagiotti G, Lo Giudice C. Association between Peyronie’s disease and low serum testosterone levels: detection and therapeutic considerations. J Androl. 2012;33(3):381–8. Epub 2011 Jun 30.
Nam HJ, Park HJ, Park NC. Does testosterone deficiency exaggerate the clinical symptoms of Peyronie’s disease? Int J Urol. 2011;18(11):796–800.
Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005;186(3):411–27.
Anderson RA, Bancroft J, Wu FC. The effects of exogenous testosterone on sexuality and mood of normal men. J Clin Endocrinol Metabol. 1992;75(6):1503–7.
Stoleru S, et al. Neuroanatomical correlates of visually evoked sexual arousal in human males. Arch Sex Behav. 1999;28(1):1–21.
Redoute J, et al. Brain processing of visual sexual stimuli in human males. Hum Brain Mapp. 2000;11(3):162–77.
Bocher M, et al. Cerebral activation associated with sexual arousal in response to a pornographic clip: a 15O-H2O PET study in heterosexual men. Neuroimage. 2001;14(1 Pt 1):105–17.
Karama S, et al. Areas of brain activation in males and females during viewing of erotic film excerpts. Hum Brain Mapp. 2002;16(1):1–13.
Mouras H, et al. Brain processing of visual sexual stimuli in healthy men: a functional magnetic resonance imaging study. Neuroimage. 2003;20(2):855–69.
Corona G, et al. Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int J Impot Res. 2004;16(3):275–81.
Corona G, et al. The impotent couple: low desire. Int J Androl. 2005;28 Suppl 2:46–52.
Corona G, et al. Effect of hyperprolactinemia in male patients consulting for sexual dysfunction. J Sex Med. 2007;4(5):1485–93.
Carter JN, et al. Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med. 1978;299(16):847–52.
Buvat J. Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res. 2003;15(5):373–7.
Ciccarelli A, et al. PRL secreting adenomas in male patients. Pituitary. 2005;8(1):39–42.
Pehek EA, et al. Apomorphine and haloperidol, but not domperidone, affect penile reflexes in rats. Pharmacol Biochem Behav. 1988;31(1):201–8.
Baggaley M. Sexual dysfunction in schizophrenia: focus on recent evidence. Hum Psychopharmacol. 2008;23(3):201–9.
Kratzik CW, et al. The impact of age, body mass index and testosterone on erectile dysfunction. J Urol. 2005;174(1):240–3.
Khera M, et al. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). J Sex Med. 2011;8(11):3204–13.
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Hsiao, W., Mulhall, J.P. (2013). Testosterone and Sexual Function. In: Kavoussi, P., Costabile, R., Salonia, A. (eds) Clinical Urologic Endocrinology. Springer, London. https://doi.org/10.1007/978-1-4471-4405-2_4
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DOI: https://doi.org/10.1007/978-1-4471-4405-2_4
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