The Role of Testosterone in Male Sexual Function

Overview

Journal Rev Endocr Metab Disord

Publisher Springer

Specialty Endocrinology

Date 2022 Aug 23

PMID 35999483

Authors

Giovanni Corona

Mario Maggi

Affiliations

Soon will be listed here.

Abstract

Sexual function, and testosterone (T) levels, progressively decline in aging men. Associated morbidities and metabolic disorders can accelerate the phenomenon. The specific contribution of low T to sexual function impairment in aging men has still not been completely clarified. Similarly, the role of T replacement therapy (TRT), as well as the combination of TRT with phosphodiesterase type 5 inhibitors (PDE5i) for patients with erectile dysfunction (ED), is still conflicting. Here we aim to summarize and critically discuss all available data supporting the contribution of low T to sexual impairment observed with aging as well as the possible role of TRT. Available data on men with sexual dysfunction show that reduced sexual desire is the most important correlate of male hypogonadism. Conversely, aging and associated morbidities substantially attenuate the relationship between ED and T. TRT is effective in improving sexual function in middle-aged and older subjects but its role is small and extremely variable. Lifestyle interventions can result in similar outcomes to those of TRT. In conclusion, it is our opinion that PDE5i along with lifestyle measures should be considered the first approach for treating ED even in subjects with milder T deficiency. When these interventions fail or are difficult to apply, TRT should be considered.

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References

Yafi F, Jenkins L, Albersen M, Corona G, Isidori A, Goldfarb S . Erectile dysfunction. Nat Rev Dis Primers. 2016; 2:16003. PMC: 5027992. DOI: 10.1038/nrdp.2016.3. View

Foresta C, Caretta N, Rossato M, Garolla A, Ferlin A . Role of androgens in erectile function. J Urol. 2004; 171(6 Pt 1):2358-62, quiz 2435. DOI: 10.1097/01.ju.0000124323.02868.68. View

Corona G, Mannucci E, Lotti F, Boddi V, Jannini E, Fisher A . Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism. J Sex Med. 2009; 6(9):2591-600. DOI: 10.1111/j.1743-6109.2009.01352.x. View

Lee D, ONeill T, Pye S, Silman A, Finn J, Pendleton N . The European Male Ageing Study (EMAS): design, methods and recruitment. Int J Androl. 2008; 32(1):11-24. DOI: 10.1111/j.1365-2605.2008.00879.x. View

Marchiani S, Vignozzi L, Filippi S, Gurrieri B, Comeglio P, Morelli A . Metabolic syndrome-associated sperm alterations in an experimental rabbit model: relation with metabolic profile, testis and epididymis gene expression and effect of tamoxifen treatment. Mol Cell Endocrinol. 2014; 401:12-24. DOI: 10.1016/j.mce.2014.11.005. View

Rastrelli G, Guaraldi F, Reismann Y, Sforza A, Isidori A, Maggi M . Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev. 2019; 7(3):464-475. DOI: 10.1016/j.sxmr.2018.11.005. View

Corona G, Petrone L, Paggi F, Lotti F, Boddi V, Fisher A . Sexual dysfunction in subjects with Klinefelter's syndrome. Int J Androl. 2009; 33(4):574-80. DOI: 10.1111/j.1365-2605.2009.00986.x. View

Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E . A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med. 2021; 9(6):100434. PMC: 8766276. DOI: 10.1016/j.esxm.2021.100434. View

Santi D, Granata A, Guidi A, Pignatti E, Trenti T, Roli L . Six months of daily treatment with vardenafil improves parameters of endothelial inflammation and of hypogonadism in male patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, prospective trial. Eur J Endocrinol. 2016; 174(4):513-22. DOI: 10.1530/EJE-15-1100. View

10.

Corona G, Rastrelli G, Ricca V, Jannini E, Vignozzi L, Monami M . Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction. J Sex Med. 2013; 10(4):1074-89. DOI: 10.1111/jsm.12043. View

11.

Blanker M, Bosch J, Groeneveld F, Bohnen A, Prins A, Thomas S . Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity. Urology. 2001; 57(4):763-8. DOI: 10.1016/s0090-4295(00)01091-8. View

12.

Corona G, Isidori A, Buvat J, Aversa A, Rastrelli G, Hackett G . Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014; 11(6):1577-92. DOI: 10.1111/jsm.12536. View

13.

Lindau S, Gavrilova N . Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ. 2010; 340:c810. PMC: 2835854. DOI: 10.1136/bmj.c810. View

14.

Rastrelli G, ONeill T, Ahern T, Bartfai G, Casanueva F, Forti G . Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: Prospective results from the EMAS. Clin Endocrinol (Oxf). 2018; 89(4):459-469. DOI: 10.1111/cen.13756. View

15.

Morelli A, Sarchielli E, Comeglio P, Filippi S, Vignozzi L, Marini M . Metabolic syndrome induces inflammation and impairs gonadotropin-releasing hormone neurons in the preoptic area of the hypothalamus in rabbits. Mol Cell Endocrinol. 2013; 382(1):107-119. DOI: 10.1016/j.mce.2013.09.017. View

16.

Corona G, Rastrelli G, Morgentaler A, Sforza A, Mannucci E, Maggi M . Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. Eur Urol. 2017; 72(6):1000-1011. DOI: 10.1016/j.eururo.2017.03.032. View

17.

Corona G, Rastrelli G, Isidori A, Pivonello R, Bettocchi C, Reisman Y . Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther. 2020; 18(3):155-164. DOI: 10.1080/14779072.2020.1745632. View

18.

Chew P, Choy C, Sidi H, Abdullah N, Che Roos N, Mohd Salleh Sahimi H . The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-Analysis. J Sex Med. 2020; 18(1):99-112. DOI: 10.1016/j.jsxm.2020.10.001. View

19.

Corona G, Rastrelli G, Vignozzi L, Barbonetti A, Sforza A, Mannucci E . The Role of testosterone treatment in patients with metabolic disorders. Expert Rev Clin Pharmacol. 2021; 14(9):1091-1103. DOI: 10.1080/17512433.2021.1938548. View

20.

Sesti F, Pofi R, Minnetti M, Tenuta M, Gianfrilli D, Isidori A . Late-onset hypogonadism: Reductio ad absurdum of the cardiovascular risk-benefit of testosterone replacement therapy. Andrology. 2020; 8(6):1614-1627. DOI: 10.1111/andr.12876. View