Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction

Abstract

Sexual Dysfunction a useful correlate to define a symptomatic LOH. 3,5-7 By restricting the construct of LOH to those having both TD and the aforementioned sexual symptoms, the figure of its representation in Europe is dramatically reduced, i.e., 2.1% of the European general population older than 40 years. 3 The presence of a specific association between sexual symptoms and TD is not enough to establish the direction of the relationship; in fact, it is possible that TD is responsible for causing the symptoms or the other way around. Longitudinal extensions of the EMAS studies clarified that the development of both primary and secondary hypogonadism predicts the occurrence or worsening of sexual symptoms at follow-up. 5,8 On the other hand, the incidence or worsening of these symptoms is not negligible-although lower than in men developing primary or secondary hypogonadism-even among men who remain eugonadal during the follow-up. 5,8 This suggests that factors other than TD play a role in determining sexual symptoms compatible with those of LOH. Intervention studies are useful in defining causality in the relationship between TD and sexual symptoms. In particular, it is

Controversial aspects of testosterone in the regulation of sexual function in late‐onset hypogonadism

“…To evaluate the comorbidity burden of sexual symptoms compatible with T deficiency in subjects consulting for sexual dysfunction, we used a validated aggregate comorbidity measure, termed “chronic disease score” (CDS), which reflects the weighted number of medications used by the patients. We found that several symptoms and signs, potentially associated with LOH, could be due to chronic illnesses, occasionally present in subjects with sexual dysfunction 11 …”

“…Although low T is only one of the factors associated with reduced libido 38 (see also Figure 3B), this symptom is rather specific to the condition of LOH. In fact, by using Chronic Disease Score (CDS), a widely accepted measure of comorbidities, we found that several LOH correlates‐—such as reduced penile blood flow, severe ED, reduced spontaneous erection, and related psychological burden—are relatively unspecific for LOH because they could be ascribed either to low T or to age‐associated morbidities 11 . However, this is not the case for HSD 11 .…”

“…In fact, by using Chronic Disease Score (CDS), a widely accepted measure of comorbidities, we found that several LOH correlates‐—such as reduced penile blood flow, severe ED, reduced spontaneous erection, and related psychological burden—are relatively unspecific for LOH because they could be ascribed either to low T or to age‐associated morbidities 11 . However, this is not the case for HSD 11 . In fact, in a logistic adjusted model, low desire was positively associated with low T, but it was negatively associated with high CDS.…”

“…In fact, in a logistic adjusted model, low desire was positively associated with low T, but it was negatively associated with high CDS. In other words, subjects with LOH could have ED and HSD, while subjects with comorbidities more often complain of ED with a preserved or even increased sexual desire 11 . Hence, hypoactive sexual desire is a genuine symptom of LOH.…”

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

“…Unlike classical hypogonadism, functional hypogonadism usually presents a more subtle clinical picture, with non‐specific symptoms and usually no overt signs of androgen deficiency. Furthermore, these symptoms often overlap with those arising from co‐existing co‐morbidities and the effects of ageing in older men . Nevertheless, sexual complaints, such as decreased libido, morning erections or erectile dysfunction (ED), were more frequently associated with low T in community‐dwelling middle‐aged and elderly European men .…”