Oestrogens are not exclusive to the female gender but occur in moderate circulating levels of 25-70 pg ml 21 in men, compared to 44-153 pg ml 21 in women. Arising from aromatisation of testosterone (T), oestrogen is considered to have many opposing physiological functions and the progressive T decline in the aging male is associated with relative and/or absolute increase in serum oestradiol (E 2 ). Sexual disinterest and erectile dysfunction (ED) in the elderly may well be due to pathophysiological E 2 -T imbalance; the altered hormonal ratio may also explain the higher incidence of ED in hyperestrogenism or following exposure to environmental/plant oestrogens. Keywords: aging; erectile dysfunction; hormone imbalance; oestradiol; phytoestrogen; testosterone
INTRODUCTIONThe last two decades have witnessed the change in the scientific outlook of erectile dysfunction (ED) which is now regarded as a multifactorial and predominantly an organic disorder. Since the erectile process is a coordinated function with neurologic, vascular, endocrine and ionic inputs, successful therapeutic outcome for ED envisages recognition and delineation of the precipitating causes. An important premise is the increased prevalence of ED with aging 1 coupled with the possibility that the present population of men older than 65 years will double by the year 2025. 2 ED in the elderly is a pertinent clinical issue.Aging is associated with a number of comorbid conditions and risk factors for ED, including central and peripheral nervous system disorders, cardiovascular dysfunctions and side-effect profile of prescription medications. In addition to the wide range of general physical complaints in the elderly, it is imperative to address age-related affective alterations arising possibly from hormonal and lifestyle adjustments. 3 With the multifactorial symptoms and evidence for the missing correlation of testosterone (T) levels in the clinical features of hypogonadism, 4 further complexities have to be considered. For instance, not all aging males present with sexual deterioration and in some, a non-hormonal background to the precipitating conditions affecting sexuality may coexist. These include depression, fragility, decreased vitality, endothelial dysfunction, chronic diseases, cancer, incontinence, cognitive impairment and concurrent problems of the aging partner. At the cellular level too, decreased expression and activation of endothelial nitric oxide (NO) synthase with aging and the subsequent blunting of the physiological actions of NO, may have a non-hormonal basis. Therefore, caution should be used while associating hormonal, particularly oestradiol (E 2 )-T imbalance, to ageassociated ED.Nevertheless, steroid hormone secretion conforms to overall health status in men and understanding the dynamics of endocrine