The role of testosterone in male sexual function

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.

Associations between Self-Reported Anatomical Characteristics of the Penis, Age and Sexual Dysfunction in Men

“…Interestingly, both cross-sectional and longitudinal studies have shown that testosterone levels decline gradually as men age from their 30s to their 90s (48-50). Testosterone plays a role in every step of the male sexual response (51) with previous research showing that lower testosterone levels are associated with reduced sexual desire (52) and a higher risk of ED (52,53). In addition, testosterone replacement treatment can improve the latency times of men with acquired PE (PE appearing only after a man's rst sexual experience) (54).…”

“…In addition, testosterone replacement treatment can improve the latency times of men with acquired PE (PE appearing only after a man's rst sexual experience) (54). However, a recent review has indicated that the effectiveness of testosterone replacement treatment in improving sexual function is modest and inconsistent, comparable to that of lifestyle interventions (53). In a similar vein, another contributing factor is cardiovascular disease contributing to ED with age (55).…”

“…The association between age and sexual function is still controversial (2,42,43). Testosterone levels in adult men, which are positively associated with better sexual function (51)(52)(53) begin to decline after age 30 (48-50). In contrast, as young men gain more sexual experience with increasing age, they may be less likely to experience sexual performance anxiety, particularly in long-term relationships, which could lower the risk of both PE and ED (47).…”

The future role of precision medicine in male sexual dysfunction

“…PM allows for identifying specific genetic markers [ 1 ], hormonal imbalances [ 2 3 ], and other physiological factors that contribute to sexual dysfunction. By analyzing an individual’s genetic and biochemical profiles, healthcare providers can better understand the root cause of sexual dysfunction; consequently, this can be used to design targeted treatment plans that address the unique factors contributing to a patient’s condition, resulting in more accurate diagnoses and improved outcomes.…”

Self-Reported Anatomical Characteristics of the Penis and Male Sexual Function

“…Interestingly, both cross-sectional and longitudinal studies have shown that testosterone levels decline gradually as men age from their 30s to their 90s [24][25][26]. Testosterone plays a role in every step of the male sexual response [27] with previous research showing that lower testosterone levels are associated with reduced sexual desire [28] and ED [28,29]. In addition, testosterone replacement treatment can improve the latency times of men with acquired PE (PE appearing only after a man's rst sexual experience) [30].…”