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Late Onset Hypogonadism (LOH) and sexual Health

Late Onset Hypogonadism (LOH) and sexual Health

It is well established that there is an age-related decline in testosterone production of men, which might play a role in the age-related decline in sexual desire and erections. Such a causal relationship is still debated since few studies found significant relationships between serum testosterone and sexual parameters of aging men that persist after adjustment of the data for age. In addition although 2 meta-analyses of randomized controlled trials confirmed a significant effect of testosterone therapy on sexual desire and erections of men of any age when baseline testosterone is below 12 nmol/l, the effect of this therapy is rather disappointing when it is used in the specific and prevalent population of the men presenting with erectile dysfunction (ED), and who are subsequently diagnosed with LOH.
Several causes may account for this lower success rate: the threshold level of the testosterone activity on sexual desire and erections may be as low as 7 nmol/l in some men. In addition, in men with ED and LOH vascular comorbidities are prevalent and may prevent the effect of testosterone therapy on erections. Lastly the hypogonadism associated with ED may be in some cases a consequence rather than the cause of ED. Even if  testosterone therapy may fail to improve erectile function of  some hypogonadal ED patients, routine testosterone determination remains mandatory in aging men consulting for ED. Achieving physiologic levels of testosterone is indeed one of the rare opportunities to restore spontaneous erections and save the patient from having to plan sexual activity. In addition restoring testosterone, which is generally low in such patients, is the only way of restoring sexual desire. Replacing testosterone may also improve other symptoms associated with LOH. Lastly a threshold testosterone level appears to be required to achieve full efficacy with PDE5 inhibitors in certain men, although this hypothesis has still to be confirmed.

 

Conference: Demo
Areas of Interest / Categories: Androgen, Androgen Therapy, Desire, Erectile Dysfunction

Androgen Therapy

Ejaculation disorders - Diagnosis & Treatment.

The commonest male ejaculation disorder is Premature Ejaculation (PE). Inhibited or Delayed Ejaculation can be a more challenging condition to assess and treat. This discussion will focus on the diagnosis, investigations and management of ejaculation problems including an overview of the first medication specifically approved for the treatment of PE, dapoxetine, released under the trade name of Priligy™. 

Androlife Campaign: andrologists and psychosexologists in team- premature ejaculation, the main sexual dysfunction diagnosed in young men

Androlife is the first Italian national campaign, supported by Italian Society of Andrology and Medical Sexology (SIAMS) aimed to: promote the primary prevention of the reproductive male tract pathologies, inform boys about the importance of controlling risk factors for male infertility, sensitize public awareness about male reproductive health, collect data on lifestyle, habits, and general health status in young males aged 18 to 35, and diagnose possible andrological pathologies.

Obesity, Smoking and ED in Sexual Health Medicine

Obesity and Cigarette Smoking are risk factors related to accelerate degenerative diseases in man which enhance precocious aging process. This condition states the heightened Oxidative Stress which is indicative for the changes made at the genetic materials level. Obesity and smoking increase the rate of telomere erosion per replication and occurring of inflammation which enhance leukocytes turn-over and shortened telomere arm length of leukocyte cells. Oxidative Stress induced extensive vascular endothelial cells dysfunction causing Vascular Diseases and other Degenerative Morbidities.

What is Driving Sexual Desire?

The total number of sexual activities for an individual varies greatly across the lifespan. The driving forces for sexual behaviour remain contentious with the role of androgens, other hormones, neurotransmitters and physiological factors often considered to be key components. Increasingly, scientific advances have attempted to provided explanations for understanding differences that have been attributed to factors such as genetic variations in CAG repeat polymorphisms or brain neuronal networks and these will be explored. However, emotional and relational problems may have equal or greater impact and there are concerns about the limitations of the medical model to explain sexual ‘differences’ and diversity.

Aphrodisiacs in sexual medicine arena

A significant advancement in plant derived medicines in the last two centuries in such areas as central nervous system, anti-tumor and anti-inflammatory activities has led to the development and identification of active chemicals and understanding of their modes of action. As for man’s health related to sexuality, numerous age-old natural products have been historically claimed as ‘aphrodisiacs’ – a collective meaning, which describes improvement of arousal, libido and/or sexual energy and activity.  It would appear that most natural herbal preparations considered as aphrodisiacs are acting like synthetic anabolic hormones. Sometimes, they are considered as a form of testosterone replacement therapy (TRT) since some of them are shown to stimulate the body to produce natural testosterone and even DHEA. 

The Sexual Life of Prostate Cancer Patients Treated with ADT

Medical or surgical castration for palliative treatment of prostate cancer gives rise to significant negative impacts on quality of life (QoL) for patients. This is because of adverse effects including decreased libido and erectile function, in addition to other conditions such as osteoporosis, vasomotor flushing, fatigue, anaemia, diabetes mellitus, metabolic syndrome, and altered body composition.

Unexplored Problems of PCOS Patients

Aim: Studies have shown sexual dysfunctionality in 20-25% of infertile couples. Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. Infertility may alter a woman’s sexual expression by causing or exacerbating sexual problems as a consequence of the diagnosis, investigation and treatment of infertility. Adequate sexual function can contribute to the success of fertility treatments. This study aims to assess sexual function in infertile and PCOS women in relation to their age, body mass index and duration of infertility. The prevalence of Female Sexual Dysfunction (FSD) and PCOS in infertile women and its correlation with infertility was also evaluated. And to find the relationship between Female Sexual Dysfunction and testosterone levels in women with Polycystic Ovary Syndrome (PCOS).

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