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Review
. 2022 Dec;23(6):1159-1172.
doi: 10.1007/s11154-022-09748-3. Epub 2022 Aug 23.

The role of testosterone in male sexual function

Giovanni Corona  1 , Mario Maggi  2
Affiliations
Review

The role of testosterone in male sexual function

Giovanni Corona et al. Rev Endocr Metab Disord. 2022 Dec.

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.

Keywords: Erectile dysfunction; Hypogonadism; Testosterone; Testosterone replacement therapy.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Relationships among T levels (A, D, G, L), age (B, E, H, M), comorbidities (as detected by Chronic Disease Score; CDS; C, F, I, N) and several symptoms of an impaired male sexuality; in subjects consulting for sexual dysfunction at the university of Florence, Florence, Italy (see also Table 1). ED = erectile dysfunction; SIEDY = Structured Interview on Erectile Dysfunction. Reported significances are those derived after adjusting each association for the other two determinants using ANOVA and post-hoc Bonferroni test
Fig. 2
Fig. 2
Unadjusted and (age and chronic disease score, CDS) adjusted relationships (derived from fitting regression model) between prostaglandin E1 (PGE1)-stimulated penile blood (dynamic peak systolic velocity, PSV) at penile doppler ultrasound and total testosterone in a cohort of more than 2500 men complaining of sexual dysfunction at the university of Florence, Florence, Italy
Fig. 3
Fig. 3
Percentage of efficacy against placebo after normalization for the maximal effect in the different International Index of Erectile Function subdomains as derived from the most recent meta-analysis on testosterone replacement therapy in sexual function [59]
Fig. 4
Fig. 4
Influence of baseline diabetes mellitus prevalence on erectile function of combined therapy (testosterone and phosphodiesterase type 5 inhibitors, PDE5i) versus PDE5i alone. Results are derived from the analysis of previously reported data [85]
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