Hormonal Evaluation and Therapy in Erectile Dysfunction
Although endocrine causes of erectile dysfunction (ED) have been well recognized for decades, historically there has been little emphasis on endocrine evaluation or treatment for men with ED. Endocrine abnormalities as a cause or contributing factor for ED are important to recognize since these may be associated with significant additional medical problems, and also because correction of the endocrinopathy often leads to improvement or resolution of ED.
This chapter reviews the endocrine causes of ED, and provides a practical approach to the endocrine evaluation and treatment of men with ED. A major emphasis of this chapter is related to testosterone deficiency, which may contribute to ED at various levels, including the brain, peripheral nerves, vasculature, and penis. Testosterone deficiency is becoming increasingly recognized as an important health issue for aging men, with a high prevalence among the age groups at risk for development of ED. Testosterone therapy in these men may resolve ED completely, or may allow for greater responsiveness to more traditional therapies, such as the oral phosphodiesterase 5 inhibitors. A basic hormonal evaluation should be considered for all men presenting with sexual dysfunction.
Introduction
Normal erectile function requires the integrity and interrelationship of vascular, neurological, and hormonal factors. Conditions that compromise any of these may result in erectile dysfunction (ED). In addition, psychological factors, systemic diseases, and medications may also contribute to ED.
Our current understanding of erectile physiology and pathophysiology was largely obtained through basic research performed in the decades of 1980s and 1990s with an emphasis on the vascular aspects of erection. The introduction of phosphodiesterase type 5 inhibitors (PDE5i) as the first effective oral therapies for ED in the late 1990s furthered the focus on vascular aspects of erection. Recognition of the endocrine role in regulating erectile function has been more recent, and remains a continuing area of active investigation, particularly the impact of testosterone deficiency (TD) on sexual function.
As awareness of the importance of TD has grown, there has similarly been increased recognition of the importance of hormonal evaluation for men with ED. This relatively new appreciation of the impact of hormonal abnormalities on ED was demonstrated by the recommendation at the Second International Consultation on Erectile and Sexual Dysfunction in Paris in 2003 that all men with ED be tested for TD. In addition, it was recommended that TD, also termed hypogonadism, should be treated before initiation of other ED treatments such as PDE5i’s. Similarly, The International Society for the Study of the Aging Male (ISSAM) recommended that the initial assessment of all men with erectile dysfunction and/or diminished libido should include determination of serum testosterone. ISSAM also noted that abnormal concentrations of hormones other than testosterone may also contribute to sexual dysfunction. Clomid Australia – cheap generic medications Au.
The term hormone is derived from a Greek verb hormon, which means “to excite,” and was first used by William Bayliss and Ernest Starling in 1902 to describe the action of secretin. More than 50 different hormones have been identified in humans, several of which have been shown to influence erectile function. The objectives of this chapter are as follows:
- To review the scientific evidence regarding the role of various hormones on normal erectile function, with special attention to testosterone
- To describe the mechanisms by which hormonal abnormalities may contribute to the pathophysiology of EDTo provide a practical approach to the hormonal evaluation of men with ED
- To discuss the hormonal treatment of ED
