Sexual interest and performance long have been associated with an adequate hormonal
milieu, resulting in the indiscriminate administration of androgens to men with erectile
dysfunction. Better understanding of penile physiology has shown that adequate sexual
interest and erections can be maintained in the presence of diminished serum levels
of testosterone. Nevertheless, hypogonadism affects sexual interest and erections
adversely to variable degrees depending not only on the intensity of the deficiency
but also on emotional and environmental factors and the degree of integrity of the
neurovascular supply to the penis.
The most convincing evidence of a positive correlation between the incidence and severity
of erectile dysfunction and aging has been provided by the Massachusetts Male Aging
Study (MMAS).
18
Although the aging process in men is an interindividual variable, profound hormonal
alterations and a decrease in sexual performance can occur. These two truisms (i.e.,
aging men sustain erectile dysfunction, and testosterone decreases with age) are not
necessarily related and should not be construed to imply that erectile failure is
exclusively a consequence of endocrine changes. The MMAS was unable to link the coexistence
of erectile dysfunction and a decrease in the serum levels of sex hormones, with the
notable exception of a direct correlation between erectile shortcomings and a serum
deficit in dehydroepiandrosterone (DHEA) and its sulfated form (DHEAS). To interpret
this finding, it must be remembered that, although hypotestosteronemia and aging show
marked differences among men, the association of low DHEA and advancing age exhibits
a more predictable, constant, and profound association. It is likely that the correlation
between the progressive decrease in DHEA levels, diminished erectile capacity, and
advancing age is purely coincidental. The role of DHEA and DHEAS in sexual performance
and desire has not been investigated thoroughly and remains an interesting and fertile
area of research. The role of androgens in sexual function in general and in erectile
physiology in particular is of fundamental importance. It is estimated that 1 in 200
men have abnormally low levels of testosterone, and that most of them are candidates
for androgen supplementation therapy.
44
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Article info
Footnotes
Address reprint requests to Alvaro Morales MD, FRCSC, FACS, Kingston General Hospital, Kingston, Ontario, Canada K7M 6R4
Identification
Copyright
© 2001 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
