Urologists Discuss the Effects of Age and Hormonal Status

It’s not breaking news that hormones play a major role in human sexual function. But studies presented at the annual meeting of the American Urological Association revealed just how complicated the whole process can be.

Edgardo F. Becher, Buenes Aires, Argentina, presented a study titled the “Influence of Testosterone on the Cavernosal Hemodynamic Response.” He and his colleagues evaluated erections in 12 prostate cancer patients before and after complete androgen blockade (CAB). Prior to CAB the men were capable of normal erections. Three months after CAB, the men were unable to develop normal erections. The researchers investigated the in vivo hemodynamic response of the corpus cavernosum.

“We found that acute hormonal deprivation interferes with cavernosal smooth muscle relaxation,” concluded Becher. “This suggests that testosterone plays an important role in preserving erectile function.”

In a different study conducted in Porto Alegre, Brazil, Claudio Telokin examined the relationship between serum testosterone levels and erectile function in healthy aging men. The data showed a clear inverse association of erectile dysfunction with aging: the older the man, the more likely he was to experience erectile dysfunction. Telokin’s team was not able to demonstrate a correlation between total testosterone levels and erectile function.

In a related study, Sung W. Lee and colleagues, Seoul, Korea, studied the clinical relevance of testosterone levels and sexual activities in aging men. They found that “among testosterone levels, the change of free testosterone was most closely correlated with aging. The free testosterone levels also showed a close relationship with sexual activities.”

In other words, men with lower free testosterone levels showed reduced erectile function and diminished orgasmic function. The older the man, the lower his free testosterone levels.

“In contrast to previous reports, the free testosterone and SHBG levels showed significant correlation with orgasmic function and erectile function rather than sexual desire,” Lee reported at the conference.

Irwin Goldstein, Boston, Massachusetts, discussed sexuality and hormones in women. The title of one of the studies he presented was “Hormone, Sexual Function, and Personal Sexual Distress (SDS) Outcomes Following Dehydroepiandosterone (DHEA) Treatment for Female Sexual Dysfunction (FSD) and Androgen Deficiency Syndrome (ADS).”

According to Goldstein, quality of life (QOL) in women can be significantly impacted by sexual dysfunction. Sexual dysfunction can cause patients to be depressed, embarrassed, and ashamed. It can cause intense stress in a patients’ relationships and is a difficult subject for many women to broach with a physician.

“Treatment can markedly improve QOL in these patients,” stated Goldstein.

He reported a study that showed ADS is often the culprit in sexual dysfunction in women. Other research has suggested that DHEA can help treat these women. DHEA is an adrenal androgen and a precursor of sexual steroids. In conditions of inactivity of the adrenal enzyme 17-20 lyase, DHEA is the most physiologic treatment option, indicated Goldstein.

Study data showed that DHEA was effective treatment for sexual dysfunction caused by ADS. Side effects were mild.

“DHEA treatment of women with FSD from ADS was capable of increasing androgen steroids, improving sexual function, and diminishing personal sexual distress,” concluded Goldstein.

In a plea for responsible reporting, Goldstein warned that this product could be severely abused and misused to the detriment of women’s health. DHEA is available over-the-counter, but because it is unregulated, physicians are concerned about the uncertainty of purity and concentration of DHEA products. Women should be cautioned NOT to take DHEA without first seeing a doctor and then taking it only on that doctor’s recommendation, he emphasized.

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