Effect of testosterone administration on sexual behavior and mood in men with erectile dysfunction.

This double-blind placebo controlled, cross-over study was carried out to assess the effect of testosterone administration on sexual behavior mood, and psychological symptoms in healthy men with erectile dysfunction. Biweekly injections of 200 mg of testosterone enanthate were given over a period of 6 weeks separated by a washout period of 4 weeks. Blood samples for hormonal assessment, behavioral and psychological ratings were obtained prior to each injection. Luteinizing hormone remained significantly depressed but circulating testosterone had returned to baseline levels by 2 weeks following each hormonal injection. The ejaculatory frequency during the testosterone phase was statistically higher than during the placebo phase. There were marked, although statistically nonsignificant, increases in median frequency of reported sexual desire, masturbation, sexual experiences with partner, and sleep erections during the testosterone period. Testosterone did not have demonstrable effects on ratings of penile rigidity and sexual satisfaction. Mood variables and psychological symptoms did not change following hormonal administration. Results suggest that androgen administration to eugonadal men with erectile dysfunction may activate their sexual behavior without enhancing erectile capacity and without effects on mood and psychological symptoms.

Sexuality and aging.

Because aging is frequently associated with medical conditions likely to impair sexual performance, there is a tendency to view sexual changes in older men as the result of pathology, overlooking the effect of natural processes of aging in sexuality. This article discusses the sexual responses in the aging male, the physiologic aspects of aging male sexuality, psychologic aspects of aging and sexuality, studies on aging male sexuality, a psychobiological investigation of healthy aging men, medical causes of erectile dysfunction in elderly men, and the effect of medications on the sexual functioning of aging men.

Chronic alcoholism and male sexual function.

OBJECTIVE: The relation between chronic alcohol abuse and male sexuality remains uncertain. This study assessed the effect of chronic alcoholism on sexual function, marital adjustment, sleep-related erections, sleep disorders, and hormone levels during abstinence from alcohol. METHOD: Twenty chronically alcoholic men, aged 28-59 years, without evidence of severe hepatic disease and free from unrelated medical illnesses, were assessed 2-36 months after achieving sobriety and compared to a group of 20 nonalcoholic volunteers. Each subject and his sexual partner underwent semistructured interviews and completed several questionnaires; the men had medical and psychiatric evaluations and polygraphic assessment of sleep parameters and nocturnal penile tumescence during 4 nights, with the last night devoted to sequential blood sampling for evaluation of hormone levels. RESULTS: The alcoholic men did not differ from the comparison group in any sexual dimension or in the prevalence of sexual problems despite the significant marital dissatisfaction reported by their sexual partners. In addition, there were no differences between groups in sleep and nocturnal penile tumescence measures. The alcoholic group had a greater prevalence of periodic leg movement disorders but no respiratory abnormalities during sleep. Except for a significant overnight increase in plasma luteinizing hormone in the alcoholic men, there were no differences between groups in total and bioavailable testosterone, dihydrotestosterone, and prolactin or in the nocturnal circadian changes in testosterone and prolactin levels. CONCLUSIONS: These findings suggest that prolonged and severe alcohol abuse in men is compatible with normal sexual function during sobriety in the absence of substantial hepatic or gonadal failure.

Diabetes, psychological function and male sexuality.

The aim of the study was to assess psychological contributors or correlates of sexual dysfunction in diabetic men. The study was conducted on 40 diabetic men and 40 age-matched healthy volunteers. The subjects underwent a psychosexual interview with their sexual partners and had a comprehensive medical evaluation to rule out the confounding effects of other illnesses or medications. Psychiatric, psychological and marital information was obtained with the Schedule for Affective Disorders and Schizophrenia (SADS-L), the SCL-90-R, the Derogatis Sexual Function Inventory, the Locke-Wallace Marital Adjustment test and the Dyadic Adjustment Inventory. Compared to controls, diabetic patients had significantly lower levels of erotic drive, sexual arousal, enjoyment and satisfaction. Problems in these areas coexisted with alterations in sexual attitudes and body image but were not related to group differences in marital adjustment as reported separately by the patients and their partners. There was no evidence that psychological distress or psychiatric disorders are associated with diabetes or with its effects on sexual function.

The biology of sexual function.

This article provides a selective overview of the physiologic substrates of sexual desire, arousal, and orgasm, and reviews their changes with age. The effect of pharmacologic agents on sexual physiology is discussed, highlighting both the clinical significance and underlying neurophysiologic mechanisms of these agents.

The role of the sleep laboratory in the evaluation of male erectile dysfunction.

Considerable advances have been made in the evaluation of male erectile dysfunction. The assessment of sleep-related nocturnal penile tumescence has emerged as one of the better established methods for the objective assessment of erectile capacity. This article summarizes information on the clinical use of the nocturnal penile tumescence test and discusses conceptual and methodological issues derived, in part, from our own research that are important for the valid interpretation of the test results in the diagnosis of erectile disorders.

Erectile function and penile blood pressure in diabetes mellitus.

Thirty-seven diabetic men selected to exclude the confounding effects of other medical illnesses and nondiabetic medications and 53 healthy controls underwent extensive psychosexual and medical evaluations and penile blood pressure assessments by ultrasonic Doppler measurement and mercury strain-gauge plethysmography. There was a significant negative correlation between age and the penile-brachial index (PBI) in the diabetic but not in the control group. The impotent diabetic group had significantly lower PBI than nondysfunctional diabetic and healthy control subjects. Diabetic type, complications, and adequacy of metabolic control were not statistically related to PBI. Although the PBI may not have diagnostic utility for individual patients, it may provide a valuable noninvasive physiologic measure of penile vascular changes in studies on the aged and the medically ill. The processes that mediate the interaction of diabetes and aging on penile blood pressure and erectile capacity deserve further investigation.

Sexual satisfaction in healthy aging men.

Systematic information on the contributing factors to sexual satisfaction in healthy older men is lacking. The central aim of the study was to explore the predictive significance of psychological, marital, and behavioral variables and their interaction on the satisfaction of healthy married volunteers aged 45 to 74. All subjects had an extensive psychosexual and medical evaluation and completed a battery of psychological tests which included the Derogatis Sexual Functioning Inventory (DSFI), the Locke-Wallace Marital Adjustment Test (L-W) and the Dyadic Adjustment Scale (DAS). Step-wise regression analysis demonstrated that the subjects' perception of erectile difficulties, sexual information, affect, and marital adjustment had a differential correlation pattern with three measures of sexual satisfaction explaining a substantial amount of the variance. There is a need to move beyond an exclusive focus on performance to the determinants of sexual enjoyment and satisfaction in the later years.

Diabetes mellitus and male sexual function: a controlled study.

There is an extensive clinical literature on the erectile disorders of diabetic men but a paucity of controlled studies that have taken into account the effects of age, concurrent illnesses and medication on sexual function. This investigation was carried out on 40 diabetic men free from other illness or drugs that could affect sexual capacity and 40 age-matched healthy control subjects. Each subject and his female partner underwent semistructured interviews and the men had comprehensive medical evaluations and polygraphic assessment of sleep and nocturnal penile tumescence in the sleep laboratory during three nights. In comparison to control subjects, diabetic patients reported significant decreases in sexual desire, subjective arousal, erectile capacity, coital frequency and sexual satisfaction. The diabetic group also had significant decrements in duration of rapid eye movement sleep and in frequency, duration and degree of nocturnal penile tumescent episodes. There were no differences between Type 1 (insulin-dependent) and Type 2 (non-insulin dependent) diabetic patients in prevalence of sexual problems or in nocturnal tumescent measures. Significant relations were observed between lack of metabolic control, diabetic complications and impaired nocturnal tumescence. Sexually non-dysfunctional diabetic men had significant nocturnal penile tumescence abnormalities. Diabetic men without coital failures may have a subclinical impairment in erectile function which, although of not significant magnitude to interfere with penetration, is reflected in nocturnal penile tumescent measures. This result raises a note of caution in the interpretation of the nocturnal penile tumescence test for the differential diagnosis of diabetic erectile impotence.

Diabetes, sleep disorders, and male sexual function.

The prevalence and role of sleep disorders in the sexual problems of diabetic patients remain unexplored. This study was conducted on 40 diabetic men carefully screened to exclude the confounding effects of other medical illnesses or drugs likely to impair sexual function and 40 age-matched healthy volunteers. They underwent an extensive psychosexual interview, medical and psychiatric evaluations, and three recorded nights in a sleep laboratory. Electroencephalogram, eye movements, muscle tone, and nocturnal penile tumescence were monitored continuously. Respiratory airflow and bilateral anterior tibialis recordings were obtained during the first sleep session. Diabetic men had significantly higher prevalences of respiratory and periodic leg movement disturbances during sleep. There was clinical, although not nocturnal penile tumescence, evidence suggesting that respiratory abnormalities during sleep are associated with erectile difficulties in diabetic men. Future studies should include blood oxygenation and respiratory effort measures to clarify the significance of sleep-related airflow disturbances in diabetic patients.

Hormones and nocturnal penile tumescence in healthy aging men.

There is no information on the relationship between endogenous pituitary and gonadal hormones and nocturnal penile tumescence (NPT) in healthy aging men. Sixty-seven married volunteers ages 45-74 years were studied in the sleep laboratory for 4 nights with the last night devoted to sequential blood sampling every 20 min. Bioavailable testosterone (bT) correlated significantly with several NPT measures while total testosterone, estradiol, LH, and prolactin were mostly unrelated to NPT. All bT-NPT correlations lost their significance after adjustment by multiple regression for the effect of age on both bT and NPT variables in the total subject sample. Analysis of bT-NPT relations by age groups revealed a significant association between bT and duration NPT in men ages 55 to 64 years, but no statistical relations in younger and older age groups. Changes in the central threshold of activation of NPT as age progresses may explain the age-dependent effect of bT in sleep erections.

Pituitary-gonadal function during sleep in healthy aging men.

There is limited information on the relation between age-related changes in pituitary-gonadal function and sleep physiology in older men. In this cross-sectional study of 67 healthy volunteers free from sleep complaints, aged 45-75 yr, we (1) assessed peak fluctuations and hourly variations in plasma testosterone, LH and prolactin sampled every 20 min during sleep, and (2) explored the relation between sleep parameters, respiratory and periodic leg movement disturbances, and circulating concentrations of the aforementioned hormones. We hypothesized that alterations in sleep architecture or presence of sleep disorders may contribute to hormonal variations in aging subjects. Bioavailable testosterone decreased and LH increased with age, but there were no differences in total testosterone and prolactin and no major changes in peak hormonal release. There were positive associations, independent from the age effect, between sleep efficiency, decreased latency to onset of REM activity, and number of REM episodes, and circulating testosterone. Sleep-disordered breathing significantly increased with age. The degree of respiratory disturbance was associated with decreased overnight plasma bioavailable testosterone, but this relationship lost its significance after age-adjustment. The findings demonstrate a decrease in gonadal function during sleep in healthy aging men and suggest that changes in sleep efficiency and architecture are associated with alterations in gonadal activity in these older individuals.

Psychometric characteristics of individuals with sexual dysfunction and their partners.

This study assessed psychological dimensions and marital adjustment of 52 couples in which one of the partners met operational criteria for hypoactive sexual desire or erectile dysfunction. Information was obtained independently from the dysfunctional subjects and their partners by means of validated inventories: the Derogatis Sexual Function Inventory (DSFI), Locke-Wallace Marital Adjustment Test (L-W), and the Dyadic Adjustment Scale (DAS). The global measures of sexual function and satisfaction of the DSFI showed marked impairment in all groups, while its subscale scores suggested characteristic differences in the profiles of the dysfunctional groups and their partners. In contrast to individual psychologic measures, the assessment of marital adjustment was within the scale's normative limits in all diagnostic groups. There is a need for controlled studies to better characterize sexual and marital dimensions in diagnostically well-defined dysfunctional couples.

Sexual function and testosterone levels in men with nonalcoholic liver disease.

The effects of nonalcoholic liver disease on sexual desire, arousal, activity, orgasmic function and satisfaction and serum testosterone levels were studied in 75 men with nonalcoholic liver disease. Each man was interviewed about his sexual behavior and problems and was asked to comment on whether he felt liver disease affected his sexual function. The average age of the patients was 49 yr, and a wide variety of liver diseases was represented. Child-Pugh grading was A in 51 patients, B in 18 and C in 6; the mean duration of liver disease was 8 yr. Sexual desire, arousal and activity of patients with grade A disease were within the ranges observed in studies of healthy men of comparable age. Diminished sexual desire was reported by 2% of grade A patients and 35% of grade B and C patients (p less than 0.005). Arousal problems were noted by 16% of grade A patients, 60% of grade B patients and 67% of C patients (p less than 0.005). Loss of erection and inability to regain erection were noted by 7%, 40% and 67% of grade A, B and C patients, respectively (p less than 0.01). Premature and retarded ejaculation were more frequent in patients classed in Child-Pugh grades B and C. Frequency of coitus and orgasm were significantly higher in grade A patients than in grade B and C patients. Total and free testosterone levels were (in nanograms per milliliter) A, 677/1.78; B, 416/1.06; and C, 178/0.43 (p less than 0.002). We concluded that Child-Pugh grade A nonalcoholic liver disease in men does not affect sexual desire, function or performance. Men with disease grades B and C have significant sexual dysfunction and significant reduction of both total and free testosterone levels.

Aging, sleep disorders, and male sexual function.

The relation between age, sleep disorders, nocturnal penile tumescence, and sexual behavior was investigated in 70 healthy married men aged 45-75 years. They had an extensive psychosexual interview, a medical and psychiatric evaluation, and were studied in the sleep laboratory for four nights. Electroencephalogram (EEG), eye movements, muscle tone, and penile tumescence were monitored continuously, and respiratory airflow and bilateral anterior tibialis recordings were obtained during the first sleep session. There was a marked age-related increase in sleep-disordered breathing, but no significant changes in periodic leg movements with age. Respiratory distress and periodic leg movement (PLM) indices were mostly unrelated with nocturnal penile tumescence (NPT) measures as well as with all sexual behavior dimensions when age was taken into account in the analysis of results. Men with a respiratory distress disorder did not differ from a nondisordered group of similar age in NPT and behavioral parameters. Men with PLM disorder differed from their comparison group in only two variables: fewer number of maximum tumescent episodes and less frequent sexual thoughts. Men who met criteria for erectile impotence did not differ significantly in degree of respiratory or PLM disturbances or in the prevalence of sleep disorders when compared to an aged-matched sexually nondysfunctional group. The overall results did not support the notion that sleep disorders are involved in the increased prevalence of erectile impotence in healthy older individuals. Assessment of blood oxygenation and respiratory effort, in addition to airflow, need to be carried out before final conclusions can be drawn on the significance of sleep-disordered breathing in male sexuality.

The relationship between pituitary-gonadal function and sexual behavior in healthy aging men.

Few studies have assessed the role of pituitary and gonadal hormones on age-related changes in sexual behavior in healthy men. We conducted a retrospective and prospective evaluation of sexual function and behavior in 77 healthy married men aged 45 to 74 years. The subjects were studied in the sleep laboratory for four nights with the last night devoted to sequential blood sampling every 20 minutes. Significant age-related decreases in sexual desire, sexual arousal and activity, and increases in erectile problems were noted. Aging was negatively correlated with bioavailable testosterone (bT), was positively correlated with luteinizing hormone (LH), and was not related to total testosterone, estradiol, and prolactin. Bioavailable testosterone, and the ratio of bT over LH showed a close association with several sexual behavior dimensions while total testosterone, estradiol, and prolactin demonstrated few or no behavioral relationships. The age-related effect of bT was, however, a more important determinant of the reported behavioral differences than were the effect of bT independent of age. There was no evidence that changes in circulating hormones contribute to erectile disorders in healthy aging men.

Healthy aging and male sexual function.

The authors examined the effect of age on sexual function and behavior and on nocturnal penile tumescence in 65 healthy married men aged 45 to 74 years. There was a significant negative relation between age and sexual desire, arousal, and activity and an increasing prevalence of sexual dysfunction with age but no age difference in sexual enjoyment and satisfaction. Significant age-related decreases in frequency, duration, and degree of nocturnal penile tumescence were found. Sexual desire, arousal, coital frequency, and prevalence of erectile problems correlated with nocturnal penile tumescence measures. The authors discuss the relevance of these findings for the understanding of sexual function in aging men.

Chronic alcoholism and male sexual dysfunction.

Chronic alcoholism can profoundly influence marital relationships, but the nature of the effect of alcohol abuse on sexual interactions is not clear. This article critically reviews information on the prevalence of sexual disorders and possible endocrine, neurologic, and psychologic processes that may mediate the effects of chronic alcoholism on male sexual functioning. Emphasis is placed on a conceptual model that integrates biologic and psychologic perspectives, moving away from simplistic unidimensional approaches to the study of the behavioral effects of this serious medical and social problem.

Gonadal hormones, sex and behavior.

Gender differences have been demonstrated in several regions of the central nervous system (CNS) in animals and humans. These differences change with development and aging and are probably influenced by hormones. Gender differences have been demonstrated clinically in the prevalence of some mental disorders and responses to psychotropic medications. Gonadal hormones might be involved in these differences as well as in differential cognitive functions. The two genders also differ in the aging process. While it is well known that changes in the pituitary gonadal system influence the aging process in women, preliminary data described here demonstrate the association between pituitary-gonadal hormones and the aging process of sexual desire and activity in men. The changes in levels of gonadal hormones might contribute to the pathophysiology of dysphoric cyclic disorders and increased vulnerability to affective disorders in women. This vulnerability might be related to hormonal fluctuations over time as well as to alteration in internal oscillators and time-related functions.