Endocrine_Aspects_of_Sexual_Dysfunction_in_Men

69 Endocrine Aspects of Sexual Dysfunction in Men

Alvaro Morales, MD,* Jacques Buvat, MD,†Louis J. Gooren, MD,‡Andre T. Guay, MD,§

Jean-Marc Kaufman, MD,¶Hui Meng Tan, MD,#and Luiz O. Torres, MD**

*Department of Urology, Queen’s Univerisity, Kingston, ON, Canada; †Centre ETPARP, Lille, France, ‡Department of Endocrinology, Vrije University, Amsterdam, The Netherlands; §Center for Sexual Function/Endocrinology, Lahey Clinic Northshore, Peabody, MA, USA; ¶Department of Endocrinolgy and Rheumatology, University Hospital Ghent, Ghent, Belgium; #University of Malaya, Selangor, Malaysia; **Funcionarios Belo Horizonte, Minas Gerais, Brazil

Summary of Committee. For the complete report please refer to Sexual Medicine: Sexual Dysfunctions in Men and Women, edited by T.F. Lue, R. Basson, R. Rosen, F. Giuliano, S. Khoury, F. Montorsi, Health Publications, Paris 2004.

A B S T R A C T

Introduction.Endocrine disorders of sex steroid hormones may adversely affect men’s sexual

function.

Aim.T o provide expert opinions/recommendations concerning state-of-the-art knowledge for the

pathophysiology, diagnosis and treatment of endocrinologic sexual medicine disorders.

Methods.An International Consultation in collaboration with the major urology and sexual med-

icine associations assembled over 200 multidisciplinary experts from 60 countries into 17 commit-

tees. Committee members established specific objectives and scopes for various male and female

sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respec-

tive sexual medicine topic represent the opinion of experts from five continents developed in a sci-

entific and debate process. Concerning the Endocrine committee, there were eight experts from

seven countries.

Main Outcome Measure.Expert opinions/recommendations are based on grading of evidence-

based medical literature, extensive internal committee discussion over 2 years, public presentation

and deliberation.

Results.Hypogonadism is a clinical and biochemical syndrome characterized by a deficiency in

serum androgen levels which may decrease sexual interest, quality of erections and quality of life.

Biochemical investigations include testosterone and either bioavailable or calculated free testos-

terone; prolactin should be considered when hypogonadism has been documented. If clinically indi-

cated, androgen therapy should maintain testosterone within the physiological range avoiding

supraphysiologic values. Digital rectal examination and determination of serum prostate specific

antigen values are mandatory prior to therapy and regularly thereafter. Androgen therapy is usually

long-term requiring regular follow-up, frequent monitoring of blood levels and beneficial and

adverse therapeutic responses.

Conclusions.Safe and effective treatments for endocrinologic sexual medicine disorders examined

by prospective, placebo-controlled, multi-institutional clinical trials are needed.

Key Words.Hormone Therapy; Endocrine Sexual Dysfunction; Hypogonadism; Androgens;

Andropause; T estosterone; Dehydroepiandrosterone; Sex Hormone Binding Globulin;

Prolactin

© Journal of Sexual Medicine 1743 6095