Revisión: influencia hormonal en deseo sexual y erecciones

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Revisión: influencia hormonal en deseo sexual y erecciones

Notapor Fisio » Vie, 08 Abr 2016, 02:37

Endocrinologic Control of Men’s Sexual Desire and Arousal/Erection


Recommendations

Recommendation 1

Testosterone (T) significantly contributes to the regulation of male sexual desire (level 1A), and T treatment (TTh) can improve libido in hypogonadal (total T < 12 nmol/L) men (level 1A).

T evaluation is strongly recommended in all men complaining of decreased sexual desire (level 1A).

Recommendation 2

Dihydrotestosterone (DHT) and estrogens play a minor role in the regulation of male sexual desire (level 2B).

DHT and estradiol (E2) evaluations are not recommended in men complaining of decreased sexual desire (level 3B).

Recommendation 3

Adrenal hormones, including dehydroepiandrosterone (DHEA) and its sulfate (DHEAS; level 2A), and cortisol and aldosterone (level 3B) are not involved in the regulation of male sexual desire.

Adrenal hormone evaluation is not recommended in men complaining of decreased sexual desire (level 1A).

Recommendation 4

Prolactin (PRL) plays a major role in regulating male sexual desire (level 2A), acting through direct and indirect pathways (level 3B).

PRL levels should be evaluated in all men complaining of decreased sexual desire (level 2A).

Treating hyperprolactinemia restores sexual desire (level 2A).

Recommendation 5

The contribution of thyroid hormones (THs) in the regulation of male sexual desire is contradictory (level 3B).

TH evaluation is not recommended in men complaining of decreased sexual desire (level 2B).

Recommendation 6

T regulates penile development and growth in early life, but not after puberty (level A).

T targets several molecular pathways involved in the physiology of erections, including the nitric oxide and cyclic guanosine monophosphate (NO-cGMP) pathway (level A), RhoA-ROCK signaling, adrenergic response, and cavernous smooth muscle cell (SMC) turnover (level B).

Recommendation 7

The decrease of circulating T levels is associated with a decrease in erectile function (EF; level 2B).

TTh in hypogonadal men (total T level < 12 nmol/L) is associated with significant increases in self-reported measurements of EF that are proportional to the severity of hypogonadal status before treatment (level 1A).

Basal and longitudinal assessments of T are recommended in men with erectile dysfunction (ED; level 1A).

Recommendation 8

DHT exerts qualitatively similar effects as T on EF (level 2A), although it has been studied less extensively.

Treatment with DHT and its analogs (mesterolone) cannot be recommended as an alternative to TTh to improve EF in hypogonadal men (level 4B).

Measurement of DHT is not recommended in the assessment of EF (level 3A).

Recommendation 9

The role of E2 on EF is controversial. Experimental evidence indicates that E2 downregulates phosphodiesterase type 5 (PDE5) expression (level 3C).

Measurement of estrogens is not recommended in the assessment of EF (level 2C).

Recommendation 10

DHEA and DHEAS are not involved in the regulation of male EF (level 2A).

Glucocorticoid and mineralocorticoid in adrenal insufficiency might play a role in restoring EF (level 4C).

Recommendation 11

PRL does not play a direct role in the regulation of male EF (level 3B).

PRL evaluation is not recommended in patients complaining of ED (level 2B).

Treating hyperprolactinemia might have indirect, positive effects on arousal and erection (level 3B)

Recommendation 12

Conclusive data regarding the potential therapeutic role of oxytocin (OT) in male sexual dysfunctions are lacking (level 2B).

Recommendation 13

Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) are not involved in the regulation of male EF (level 3B).

GH and IGF-1 levels should not be evaluated in men complaining of ED (level 2B).

Recommendation 14

Animal models indicate that the melanocortin system is involved in the regulation of EF acting at a central level (level 2C).

Available randomized controlled trials (RCTs) do not suggest analogs of α-melanocyte-stimulating hormone (α-MSH) for the treatment of ED because of associated adverse events (level 1B).

Recommendation 15

Hyperthyroidism is significantly associated with an increased risk of ED (level 3B).

Treating hyperthyroidism improves ED (level 3B).

Sexual function should be assessed in all men with hyperthyroidism (level 3B).

The prevalence of hyperthyroidism in men seeking medical care for ED is low (level 2B).

TH evaluation is not recommended in all men complaining of ED (level 2B).

The association between hypothyroidism and impairment of EF is contradictory (level 2C).

Sexual function should not be assessed in all men with hypothyroidism (level 2B).

The prevalence of hypothyroidism in men seeking medical care for ED is low (level 2B).

TH evaluation is not recommended in all men complaining of ED (level 2B).


http://www.jsm.jsexmed.org/article/S174 ... 9/fulltext
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