Effect of hyperprolactinemia in male patients consulting for sexual dysfunction.
BACKGROUND
The physiological role of prolactin (PRL) in male sexual function has not been completely clarified.


OBJECTIVE
The aim of this study is the assessment of clinical features and of conditions associated with hyperprolactinemia in male patients consulting for sexual dysfunction.


METHODS
A consecutive series of 2,146 (mean age 52.2 +/- 12.8 years) male patients with sexual dysfunction was studied.


METHODS
Several hormonal and biochemical parameters were studied along with validated structured interviews (ANDROTEST and the Structured Interview on Erectile Dysfunction [SIEDY]). Mild hyperprolactinemia (MHPRL; PRL levels of 420-735 mU/L or 20-35 ng/mL) and severe hyperprolactinemia (SHPRL, PRL levels >735 mU/L, 35 ng/mL) were considered.


RESULTS
MHPRL and SHPRL were found in 69 (3.3%) and in 32 (1.5%) patients, respectively. Mean age and the prevalence of gynecomastia were similar in the two groups and in subjects with normal prolactin values. MHPRL was not confirmed in almost one-half of the patients after repetitive venous sampling. Hyperprolactinemia was associated with the current use of antidepressants, antipsychotic drugs, and benzamides. SHPRL was also associated with hypoactive sexual desire (HSD), elevated thyrotropin (TSH), and hypogonadism. The association between HSD and SHPRL was confirmed after adjustment for testosterone and TSH levels, and use of psychotropic drugs (hazard ratio [HR] = 8.60[3.85-19.23]; P < 0.0001). In a 6-month follow-up of patients with SHPRL, testosterone levels and sexual desire were significantly improved by the treatment.


CONCLUSIONS
Our data indicate that SHPRL, but not MHPRL, is a relevant determinant of HSD. Gynecomastia does not help in recognizing hyperprolactinemic subjects, while the use of psychotropic medications and HSD are possible markers of disease. In the case of MHPRL, repetitive venous sampling is strongly encouraged.
Corona
Giovanni
G
Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Mannucci
Edoardo
E
Fisher
Alessandra D
AD
Lotti
Francesco
F
Ricca
Valdo
V
Balercia
Giancarlo
G
Petrone
Luisa
L
Forti
Gianni
G
Maggi
Mario
M
D000328:Adult; D000368:Aged; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000097:blood / Q000453:epidemiology*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000453:epidemiology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D013739:Testosterone / Q000097:blood
D013739:Testosterone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone