title: Endocrine aspects of male sexual dysfunctions.
abstract: BACKGROUND
  Endocrine disorders may adversely affect men's sexual function.
  
  
  OBJECTIVE
  To provide recommendations based on best evidence for diagnosis and treatment of endocrine-related male sexual dysfunctions.
  
  
  METHODS
  The Endocrine Aspects of Male Sexual Dysfunctions Committee, including 11 members from eight countries and four continents, collaborated with the Endocrine subcommittee of the Standards Committee of the International Society for Sexual Medicine. Medical literature was reviewed in detail, followed by extensive internal committee discussion over 2 years, then public presentation and discussion with the other experts before finalizing the report.
  
  
  METHODS
  Recommendations based on grading of evidence-base medical literature and interactive discussion.
  
  
  RESULTS
  From animal studies, it is derived that testosterone modulates mechanisms involved in erectile machinery, including expression of enzymes that both initiate and terminate erection. In addition, testosterone is essential for sexual motivation. Whether these findings could be extrapolated to human erections is unclear. Testosterone plays a broad role in men's overall health. Recent studies have established strong associations between low testosterone and metabolic and cardiovascular imbalances. In some studies, low testosterone decreased longevity; however, longitudinal studies do not support the predictive value of low testosterone for further cardiovascular events. The article proposes a standardized process for diagnosis and treatment of endocrine-related male sexual dysfunctions, updating the knowledge on testosterone and prostate safety. There is no compelling evidence that testosterone treatment causes prostate cancer or its progression in men without severe testosterone deficiency (TD). The possible roles of prolactin and thyroid hormones are also examined.
  
  
  CONCLUSIONS
  Men with erectile dysfunction, hypoactive sexual desire and retarded ejaculation, as well as those with visceral obesity and metabolic diseases, should be screened for TD and treated. Prospective interventional studies are required before screening for TD in more conditions, including cardiovascular diseases, and considering correction as preventive medicine as much data suggests.
authors.affiliation: Centre d'Etudes et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France. jacques@buvat.org
authors.forename: Jacques
authors.initials: J
authors.lastname: Buvat
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.forename: Louis
authors.initials: L
authors.lastname: Gooren
authors.forename: Andre T
authors.initials: AT
authors.lastname: Guay
authors.forename: Joel
authors.initials: J
authors.lastname: Kaufman
authors.forename: Abraham
authors.initials: A
authors.lastname: Morgentaler
authors.forename: Claude
authors.initials: C
authors.lastname: Schulman
authors.forename: Hui Meng
authors.initials: HM
authors.lastname: Tan
authors.forename: Luiz Otavio
authors.initials: LO
authors.lastname: Torres
authors.forename: Aksam
authors.initials: A
authors.lastname: Yassin
authors.forename: Michael
authors.initials: M
authors.lastname: Zitzmann
mesh_terms: D000465:Algorithms; D002318:Cardiovascular Diseases / Q000209:etiology; D016903:Drug Monitoring; D004700:Endocrine System Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D008403:Mass Screening; D008511:Medicine / Q000379:methods / Q000592:standards; D024821:Metabolic Syndrome / Q000150:complications; D056128:Obesity, Abdominal / Q000150:complications; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012449:Safety; D044347:Sexology / Q000379:methods / Q000592:standards; D013739:Testosterone / Q000172:deficiency / Q000627:therapeutic use; D014572:Urology / Q000379:methods / Q000592:standards
chemical_list: D013739:Testosterone