title: Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA).
abstract: BACKGROUND
  Besides hypogonadism, other endocrine disorders have been associated with male sexual dysfunction (MSD).
  
  
  OBJECTIVE
  To review the role of the pituitary hormone prolactin (PRL), growth hormone (GH), thyroid hormones, and adrenal androgens in MSD.
  
  
  METHODS
  A systematic search of published evidence was performed using Medline (1969 to September 2011). Oxford Centre for Evidence-Based Medicine-Levels of Evidence (March 2009) was applied when possible.
  
  
  METHODS
  The most important evidence regarding the role played by PRL, GH, thyroid, and adrenal hormone was reviewed and discussed.
  
  
  RESULTS
  Only severe hyperprolactinemia (>35 ng/mL or 735 mU/L), often related to a pituitary tumor, has a negative impact on sexual function, impairing sexual desire, testosterone production, and, through the latter, erectile function due to a dual effect: mass effect and PRL-induced suppression on gonadotropin secretion. The latter is PRL-level dependent. Emerging evidence indicates that hyperthyroidism is associated with an increased risk of premature ejaculation and might also be associated with erectile dysfunction (ED), whereas hypothyroidism mainly affects sexual desire and impairs the ejaculatory reflex. However, the real incidence of thyroid dysfunction in subjects with sexual problems needs to be evaluated. Prevalence of ED and decreased libido increase in acromegalic patients; however, it is still a matter of debate whether GH excess (acromegaly) may create effects due to a direct overproduction of GH/insulin-like growth factor 1 or because of the pituitary mass effects on gonadotropic cells, resulting in hypogonadism. Finally, although dehydroepiandrosterone (DHEA) and its sulfate have been implicated in a broad range of biological derangements, controlled trials have shown that DHEA administration is not useful for improving male sexual function.
  
  
  CONCLUSIONS
  While the association between hyperprolactinemia and hypoactive sexual desire is well defined, more studies are needed to completely understand the role of other hormones in regulating male sexual functioning.
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy. m.maggi@dfc.unifi.it
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.forename: Jaques
authors.initials: J
authors.lastname: Buvat
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: André
authors.initials: A
authors.lastname: Guay
authors.forename: Luiz Otavio
authors.initials: LO
authors.lastname: Torres
mesh_terms: D000172:Acromegaly / Q000150:complications; D000309:Adrenal Insufficiency / Q000188:drug therapy; D003687:Dehydroepiandrosterone / Q000008:administration & dosage / Q000502:physiology; D006062:Gonadotropins / Q000378:metabolism; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency / Q000502:physiology; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006980:Hyperthyroidism / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D007334:Insulin-Like Growth Factor I / Q000502:physiology; D007989:Libido; D008297:Male; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000628:therapy*; D013739:Testosterone / Q000502:physiology
chemical_list: D006062:Gonadotropins; D019382:Human Growth Hormone; D013739:Testosterone; D003687:Dehydroepiandrosterone; D007334:Insulin-Like Growth Factor I