-
The Urologic Clinics of North America May 2022Urologists may commonly diagnose hypogonadism in adult men experiencing an age-related decline in serum testosterone. Low serum testosterone in conjunction with symptoms... (Review)
Review
Urologists may commonly diagnose hypogonadism in adult men experiencing an age-related decline in serum testosterone. Low serum testosterone in conjunction with symptoms such as decreased libido, fatigue, memory deficit, or decreased vitality is described as testosterone deficiency syndrome. There are numerous therapeutic options, although each is unique in its formulation, administration, and side-effect profile. For this reason, treatment can prove to be challenging for each unique patient case. The clinician must carefully monitor key serum markers before and during treatment. With careful dosing and monitoring, therapeutic benefit can be achieved reliably and sustainably.
Topics: Adult; Humans; Hypogonadism; Libido; Male; Syndrome; Testosterone
PubMed: 35428426
DOI: 10.1016/j.ucl.2021.12.008 -
Endocrinology and Metabolism Clinics of... Dec 2022A small percentage of older men are hypogonadal for no apparent reason other than age, a condition called late-onset hypogonadism. This condition is accompanied by... (Review)
Review
A small percentage of older men are hypogonadal for no apparent reason other than age, a condition called late-onset hypogonadism. This condition is accompanied by symptoms, especially sexual symptoms, most notably decreased libido. Testosterone treatment of men who have late-onset hypogonadism improves all aspects of sexual function and also mood, depressive symptoms, and self-reported walking ability. Testosterone treatment would not be expected to improve similar symptoms in men who are not unequivocally hypogonadal.
Topics: Aged; Humans; Hypogonadism; Libido; Male; Testosterone
PubMed: 36244691
DOI: 10.1016/j.ecl.2022.04.001 -
The International Journal of... Dec 2019A review of Freud's ideas about the sexual drive and sexuality reveals reoccurring questions: What is the relation between the sexual drive and its somatic...
A review of Freud's ideas about the sexual drive and sexuality reveals reoccurring questions: What is the relation between the sexual drive and its somatic underpinnings? Can we integrate formulations couched in terms of meaning with those couched in terms of energy? What is the relation of the sexual drive to other drives, psychic structures and affects? The author focuses on two further questions: what can we understand about the experience of sexual passion, and why is there so much anxiety, regulation, and opposition in regard to sexuality, both individually and generally, even within psychoanalysis itself? The author argues that the discomfort with and repudiation of sexuality are related to the nature of the sexual drive itself and to its origins in early childhood and are tied to many of the issues that have marked its history in psychoanalysis. The author discusses a clinical case of a man who tried to isolate and eradicate his sexual drive. His felt absence of sexual drive is an individual instance of the larger discomfort and unease with the truths about human sexuality around which Freud built his theories of development and mind.
Topics: Freudian Theory; History, 20th Century; Humans; Libido; Psychoanalysis; Sexuality
PubMed: 33945735
DOI: 10.1080/00207578.2019.1642757 -
The Journal of Sexual Medicine Jun 2021Only few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Only few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS).
AIM
To define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS.
METHODS
A thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane's Q and I. The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg's rank correlation and trim-and-fill test were used to assess publication bias.
MAIN OUTCOME MEASURE
The pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regression models.
RESULTS
Sixteen studies included collectively gave information about ED and DL in 482 and 368 KS men, respectively, resulting in a pooled prevalence of 28% (95% CI: 19%-36%) for ED and 51% (95% CI: 36%-66%) for DL, with a large heterogeneity. The trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimates. At the meta-regression analyses, a higher prevalence of ED was significantly associated with an older age but not with lower testosterone levels. In series with a mean age >35 years, the ED prevalence estimate increased up to 38% (95% CI: 31%-44%) with no heterogeneity (I=0.0%, P=0.6). On the contrary, the prevalence of DL increased significantly as testosterone levels decreased, without a significant relationship with age.
CLINICAL IMPLICATIONS
While DL would largely reflect an androgen deficiency, in older men with KS, erectile function should be assessed irrespective of testosterone levels.
STRENGTH & LIMITATIONS
This is the first meta-analysis defining pooled prevalence estimates and correlates of ED and DL in KS. Nevertheless, caution is required when interpreting results, due to the high risk of bias in many studies, as well as the dearth of data about psychosocial and/or psychosexological variables and age at the diagnosis.
CONCLUSIONS
ED and DL represent common clinical complaints in KS. While the prevalence of ED would increase with age, DL gets more common as serum testosterone decreases. Further studies are warranted to elucidate the pathogenetic mechanism(s) underlying the age-dependent increase in the prevalence of ED, apparently unrelated to the androgenic status. A Barbonetti, S D'Andrea, W Vena, et al. Erectile Dysfunction and Decreased Libido in Klinefelter Syndrome: A Prevalence Meta-Analysis and Meta-Regression Study. J Sex Med 2021;18:1054-1064.
Topics: Adult; Aged; Erectile Dysfunction; Humans; Klinefelter Syndrome; Libido; Male; Penile Erection; Prevalence
PubMed: 34023236
DOI: 10.1016/j.jsxm.2021.03.078 -
Irish Journal of Psychological Medicine Mar 2020Sexual side effects have rarely been reported secondary to treatment with Pregabalin, a structural analogue of the inhibitory neurotransmitter gamma amino butyric acid...
INTRODUCTION
Sexual side effects have rarely been reported secondary to treatment with Pregabalin, a structural analogue of the inhibitory neurotransmitter gamma amino butyric acid (GABA).
METHOD
We present the case of AB, a 27-year-old single man with a diagnosis of recurrent depressive disorder who was prescribed pregabalin to alleviate the significant anxiety symptoms he was experiencing.
RESULTS
A significant amelioration in anxiety symptoms was attained; however, he developed the adverse effects of acute sexual disinhibition and increased libido. These adverse effects were temporally related to treatment with pregabalin and reduced with dose reduction of this agent.
CONCLUSIONS
To date, limited published data are available relating such a reaction to pregabalin. A greater clinical recognition of this association between pregabalin and sexual disinhibition, would allow clinicians to intervene at an earlier stage of this adverse effect and potentially as in this case, management may only require dose reduction rather than treatment discontinuation.
Topics: Adult; Anti-Anxiety Agents; Depressive Disorder; Humans; Libido; Pregabalin
PubMed: 32223791
DOI: 10.1017/ipm.2017.5 -
American Family Physician Oct 2017Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. There is conflicting evidence... (Review)
Review
Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone. Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia. Depressed mood, fatigue, decreased strength, and a decreased sense of vitality are less specific to male hypogonadism. Testosterone therapy should be initiated only after two morning total serum testosterone measurements show decreased levels, and all patients should be counseled on the potential risks and benefits before starting therapy. Potential benefits of therapy include increased libido, improved sexual function, improved mood and well-being, and increased muscle mass and bone density; however, there is little or mixed evidence confirming clinically significant benefits. The U.S. Food and Drug Administration warns that testosterone therapy may increase the risk of cardiovascular complications. Other possible risks include rising prostate-specific antigen levels, worsening lower urinary tract symptoms, polycythemia, and increased risk of venous thromboembolism. Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop. Testosterone therapy may also be used to treat hypoactive sexual desire disorder in postmenopausal women and to produce physical male sex characteristics in female-to-male transgender patients.
Topics: Adult; Androgens; Cardiovascular Diseases; Female; Health Status; Humans; Hypogonadism; Libido; Male; Middle Aged; Risk Factors; Sexual Dysfunction, Physiological; Testosterone; United States; Women's Health
PubMed: 29094914
DOI: No ID Found -
Wiadomosci Lekarskie (Warsaw, Poland :... 2020The aim: To systematize and bring the reader closer to knowledge about the occurrence of sexual disorders in people after heart transplantation based on available... (Review)
Review
OBJECTIVE
The aim: To systematize and bring the reader closer to knowledge about the occurrence of sexual disorders in people after heart transplantation based on available bibliography.
PATIENTS AND METHODS
Material and methods: A review of the literature on this topic from the last 30 years made with using the PubMed database, using a total of 17 articles.
CONCLUSION
Conclusions: The incidence of sexual dysfunction (SD) is higher in heart recipients than in the general population and erectile dysfunction is the most common. When the symptoms of dysfunction occur before the transplant - they do not improve, rather they get worse, which reduces the improvement in the quality of life of these patients compared to patients without sexual dysfunction. Improvement in quality of life is observed in patients with SD after heart transplantation, but not as pronounced as in subjects without sexual dysfunction. Some patients notice an increase in libido, with the genital response being insufficient or completely disappearing, which results in a decrease in the quality of relationships between partners and a deterioration in the quality of life. The cause of SD in heart recipients is unclear, but it is associated with the type of immunosuppression used, the level of sexual activity and the state of health of patients prior to transplantation. Nowadays patients after ortotrophic heart transplant live longer and their quality of life improves, but not in sexual terms. The articles concerned almost exclusively men, that is why the topic requires exploration in subsequent research.
Topics: Erectile Dysfunction; Heart Transplantation; Humans; Libido; Male; Quality of Life; Sexual Behavior; Sexual Dysfunction, Physiological
PubMed: 33310963
DOI: No ID Found -
The Urologic Clinics of North America Nov 2022This article reviews the role of testosterone in normal male sexual anatomic development and function, the consequences of low testosterone on sexual function, and... (Review)
Review
This article reviews the role of testosterone in normal male sexual anatomic development and function, the consequences of low testosterone on sexual function, and clinical standards for health care providers treating hypogonadal men with sexual dysfunction.
Topics: Male; Humans; Testosterone; Libido; Erectile Dysfunction; Sexual Dysfunction, Physiological
PubMed: 36309419
DOI: 10.1016/j.ucl.2022.07.006 -
Advances in Experimental Medicine and... 2017The 5ARIs, finasteride and dutasteride, are used to treat benign prostate hyperplasia and lower urinary tract symptoms. At much lower doses, 5ARI treatment reduces male... (Review)
Review
The 5ARIs, finasteride and dutasteride, are used to treat benign prostate hyperplasia and lower urinary tract symptoms. At much lower doses, 5ARI treatment reduces male hair loss. These drugs inhibit the conversion of testosterone to the more active dihydrotestosterone (DHT). In men taking these medications, DHT levels are reduced by some 90% while testosterone levels remain relatively stable. Well known for their negative effects on libido and erectile function, 5ARIs also cause ejaculatory dysfunction in some men, having the potential to decrease semen quality. In fact, some studies of men treated with these drugs have reported lower total sperm count, along with lower sperm motility, although the changes are probably insufficient to reduce fertility in men with normal semen before treatment. There is a population of men with more severely decreased sperm numbers; as low as 10% of pretreatment values. Fewer studies have looked at the lower doses used for male alopecia, indicating little affect in men with normal semen quality, but a negative effect on sperm numbers in men with oligozoospermia. There have been no studies looking at fertility endpoints for these medications.
Topics: 3-Oxo-5-alpha-Steroid 4-Dehydrogenase; 5-alpha Reductase Inhibitors; Dihydrotestosterone; Humans; Libido; Male; Penile Erection; Prostatic Hyperplasia; Sperm Count; Sperm Motility
PubMed: 29256127
DOI: 10.1007/978-3-319-69535-8_7 -
Obstetrics and Gynecology Clinics of... Jun 2024Female sexual desire is a complex interplay of neurotransmitters and hormones. Diagnosis is based on clinical features and sexual distress. Treatments that affect... (Review)
Review
Female sexual desire is a complex interplay of neurotransmitters and hormones. Diagnosis is based on clinical features and sexual distress. Treatments that affect neurotransmitters and hormones that may be out of balance can help improve sexual desire in women with hypoactive sexual desire disorder.
Topics: Humans; Female; Sexual Dysfunctions, Psychological; Libido
PubMed: 38777482
DOI: 10.1016/j.ogc.2024.03.004