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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 -
Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review.Dermatology Online Journal Nov 2017The 5-α-reductase inhibitors finasteride and dutasteride are frequently used in the treatment of androgenetic alopecia and benign prostatichyperplasia. These drugs are... (Review)
Review
The 5-α-reductase inhibitors finasteride and dutasteride are frequently used in the treatment of androgenetic alopecia and benign prostatichyperplasia. These drugs are effective at reducing levels of dihydrotestosterone, the primary androgen responsible for the pathogenesis of both these conditions. However, finasteride and dutasteride have also been shown to produce an increase in the incidence of sexual dysfunction, namely, impotence, decreased libido, and ejaculation disorder. The purpose of this study is to review the existing medical literature with regard to the sexual side effects of 5-α-reductase inhibitor therapy. This review is an extensive look at the sexual effects of 5-α-reductase inhibitors and compares outcomes for finasteride versus dutasteride in addition to comparing sexualside effects for each of the different dosages prescribed of finasteride and dutasteride.
Topics: 5-alpha Reductase Inhibitors; Dose-Response Relationship, Drug; Dutasteride; Ejaculation; Erectile Dysfunction; Finasteride; Humans; Libido; Male; Sexual Dysfunction, Physiological
PubMed: 29447628
DOI: No ID Found -
British Journal of Clinical Pharmacology Sep 2004To describe patients with decreased libido during use of a HMG-CoA-reductase-inhibitor, and to discuss causality and pharmacological hypotheses for this association by... (Review)
Review
AIMS AND METHODS
To describe patients with decreased libido during use of a HMG-CoA-reductase-inhibitor, and to discuss causality and pharmacological hypotheses for this association by analysis of the adverse drug reactions (ADR) database of the Netherlands Pharmacovigilance Centre Lareb.
RESULTS
Eight patients were identified as having decreased libido during use of statins. In two of these cases testosterone levels were determined and appeared to be decreased.
CONCLUSION
Decreased libido is a probable adverse drug reaction of HMG-CoA-reductase-inhibitors and is reversible. The ADR may be caused by low serum testosterone levels, mainly due to intracellular cholesterol depletion.
Topics: Fatty Acids, Monounsaturated; Fluvastatin; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Indoles; Libido; Male; Middle Aged; Pravastatin
PubMed: 15327593
DOI: 10.1111/j.1365-2125.2004.02128.x -
Menopause (New York, N.Y.) Nov 2018To identify risk factors for decreased libido among women in the late reproductive years.
OBJECTIVE
To identify risk factors for decreased libido among women in the late reproductive years.
DESIGN
Prospective cohort. Women aged 35 to 47 years identified through random digit dialing were prospectively followed for 4 years with serial hormone assays and standardized questionnaires. Mean hormone values, hormone trends over 4 years, and fluctuation in hormone levels were compared among women with and without a decrease in libido at the last assessment period. Total testosterone, dihydroepiandrosterone sulfate, estradiol, follicle-stimulating hormone, luteinizing hormone, body mass index, psychosocial, and socioeconomic variables were evaluated using multivariable logistic regression.
RESULTS
Of 326 women, 87 (27%) reported a decreased libido, whereas 239 (73%) did not. Participant-specific means for all hormone levels over the study period were similar among both groups. However, total testosterone fluctuation over the study was significantly different between groups. Women whose testosterone levels fluctuated from 3.8 to 21.5 ng/dL around a mean value of 9 ng/dL were four times more likely to report decreased libido compared with women with little fluctuation in testosterone [odds ratio (OR) 4.0; 95% CI, 1.6-10.0]. Depression (OR 3.4; 95%CI, 1.9-6.1), vaginal dryness (OR 3.5; 95%CI, 1.8-6.6), and children living at home (OR 1.4; 95%CI, 1.1-1.7) were also independently associated with decreased libido.
CONCLUSIONS
Decreased libido in the late reproductive years is associated with a pronounced fluctuation in total testosterone over time. Other independent risk factors for decreased libido include vaginal dryness, depression, and living with children. Sexual dysfunction is a complex disorder, related to physiological and psychosocial factors, requiring further investigation.
Topics: Adult; Dehydroepiandrosterone Sulfate; Depression; Estradiol; Female; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Libido; Logistic Models; Luteinizing Hormone; Menopause; Middle Aged; Mother-Child Relations; Multivariate Analysis; Prospective Studies; Risk Factors; Sexual Behavior; Sexual Dysfunction, Physiological; Surveys and Questionnaires; Testosterone
PubMed: 30358719
DOI: 10.1097/GME.0000000000001225 -
AWHONN Lifelines 2001
Review
Topics: Female; Humans; Libido; Sexual Dysfunction, Physiological; Sexuality; Women's Health
PubMed: 11982241
DOI: No ID Found -
The British Journal of Psychiatry : the... Jul 1997
Topics: Adult; Antidepressive Agents; Citalopram; Humans; Libido; Male; Sexual Dysfunction, Physiological
PubMed: 9328509
DOI: 10.1192/bjp.171.1.90a -
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 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 -
Epilepsy & Behavior : E&B Nov 2015Therapeutic treatment for persons with epilepsy (PWE) should address seizure control and the broad spectrum of associated comorbidities. Since both epilepsy and...
Therapeutic treatment for persons with epilepsy (PWE) should address seizure control and the broad spectrum of associated comorbidities. Since both epilepsy and antiepileptic drugs (AEDs) can induce decreased libido, sexual health assessment is an important aspect of quality care in PWE as well as other patients receiving AEDs. This paper presents findings from a pilot quality initiative conducted in the ambulatory care epilepsy, pain management, and psychiatric services (N=15 clinicians) which addressed two themes: 1) whether libido is routinely questioned with/without the electronic medical record (EMR) and 2) clinicians' knowledge that both epilepsy and AEDs can induce decreased libido. All clinicians used the EMR, 40% used the GU-ROS section, but only 1 clinician (6.67%) questioned patients regarding libido. Of the clinicians, 26.7% demonstrated knowledge that both AEDs and epilepsy can cause decreased libido. Our results suggest that a treatment gap for epilepsy-induced and AED-induced decreased libido may be related to systems issues (duration of clinical visit, billing codes, EMR template) and physician barriers including decreased knowledge. Further research in this field and replication of this pilot quality initiative are indicated.
Topics: Ambulatory Care Facilities; Anticonvulsants; Comorbidity; Electronic Health Records; Epilepsy; Humans; Libido; Pilot Projects; Quality Improvement
PubMed: 26469800
DOI: 10.1016/j.yebeh.2015.09.015 -
Mayo Clinic Proceedings Jan 2017The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based... (Review)
Review
The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration-approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.
Topics: Adult; Cognitive Behavioral Therapy; Consensus Development Conferences as Topic; Evidence-Based Medicine; Female; Humans; Libido; Serotonin Receptor Agonists; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Testosterone
PubMed: 27916394
DOI: 10.1016/j.mayocp.2016.09.018