Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone
Open accessAbstract
The role of androgenic hormones in human sexuality, in the mechanism of erection and in the pathogenesis of impotence is under debate. While the use of testosterone is common in the clinical therapy of male erectile dysfunction, hypogonadism is a rare cause of impotence. We evaluated serum testosterone levels in men with erectile dysfunction resulting either from organic or non-organic causes before and after non-hormonal impotence therapy. Eighty-three consecutive cases of impotence (70% organic, 30% non-organic, vascular aetiology being the most frequent) were subjected to hormonal screening before and after various psychological, medical (prostaglandin E1, yohimbine) or mechanical therapies (vascular surgery, penile prostheses, vacuum devices). Thirty age-matched healthy men served as a control group. Compared to controls, patients with impotence resulting from both organic and non-organic causes showed reduced serum levels of both total testosterone (11.1 +/- 2.4 vs. 17.7 +/- 5.5 nmol/L) and free testosterone (56.2 +/- 22.9 vs. 79.4 +/- 27.0 pmol/L) (both p < 0.001). Irrespective of the different aetiologies and of the various impotence therapies, a dramatic increase in serum total and free testosterone levels (15.6 +/- 4.2 nmol/L and 73.8 +/- 22.5 pmol/L, respectively) was observed in patients who achieved normal sexual activity 3 months after commencing therapy (p < 0.001). On the contrary, serum testosterone levels did not change in patients in whom therapies were ineffective. Since the pre-therapy low testosterone levels were independent of the aetiology of impotence, we hypothesize that this hormonal pattern is related to the loss of sexual activity, as demonstrated by its normalization with the resumption of coital activity after different therapies. The corollary is that sexual activity may feed itself throughout the increase in testosterone levels.
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The increase in testosterone with sildenafil is consistent with evidence that resumption of sexual activity by itself can increase testosterone by 30%.
“Though sildenafil may have a direct action on the testes (41), this increase is also consistent with evidence that resumption of sexual activity by itself can increase testosterone by 30% (42).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [42]
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- Authors
- Jannini, E. A., Screponi, E., Carosa, E., Pepe, M., Lo Giudice, F., Trimarchi, F., & Benvenga, S.
- Affiliations
- University of L'Aquila (IT)
- Sapienza University of Rome (IT)
- University of Messina (IT)
- Corresponding author
- Jannini, Emmanuele A.
- Venue
- International Journal of Andrology
- Publisher
- Wiley
- Published
- 1999-12
- Volume
- 22
- Issue
- 6
- Pages
- 385-392
- ISSN
- 0105-6263 (ISSN-L)
- 1365-2605
- OpenAlex
- W2057426299
- Cited by
- 146
- References
- 40
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 7 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 4 · 2017: 9 · 2016: 5 · 2015: 4 · 2014: 6 · 2013: 6 · 2012: 7
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Andrology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Chiba University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Keywords
- erectile dysfunction, serum testosterone, free testosterone, sexual activity, hypogonadism, testosterone replacement therapy, prostaglandin E1, yohimbine, penile prosthesis, vacuum systems, vascular impotence, psychological impotence, androgens
- MeSH terms
- Adolescent, Adult, Aged, Humans, Erectile Dysfunction, Male, Middle Aged, Prospective Studies, Sexual Behavior, Testosterone, Matched-Pair Analysis
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