Male sexual function can be maintained without aromatization: randomized placebo-controlled trial of dihydrotestosterone (DHT) in healthy, older men for 24 months
Abstract
INTRODUCTION: Male sexual function is highly androgen dependent but whether aromatization of testosterone (T) to estradiol is required remains contentious. AIM: This study aims to investigate the effects of selective estrogen deficiency induced by a nonaromatizable androgen, dihydrotestosterone (DHT), on sexual function of healthy middle-aged and older men. METHODS: Randomized clinical trial of daily transdermal DHT (70 mg) or placebo gel treatment in 114 healthy middle-aged and older (>50 years, mean 60.5 years) men without known prostate disease maintaining selective estrogen deficiency for 24 months. OUTCOME MEASURES AND ANALYSIS: The end points were responses to a psychosexual and mood questionnaire completed before, at 3 months, then at 6 monthly intervals during and 3 months after study. Data were analyzed by mixed model analysis of variance for repeated measures using age and body mass index (BMI) as covariates and including interactions of treatment with age and time-on-study. RESULTS: DHT treatment increased serum DHT with complete suppression of serum T, luteinizing hormone, follicle stimulating hormone, and estradiol throughout the 24-month study resulting in reduced spinal bone density. There were no spontaneous complaints, or discontinuations for, adverse effects on sexual function during the study. DHT administration had no effects on any of 33 measures of sexual function and mood, apart from a mild, but significant decrease in overall sexual desire, which was reversible after cessation of treatment. Increasing age and less often increasing BMI were associated with significant decreases in most aspects of sexual function. CONCLUSIONS: We conclude that aromatization plays only a minimal role in maintenance of sexual function in healthy eugonadal middle-aged or older men, but age and obesity are significantly associated with decreases in most aspects of self-reported sexual function and satisfaction. The dependence of male sexual function on aromatization may be conditional on age and obesity and can be overcome by a nonaromatizable androgen.
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In healthy middle-aged men, male sexual function was fully maintained during 2 years of treatment with an exogenous androgen (DHT) despite sustained, complete suppression of endogenous testosterone.
“Similar effects were also observed in healthy, middle-aged men in whom male sexual function was fully maintained (compared with placebo) during 2 years of treatment with an exogenous androgen (DHT) despite that treatment causing sustained, complete suppression of endogenous testosterone (68).”
From Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) · cites this paper as [68]
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Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance
Handelsman, D. J., Hirschberg, A. L., & Bermon, S. (2018) · Endocrine Reviews · doi:10.1210/er.2018-00020 · Cited by 594 · see citing works
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- Authors
- Sartorius, G. A., Ly, L. P., & Handelsman, D. J.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Handelsman, David J.
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-01
- Volume
- 11
- Issue
- 10
- Pages
- 2562-2570
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W2123655543
- Cited by
- 44
- References
- 56
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 7 · 2016: 5 · 2015: 4 · 2014: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Keywords
- dihydrotestosterone, male sexual function, aromatization, older men, sexual desire, mood, age effects, obesity, bone mineral density, gonadotropin suppression
- MeSH terms
- Administration, Cutaneous, Aged, Androgens, Double-Blind Method, Estradiol, Humans, Luteinizing Hormone, Male, Middle Aged, Obesity, Dihydrotestosterone, Testosterone, Body Mass Index, Sexuality
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