Aversa Antonio, Isidori Andrea M, Greco Emanuela A, Giannetta Elisa, Gianfrilli Daniele, Spera Enrico, Fabbri Andrea
Cattedra di Medicina Interna, Department of Medical Pathophysiology, University La Sapienza, Viale Policlinico 155, 0061 Rome, Italy.
Eur Urol. 2004 May;45(5):535-8. doi: 10.1016/j.eururo.2004.01.005.
The role of testosterone on sexual desire is well established. However, the effects of low testosterone levels in the pathophysiology of erectile mechanism in humans remains unclear. Recent evidence indicate that approximately 10-20% of men with erectile dysfunction (ED) have hormonal abnormalities, raising up to 35% over the age of sixty. It is now clear that sexual desire and erectile function in humans are both responsive to androgens, probably at different threshold values. In fact, different degrees of testosterone deficiency may determine a sequence of molecular penile events leading to reduced capacity of penile smooth muscle and endothelial cells of relaxation, without greatly affecting sexual desire. Also, androgens may directly control the expression and activity of phosphodiesterase type-5 in human corpus cavernosum. In some selected men with total testosterone below 10-13nmol/l and/or free testosterone below 200-250pmol/l, androgen supplementation may improve therapeutic efficacy of phosphodiesterase type-5 inhibitors. For ageing men with partial androgen deficiency (PADAM) who fail first-line oral treatments in whom androgens are not contraindicated, a combination of testosterone and phosphodiesterase type-5 inhibitors may be considered to improve erectile function and improve the quality of life.
睾酮对性欲的作用已得到充分证实。然而，低睾酮水平在人类勃起机制病理生理学中的影响仍不清楚。最近的证据表明，大约10% - 20%的勃起功能障碍（ED）男性存在激素异常，60岁以上的男性这一比例高达35%。现在很清楚，人类的性欲和勃起功能对雄激素都有反应，可能阈值不同。事实上，不同程度的睾酮缺乏可能决定一系列阴茎分子事件，导致阴茎平滑肌和内皮细胞舒张能力下降，而对性欲影响不大。此外，雄激素可能直接控制人类海绵体中5型磷酸二酯酶的表达和活性。在一些总睾酮低于10 - 13nmol/l和/或游离睾酮低于200 - 250pmol/l的特定男性中，补充雄激素可能会提高5型磷酸二酯酶抑制剂的治疗效果。对于雄激素部分缺乏（PADAM）且一线口服治疗失败且雄激素无禁忌证的老年男性，可考虑联合使用睾酮和5型磷酸二酯酶抑制剂来改善勃起功能并提高生活质量。
