Rodríguez-Izquierdo Marta, Martínez-Salamanca Juan I, Moncada Ignacio, Linares Espinós Estefanía, del Portillo Luis, Areche Jennifer, Carballido Joaquín
Servicio y Catedra de Urologia. Area de Medicina Sexual. Hospital Universitario Puerta de Hierro-Majadahonda Hospital de la Zarzuela. Madrid. Spain.
Arch Esp Urol. 2013 Sep;66(7):723-8.
Androgens play an essential role in the corporo-venous occlusive mechanism that provokes erection. Accordingly to various studies based on animal models,testosterone deficit syndrome causes an endothelial disorder in the corpora cavernosa with diminished secretion of NO, alteration of penile smooth muscle and tunica albuginea structure, and increase of the number of adipocytes within the erectile tissue, which favors fibrosis and impairs erection. All these alterations are reversible with the exogenous administration of androgens. There are not enough studies to get definitive conclusions about androgen supply improving erectile dysfunction in patients with hypogonadism. Studies have been published in which seems that exogenous testosterone could be useful in the treatment of this type of patients. Nevertheless,in most published randomized double blind studies comparing with placebo, testosterone supply does not provide greater benefit on erectile dysfunction than PDE-5 Inhibitors exclusively. All studies coincide in the need to optimize the treatment with PDE-5 Inhibitors since they do have proven to be effective for the treatment of erectile dysfunction in patients with testosterone deficit syndrome.
雄激素在引发勃起的海绵体静脉闭塞机制中起着至关重要的作用。根据基于动物模型的各种研究，睾酮缺乏综合征会导致海绵体内皮功能障碍，一氧化氮分泌减少，阴茎平滑肌和白膜结构改变，勃起组织内脂肪细胞数量增加，这有利于纤维化并损害勃起功能。所有这些改变通过外源性给予雄激素是可逆的。目前尚无足够的研究得出关于雄激素补充改善性腺功能减退患者勃起功能障碍的确切结论。已有研究发表，似乎外源性睾酮可能对这类患者的治疗有用。然而，在大多数已发表的与安慰剂比较的随机双盲研究中，单独给予睾酮对勃起功能障碍的改善并不比磷酸二酯酶-5抑制剂更有优势。所有研究都一致认为需要优化磷酸二酯酶-5抑制剂的治疗，因为它们已被证明对治疗睾酮缺乏综合征患者的勃起功能障碍有效。
