Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Department of NEUROFARBA, University of Florence, Florence, Italy.
Andrology. 2020 Nov;8(6):1580-1589. doi: 10.1111/andr.12794. Epub 2020 May 8.
Testosterone (T) plays a pivotal role in coordinating a series of psychological, cognitive and physical events that might (or might not) culminate in male sexual activity. In fact, T deficiency is associated, in a statistically significant way, with several sexual dysfunctions including erectile dysfunction (ED), reduction of spontaneous erection and hypoactive sexual desire (HSD). Although these associations are statistically significant, there is debate if they are also clinically meaningful. In addition, sexual dysfunctions are present also in several metabolic conditions - such as type 2 diabetes mellitus and obesity - that often associate with low T. In particular, this is the case of ED, but not of HSD, that, therefore, should be considered a more genuine correlate of T deficiency in adulthood and aging (late-onset hypogonadism, LOH).
The aim of this review is to scrutinize evidence from our and other studies on sexual effects of T replacement therapy (TRT) in LOH.
We will use preclinical and clinical data coming from our and other laboratories and meta-analyses.
Intervention studies in clinical trials involving subjects with LOH, and their meta-analyses, indicate that TRT is able to ameliorate HSD, spontaneous erection and ED. However, the relative improvement of ED by TRT is marginal [2-3 points of International Index of Erectile Function-erectile function domain (IIEF-EFD)] and significantly smoothed in subjects with the aforementioned metabolic conditions. In LOH, positive effects of TRT on other domains of sexual activity, such as orgasm and sexual satisfaction, are also apparent in the different meta-analyses.
Hence, TRT is a reasonable treatment for restoring sexual drive in LOH, with some additional positive effects also on erection (spontaneous and sexual-related) and on orgasm. In contrast, preclinical and clinical studies indicate that T administration to eugonadal subjects does not improve male sexual activity.
睾丸激素（T）在协调一系列心理、认知和身体事件中起着关键作用，这些事件可能（或可能不会）最终导致男性性行为。事实上，T 缺乏与几种性功能障碍相关，包括勃起功能障碍（ED）、自发性勃起减少和性欲低下（HSD）。尽管这些关联具有统计学意义，但它们是否具有临床意义仍存在争议。此外，性功能障碍也存在于几种代谢疾病中，如 2 型糖尿病和肥胖症，这些疾病通常与低 T 有关。特别是 ED，但不是 HSD，因此，应将其视为成年和衰老（迟发性性腺功能减退症，LOH）中 T 缺乏的更真实相关因素。
本综述旨在仔细审查我们和其他研究中关于 LOH 中 T 替代治疗（TRT）对性功能影响的证据。
我们将使用来自我们和其他实验室的临床前和临床数据以及荟萃分析。
涉及 LOH 患者的临床试验中的干预研究及其荟萃分析表明，TRT 能够改善 HSD、自发性勃起和 ED。然而，TRT 对 ED 的相对改善程度较小[国际勃起功能指数-勃起功能域（IIEF-EFD）的 2-3 分]，并且在上述代谢条件的患者中明显平滑。在 LOH 中，TRT 对性活动的其他领域（如性高潮和性满意度）的积极影响也在不同的荟萃分析中明显。
因此，TRT 是恢复 LOH 性欲的合理治疗方法，对勃起（自发性和与性相关）和性高潮也有一些额外的积极影响。相比之下，临床前和临床研究表明，向生育能力正常的受试者给予 T 并不能改善男性的性活动。
