Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy.
Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Best Pract Res Clin Endocrinol Metab. 2022 Jul;36(4):101615. doi: 10.1016/j.beem.2022.101615. Epub 2022 Jan 20.
Sexual symptoms are the most specific determinants of low testosterone (T) observed during adulthood. In this narrative review, we summarize the most important evidence supporting the positive relationships between endogenous T levels and sexual activity in the adult male, by using preclinical and clinical observations. In addition, we also report an update of our previous meta-analysis evaluating the effects of T treatment (TRT) on sexual functioning in subjects with T deficiency. Available data indicate that TRT of symptomatic hypogonadal men can improve several aspects of sexual life, including erection. However, the effect is rather modest and lower in subjects with associated metabolic conditions. The specific observed effects are similar to those derived from lifestyle intervention. Since TRT might result in body composition improvement, it is reasonable to suppose that an initial treatment with T can improve the willingness of hypogonadal subjects to perform physical exercise and to adhere to a healthier behavior. Similar data were derived from animal models. However, it should be important to recognize that lifestyle modifications should be the first step to promote weigh reduction. TRT can be combined with lifestyle interventions only in symptomatic hypogonadal subjects especially in the presence of comorbid metabolic conditions.
性功能障碍是成年男性体内睾酮（T）水平降低的最特异决定因素。在本综述中，我们通过临床前和临床观察，总结了支持内源性 T 水平与成年男性性功能之间存在正相关关系的最重要证据。此外，我们还更新了之前关于评估 T 缺乏患者 T 治疗（TRT）对性功能影响的荟萃分析。现有数据表明，有症状的性腺功能减退男性的 TRT 可以改善性生活的几个方面，包括勃起。然而，这种作用在伴有代谢疾病的患者中较为温和，效果也较低。观察到的具体效果与生活方式干预得出的效果相似。由于 TRT 可能导致身体成分改善，因此可以合理地假设初始 T 治疗可以提高性腺功能减退患者进行体育锻炼和坚持更健康行为的意愿。类似的数据也来自于动物模型。然而，重要的是要认识到，生活方式的改变应该是促进减肥的第一步。TRT 只能与生活方式干预相结合，适用于有症状的性腺功能减退患者，尤其是在存在合并代谢疾病的情况下。
