Raul C. Schiavi

Effect of Testosterone Administration on Sexual Behavior and Mood in Men with Erectile Dysfunction

This double-blind placebo controlled, cross-over study was carried out to assess the effect of testosterone administration on sexual behavior mood, and psychological symptoms in healthy men with erectile dysfunction. Biweekly injections of 200 mg of testosterone enanthate were given over a period of 6 weeks separated by a washout period of 4 weeks. Blood samples for hormonal assessment, behavioral and psychological ratings were obtained prior to each injection. Luteinizing hormone remained significantly depressed but circulating testosterone had returned to baseline levels by 2 weeks following each hormonal injection. The ejaculatory frequency during the testosterone phase was statistically higher than during the placebo phase. There were marked, although statistically nonsignificant, increases in median frequency of reported sexual desire, masturbation, sexual experiences with partner, and sleep erections during the testosterone period. Testosterone did not have demonstrable effects on ratings of penile rigidity and sexual satisfaction. Mood variables and psychological symptoms did not change following hormonal administration. Results suggest that androgen administration to eugonadal men with erectile dysfunction may activate their sexual behavior without enhancing erectile capacity and without effects on mood and psychological symptoms.

The relationship between pituitary-gonadal function and sexual behavior in healthy aging men.

&NA; Few studies have assessed the role of pituitary and gonadal hormones on age‐related changes in sexual behavior in healthy men. We conducted a retrospective and prospective evaluation of sexual function and behavior in 77 healthy married men aged 45 to 74 years. The subjects were studied in the sleep laboratory for four nights with the last night devoted to sequential blood sampling every 20 minutes. Significant age‐related decreases in sexual desire, sexual arousal and activity, and increases in erectile problems were noted. Aging was negatively correlated with bioavailable testosterone (bT), was positively correlated with luteinizing hormone (LH), and was not related to total testosterone, estradiol, and prolactin. Bioavailable testosterone, and the ratio of bT over LH showed a close association with several sexual behavior dimensions while total testosterone, estradiol, and prolactin demonstrated few or no behavioral relationships. The age‐related effect of bT was, however, a more important determinant of the reported behavioral differences than were the effect of bT independent of age. There was no evidence that changes in circulating hormones contribute to erectile disorders in healthy aging men.

Pituitary-gonadal function during sleep in healthy aging men

There is limited information on the relation between age-related changes in pituitary-gonadal function and sleep physiology in older men. In this cross-sectional study of 67 healthy volunteers free from sleep complaints, aged 45-75 yr, we (1) assessed peak fluctuations and hourly variations in plasma testosterone, LH and prolactin sampled every 20 min during sleep, and (2) explored the relation between sleep parameters, respiratory and periodic leg movement disturbances, and circulating concentrations of the aforementioned hormones. We hypothesized that alterations in sleep architecture or presence of sleep disorders may contribute to hormonal variations in aging subjects. Bioavailable testosterone decreased and LH increased with age, but there were no differences in total testosterone and prolactin and no major changes in peak hormonal release. There were positive associations, independent from the age effect, between sleep efficiency, decreased latency to onset of REM activity, and number of REM episodes, and circulating testosterone. Sleep-disordered breathing significantly increased with age. The degree of respiratory disturbance was associated with decreased overnight plasma bioavailable testosterone, but this relationship lost its significance after age-adjustment. The findings demonstrate a decrease in gonadal function during sleep in healthy aging men and suggest that changes in sleep efficiency and architecture are associated with alterations in gonadal activity in these older individuals.

Low sexual desire in women: The role of reproductive hormones

The role of reproductive hormones in mediating sexual desire in healthy women is still unclear. Elucidation was sought in this study by comparing the hormonal milieu of two groups of subjects with markedly different levels of sexual desire. Seventeen women ages 27-39 who met DSM III-R criteria for severe, persistent, and generalized loss of desire (hypoactive sexual desire disorder, HSD), but had no other current psychological or medical problem, were compared to 13 healthy, sexually active women. All subjects and spouses were interviewed extensively to determine the womens sexual desire and responsiveness. Blood samples were drawn every 3 to 4 days for one menstrual cycle and were analyzed by RIA for testosterone, SHBG, estradiol, progesterone, prolactin, and luteinizing hormone. Results indicated that the HSD womens gonadal hormones fluctuated normally over the menstrual cycle, were within normal limits for each cycle phase, and were never significantly different from those of controls. Neither testosterone, non-SHBG bound testosterone, nor prolactin differentiated between the HSD women with the most and least severe HSD parameters (e.g., frequency of fantasy, masturbation, or female-initiated coitus), nor between women with lifelong and acquired HSD. The present findings did not provide evidence that reproductive hormones are important determinants of individual differences in the sexual desire of these eugonadal women.

Hormones and nocturnal penile tumescence in healthy aging men

There is no information on the relationship between endogenous pituitary and gonadal hormones and nocturnal penile tumescence (NPT) in healthy aging men. Sixty-seven married volunteers ages 45–74 years were studied in the sleep laboratory for 4 nights with the last night devoted to sequential blood sampling every 20 min. Bioavailable testosterone (bT) correlated significantly with several NPT measures while total testosterone, estradiol, LH, and prolactin were mostly unrelated to NPT. All bT—NPT correlations lost their significance after adjustment by multiple regression for the effect of age on both bT and NPT variables in the total subject sample. Analysis of bT—NPT relations by age groups revealed a significant association between bT and duration NPT in men ages 55 to 64 years, but no statistical relations in younger and older age groups. Changes in the central threshold of activation of NPT as age progresses may explain the age-dependent effect of bT in sleep erections.

Diabetes mellitus and male sexual function: a controlled study.

SummaryThere is an extensive clinical literature on the erectile disorders of diabetic men but a paucity of controlled studies that have taken into account the effects of age, concurrent illnesses and medication on sexual function. This investigation was carried out on 40 diabetic men free from other illness or drugs that could affect sexual capacity and 40 age-matched healthy control subjects. Each subject and his female partner underwent semistructured interviews and the men had comprehensive medical evaluations and polygraphic assessment of sleep and nocturnal penile tumescence in the sleep laboratory during three nights. In comparison to control subjects, diabetic patients reported significant decreases in sexual desire, subjective arousal, erectile capacity, coital frequency and sexual satisfaction. The diabetic group also had significant decrements in duration of rapid eye movement sleep and in frequency, duration and degree of nocturnal penile tumescent episodes. There were no differences between Type 1 (insulin-dependent) and Type 2 (non-insulin dependent) diabetic patients in prevalence of sexual problems or in nocturnal tumescent measures. Significant relations were observed between lack of metabolic control, diabetic complications and impaired nocturnal tumescence. Sexually non-dysfunctional diabetic men had significant nocturnal penile tumescence abnormalities. Diabetic men without coital failures may have a subclinical impairment in erectile function which, although of not significant magnitude to interfere with penetration, is reflected in nocturnal penile tumescent measures. This result raises a note of caution in the interpretation of the nocturnal penile tumescence test for the differential diagnosis of diabetic erectile impotence.

Aging, sleep disorders, and male sexual function

The relation between age, sleep disorders, nocturnal penile tumescence, and sexual behavior was investigated in 70 healthy married men aged 45-75 years. They had an extensive psychosexual interview, a medical and psychiatric evaluation, and were studied in the sleep laboratory for four nights. Electroencephalogram (EEG), eye movements, muscle tone, and penile tumescence were monitored continuously, and respiratory airflow and bilateral anterior tibialis recordings were obtained during the first sleep session. There was a marked age-related increase in sleep-disordered breathing, but no significant changes in periodic leg movements with age. Respiratory distress and periodic leg movement (PLM) indices were mostly unrelated with nocturnal penile tumescence (NPT) measures as well as with all sexual behavior dimensions when age was taken into account in the analysis of results. Men with a respiratory distress disorder did not differ from a nondisordered group of similar age in NPT and behavioral parameters. Men with PLM disorder differed from their comparison group in only two variables: fewer number of maximum tumescent episodes and less frequent sexual thoughts. Men who met criteria for erectile impotence did not differ significantly in degree of respiratory or PLM disturbances or in the prevalence of sleep disorders when compared to an aged-matched sexually nondysfunctional group. The overall results did not support the notion that sleep disorders are involved in the increased prevalence of erectile impotence in healthy older individuals. Assessment of blood oxygenation and respiratory effort, in addition to airflow, need to be carried out before final conclusions can be drawn on the significance of sleep-disordered breathing in male sexuality.

PITUITARY GONADAL FUNCTION DURING SLEEP IN MEN WITH HYPOACTIVE SEXUAL DESIRE AND IN NORMAL CONTROLS

&NA; There is virtually no information on the psychobiology of hypoactive sexual desire (HSD) in men. This study compares pituitary and gonadal hormones and nocturnal penile tumescence (NPT) during sleep in 17 physically healthy men with HSD and 17 age‐matched, nondysfunctional volunteers. There were six HSD men with problems of sexual arousal and 11 with secondary erectile impotence. The subjects, aged 27–55, were studied in a sleep laboratory for 4 nights with the last night devoted to sequential blood sampling every 20 min. The total group of HSD men had significantly lower plasma testosterone, measured hourly through the night, than controls, and there was a positive relation between testosterone and frequency of sexual behavior. There were no differences in free testosterone, prolactin, luteinizing hormone (LH), and estradiol between the HSD and control groups. The NPT parameters of HSD men with secondary impotence were consistently and significantly lower than the nondysfunctional men. These data are discussed with respect to the role of gonadal hormones in male sexual function, the significance of NPT as a window to central biologic events, and to possible heterogeneity of men with hypoactive sexual desire.

Patterns of female sexual arousal during sleep and waking: Vaginal thermo-conductance studies

The main objective of this investigation was to ascertain whether there are, in the female, periods of sexual excitation or arousal during REM sleep similar to the cycle of penile erections in the male. In a group of 10 subjects, 21–35, utilizing a thermoconductance method that gives a measure of vaginal blood flow (VBF), we are able to confirm that females manifest cyclic episodes of vascular engorgement during REMPs equivalent to erections in men. They occur with equal frequency (95% of REMPs) but differ in distribution, in greater frequency during NREM sleep, in the shorter duration of individual VBF episodes, and in the less tight linkage of VBF episodes to the REMPs. The increases in VBF, in terms of rises of the recording pen on the graph paper, varied from 10 to 45 mm. In order to ascertain the significance of these increases, we compared these sleep responses with waking VBF responses evoked by nonerotic and erotic stimuli and by masturbation. Only erotic stimuli gave VBF responses, the greatest to the movie and masturbation; these were no greater than the maximum levels attained during sleep, namely 40 to 45 mm. Maximum vascular engorgement is finite in male and female and is limited by anatomy. The fact that VBF REM increases appear to be identical to VBF responses to passive waking erotic stimulation and show similar cardiorespiratory patterns suggests that they, too, are erotic in nature. Additionally, the preliminary results of the waking experiment demonstrate that a very high percentage of VBF REM increases are associated with dreams that contain overt or symbolic sexual content. The results indicate that REM periods with VBF increases have a far greater chance of being associated with sexual dreams than do REMPs or NREMPs with minimal VBF increases.

Psychometric characteristics of individuals with sexual dysfunction and their partners

This study assessed psychological dimensions and marital adjustment of 52 couples in which one of the partners met operational criteria for hypoactive sexual desire or erectile dysfunction. Information was obtained independently from the dysfunctional subjects and their partners by means of validated inventories: the Derogatis Sexual Function Inventory (DSFI), Locke-Wallace Marital Adjustment Test (L-W), and the Dyadic Adjustment Scale (DAS). The global measures of sexual function and satisfaction of the DSFI showed marked impairment in all groups, while its subscale scores suggested characteristic differences in the profiles of the dysfunctional groups and their partners. In contrast to individual psychologic measures, the assessment of marital adjustment was within the scales normative limits in all diagnostic groups. There is a need for controlled studies to better characterize sexual and marital dimensions in diagnostically well-defined dysfunctional couples.