ROLE OF HORMONES IN SEXUAL DYSFUNCTION, H OMOSEXUALITY, TRANSSEXUALISM, AND PARAPHILIA-RELATED DISORDERS - DIAGNOSTIC AND THERAPEUTIC CONSEQUENCES

Hormones only play a minor role in sexual dysfunctions. They are clear ly involved only in erectile dysfunction. Total testosterone is low in 8 % of those patients, but only 32 % of them are improved with androg en therapy. Free testes terone is also electively decreased in 30 % an d bioavailable (non SHBG bound) testosterone in 15 %. However androgen -therapy is still less effective in these subgroups. Plain hyperprolac tinemia is found in only 0,7 % of the cases, Half of them result from a pituitary adenoma, The other endocrine dysfunctions are still scarce r, This data cannot justify a systematic determination of serum prolac tin and testosterone in sexual dysfunctions. A cost effective hormonal screening is proposed, whereas the role of androgen-therapy in erecti le dysfunction with or without hypogonadism is discussed. The hypothes is of an '' inverted brain sexual differentiation '' in homosexuality and for transsexualism, resulting from an abnormal antenatal endocrine milieu is reviewed, It cannot obviously explain by itself these condi tions, but some amazing morphological findings in transsexual people d o not permit to totally refute it, Lastly the role of androgens in par aphilia and parapaphilia related disorders seems limited to the arousa l of an abnormal sexual behaviour previously scheduled by non hormonal mechanisms. However anti-androgens are in such cases one of the main effective treatment.