Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone

The role of androgenic hormones in human sexuality, in the mechanism of ere ction and in the pathogenesis of impotence is under debate. While the use o f testosterone is common ill the clinical therapy of male erectile dysfunct ion, hypogonadism is a rare cause of impotence. We evaluated serum testoste rone levels in men with erectile dysfunction resulting either from organic or non-organic causes before and after nonhormonal impotence therapy. Eight y-three consecutive cases of impotence (70% organic, 30% non-organic, vascu lar aetiology being the most frequent) were subjected to hormonal screening before and after various psychological, medical (prostaglandin El, yokimbi ne) or mechanical therapies (vascular surgery, penile prostheses, vacuum de vices). Thirty age-matched healthy men served as a control group. Compared to controls, patients with impotence resulting from both organic and non-or ganic causes showed reduced serum levels of both total testosterone (11.1 /- 2.4 vs. 17.7 +/- 5.5 nmol/ L) and free testosterone (56.2 +/- 22.9 vs. 7 9.4 +/- 27.0 pmol/L) (both p < 0.001). irrespective of the different aetiol ogies and of the various impotence therapies, a dramatic increase in serum total and free testosterone levels (15.6 +/- 4.2 nmol/L and 73.8 +/- 22.5 p mol/L, respectively) was observed in patients who achieved normal sexual ac tivity 3 months after commencing therapy (p < 0.001). On the contrary, seru m testosterone levels did not change in patients in whom therapies were ine ffective. Since the pre-therapy low testosterone levels were independent of the aetiology of impotence, we hypothesize that this hormonal pattern is r elated to the loss of sexual activity, as demonstrated by its normalization with the resumption of coital activity after different therapies. The coro llary is that sexual activity may feed itself throughout the increase in te stosterone levels.