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Hormones, neurotransmitters and male sexual response.
Male sexuality depends, from the biological point of view, on the proper functioning of different organs, systems, devices and molecules. Hormones and neurotransmitters are precisely two distinct classes of molecules that have a key role in the male sexual response, both in relation to sexual desire, arousal and erection.
Hormones are generally secreted from the endocrine glands and released into the bloodstream, while neurotransmitters are generated in neurons and act within the synaptic cleft (which communicates some neurons with others). However, some molecules often act as a neurotransmitter or as a hormone. Any interference with cell-to-cell endocrine communication due to excessive (hyper) or low (hypo) flow results in pathological conditions including sexual dysfunctions.
Given the importance of this topic, both for the diagnosis and for the treatment of alterations of the male sexual response, we believe it is pertinent to present an article published in the Journal of Sexual Medicine in 2016, entitled Endocrinological control of sexual desire and arousal / erection of men. It presents a summary of the main endocrine control of men's sexual desire, arousal and erection, as discussed by the authors in their presentation at the Fourth International Consultation on Sexual Medicine (Madrid, Spain, June 2015).
This study aims to provide recommendations focused on the pathophysiology of male sexual dysfunctions, specifically on endocrine aspects.
These are precisely the main recommendations mentioned in the article:
Related to male sexual desire
-Testosterone contributes significantly to the regulation of male sexual desire, and testosterone treatment can improve libido in men with hypogonadism.
-The evaluation of testosterone is highly recommended in all men who complain of decreased sexual desire.
-Dihydrotestosterone and estrogens play a minor role in the regulation of male sexual desire. Therefore, evaluations of dihydrotestosterone and estradiol are not recommended in men who complain of decreased sexual desire.
-The adrenal hormones are not involved in the regulation of male sexual desire.
-Prolactin plays an important role in the regulation of male sexual desire, acting through direct and indirect pathways. Then, prolactin levels should be evaluated in all men who complain about a decrease in sexual desire. In addition, there is evidence that the treatment of hyperprolactinemia restores sexual desire.
-The contribution of thyroid hormones in the regulation of male sexual desire is contradictory, therefore the evaluation of these hormones is not recommended in men who complain of decreased sexual desire.
Related to male erectile function
-The decrease in circulating testosterone levels is associated with a decrease in erectile function. Testosterone treatment in hypogonadal men is associated with significant improvements in self-reported measurements of erectile function. Consequently, basal and longitudinal testosterone assessments are recommended in men with erectile dysfunction.
-Dihydrotestosterone exerts qualitatively similar effects to testosterone on erectile function, although it has been studied less deeply. Therefore, treatment with dihydrotestosterone and its analogues cannot be recommended as an alternative to testosterone treatment to improve erectile function in hypogonadal men.
-Estrogen measurement is not indicated in the evaluation of erectile function.
-Glucocorticoid and mineralocorticoid in adrenal insufficiency could play a role in the restoration of erectile function.
-Prolactin does not play a direct role in the regulation of male erectile function. However, the treatment of hyperprolactinemia could have indirect positive effects on arousal and erection.
-Conclusive data on the possible therapeutic role of oxytocin in male sexual dysfunctions is lacking.
-Animal models indicate that the melanocortin system is involved in the regulation of erectile function acting centrally.
-Hyperthyroidism is significantly associated with an increased risk of erectile dysfunction. Therefore, sexual function should be evaluated in all men with hyperthyroidism, and the treatment of hyperthyroidism improves erectile dysfunction.
-The association between hypothyroidism and deterioration of erectile function is contradictory.
In conclusion, several hormones regulate or even stimulate male sexual behavior, including desire and arousal. Although epidemiological and intervention studies corroborate the crucial role of testosterone as an inducer of sexual desire and erection, the results of other hormones are less clear and obvious. As we saw in the recommendations, in addition to hypogonadism other endocrine disorders are associated with sexual dysfunctions. However, apart from hyperprolactinemia, its research is not recommended in men seeking medical attention for sexual dysfunction due to the current lack of evidence.
It remains to study more deeply the relationship between hormones, neurotransmitters and male ejaculation, including their dysfunctions.
Drafted for Boston Medical Group by Ezequiel LГіpez Peralta.
Psychologist. Master in Clinical Sexology and Couples Therapy.

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