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Recent insights into androgen action on the anatomical and physiological substrate of penile erection 被引量:6

Recent insights into androgen action on the anatomical and physiological substrate of penile erection
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摘要 Erectile response is centrally and peripherally regulated by androgens. The original insights into the mechanisms of action of androgens were that androgens particularly exert effects on libido and that erections in response to erotic stimuli were relatively androgen-independent. It was shown that sexual functions in men required androgen levels at the low end of reference values of testosterone. So it seemed that testosterone was not useful treatment for men with erectile difficulties, particularly following the advent of the phosphodiesterase type 5 (PDE5) inhibitors. However, approximately 50% of those treated with PDE5 inhibitors discontinue their treatment. A number of recent developments shed new light on testosterone treatment of erectile dysfunction (ED) in aging men. (1) A recent insight is that, in contrast to younger men, elderly men might require higher levels of testosterone for normal sexual functioning. (2) Several studies have indicated that PDE5 inhibitors are not always sufficient to restore erectile potency in men, and that testosterone improves the therapeutical response to PDE5 inhibitors considerably. (3) There is growing insight that testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, reversible upon androgen replacement. The synthesis of PDE5 is upregulated by androgens, and the arterial inflow into the penis is improved by giving androgen. The above invites a re-examination of the merits of giving testosterone to aging men with ED. The beneficial effects of PDE5 inhibitors may only be optimally expressed in a eugonadal environment. (Asian J Androl 2006 Jan; 8: 3-9) Erectile response is centrally and peripherally regulated by androgens. The original insights into the mechanisms of action of androgens were that androgens particularly exert effects on libido and that erections in response to erotic stimuli were relatively androgen-independent. It was shown that sexual functions in men required androgen levels at the low end of reference values of testosterone. So it seemed that testosterone was not useful treatment for men with erectile difficulties, particularly following the advent of the phosphodiesterase type 5 (PDE5) inhibitors. However, approximately 50% of those treated with PDE5 inhibitors discontinue their treatment. A number of recent developments shed new light on testosterone treatment of erectile dysfunction (ED) in aging men. (1) A recent insight is that, in contrast to younger men, elderly men might require higher levels of testosterone for normal sexual functioning. (2) Several studies have indicated that PDE5 inhibitors are not always sufficient to restore erectile potency in men, and that testosterone improves the therapeutical response to PDE5 inhibitors considerably. (3) There is growing insight that testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, reversible upon androgen replacement. The synthesis of PDE5 is upregulated by androgens, and the arterial inflow into the penis is improved by giving androgen. The above invites a re-examination of the merits of giving testosterone to aging men with ED. The beneficial effects of PDE5 inhibitors may only be optimally expressed in a eugonadal environment. (Asian J Androl 2006 Jan; 8: 3-9)
出处 《Asian Journal of Andrology》 SCIE CAS CSCD 2006年第1期3-9,共7页 亚洲男性学杂志(英文版)
关键词 TESTOSTERONE ERECTION corpus cavernosum phosphodiesterase type 5 inhibitors testosterone erection corpus cavernosum phosphodiesterase type 5 inhibitors
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参考文献6

  • 1Alvaro Morales MD.Testosterone treatment for the aging man: The controversy[J].Current Urology Reports.2004(6)
  • 2Ronald W. Lewis,Thomas M. Mills.Effect of androgens on penile tissue[J].Endocrine (-).2004(2-3)
  • 3Dirk Schultheiss,Rafael Badalyan,Adrian Pilatz,Alexander I. Gabouev,Norbert Schlote,J?rg Wefer,Reinhard Wasielewski,Heike Mertsching,Michael Sohn,Christian G. Stief,Udo Jonas.Androgen and estrogen receptors in the human corpus cavernosum penis: immunohistochemical and cell culture results[J].World Journal of Urology.2003(5)
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