Sexual Behavior in the Human Male

Demographic data clearly demonstrate that the percentage of the population in the older age group is increasing. Androgen deficiency in the aging male has become a topic of increasing interest and debate throughout the world. Cross-sectional and longitudinal data indicate that the testosterone falls progressively with age and that a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young adult (age 20–30 years) men (1–4). The principal questions raised by these observations are whether older hypogonadal men will benefit from testosterone treatment and what will be the risks associated with such intervention.

The past decade has brought evidence of benefit of androgen treatment of hypogonadal men on multiple target organs and the recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men. This has been comprehensively reviewed and summarized by the Institute of Medicine in ‘Testosterone and Aging: Clinical Research Directions’ (5). Long-term data on the effects of testosterone treatment in the older population are limited mainly to effects on body composition and bone mass (6–11). Key questions of the effects of testosterone on patient reported outcomes and functional benefits that may retard physical or mental frailty of the elderly or improve the quality of life are not yet available. Specific risk data on the prostate and cardiovascular systems are needed.

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Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations

It is now well established that testosterone levels decline with age. What has not been established is whether the decline in testosterone is associated with a symptom complex. This study examined whether certain symptoms are more commonly present in males with low bioavailable testosterone (BT) levels. These were used to evaluate a questionnaire for androgen deficiency in aging males (ADAM). The validity of the ADAM questionnaire to screen for low BT was tested in 316 Canadian physicians aged 40 to 62 years. Low BT levels were present in 25% of this population. None had elevated luteinizing hormone (LH) levels. The ADAM questionnaire had 88% sensitivity and 60% specificity. When the questionnaire was administered twice 2 to 4 weeks apart to 10 men, it was determined that the coefficient of variation was 11.5%. In a second study of 34 ADAM-positive patients, 37% of those with clearly normal BT levels demonstrated some evidence of dysphoria. Finally, in 21 patients who were treated with testosterone, improvement on the ADAM questionnaire was demonstrated in 18 (P = .002). These data support the concept of a symptom complex associated with low BT levels in aging males. In addition, the ADAM questionnaire appears to be a reasonable screening questionnaire to detect androgen deficiency in males over 40 years of age.

Validation of a screening questionnaire for androgen deficiency in aging males

Investigation, Treatment and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, and EAU Recommendations

https://www.sjsu.edu/people/jennifer.gregg/courses/c4/s1/sex.pdf

Psychological and interpersonal dimensions of sexual function and dysfunction.

Using a balanced experimental design, 30 regularly cycling woman not using oral contraceptives, aged 20 to 30 years, were assessed in a laboratory setting during the follicular, ovulatory, and luteal phases. Sexual arousal was measured by self-report and by photoplethysmographic recordings of vaginal vasocongestion. Plasma estradiol, progesterone, and testosterone were determined by radioimmunoassay. There were marked and consistent individual differences among the women in their sexual arousability. Subjective reports of sexual arousal did not differ among menstrual cycle phases, by physiologic arousal did vary with significantly higher mean levels of arousal occurring during the follicular and luteal phases than during the ovulation phase. While hormones fluctuated predictably with menstrual cycle phase, there were wide individual differences in absolute values among women. The correlations between estradiol, progesterone and testosterone and the subjective and objective assessments of arousability were mainly low and insignificant. Some evidence suggestive of a relation between testosterone and sexual arousability was observed with three subgroups of woman were formed on the basis of relative average testosterone concentrations.

Sexual arousability and the menstrual cycle.

Lack of interest in sexual activity is one of the most prevalent psychosexual problems seen by clinicians. No consensus exists on etiology, symptomatology, appropriate therapeutic intervention, or prognosis. Desire disorders are believed to be highly refractory to treatment because of severe intrapsychic conflict, but no systematic data have been gathered about the histories of psychopathology in these individuals. Forty-six married subjects with a primary DSM-III diagnosis of global inhibited sexual desire (ISD) were compared with 36 matched controls on lifetime psychopathology, current psychological profiles, and premenstrual syndrome. A clinical interview, the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and the SCL-90-R were administered to all subjects. Only ISD subjects free from any other axis I disorder, medical illness, medication use, or substance abuse were selected; controls met similar criteria but had no sexual dysfunction. Despite the fact that all ISD subjects had nearly normal psychological profiles at the time of assessment, more ISDs than controls had significantly elevated lifetime prevalence rates of affective disorder. The proportion of ISD individuals with histories of major and/ or intermittent depression alone was almost twice as high as controls. Additionally, the initial episode of the depressive disorder almost always coincided with or preceded ISD onset. Significantly more ISD women than controls also had severe symptoms of premenstrual syndrome. The remarkable lifetime rate of affective illness in ISD patients suggests that there may be a common biological etiology or that affective psychopathology may be contributing to the pathogenesis of the ISD dysfunction.

Lifetime psychopathology in individuals with low sexual desire.

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

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

Low sexual desire in women: the role of reproductive hormones.

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.

Patricia Schreiner-Engel

Papers

Sexual arousability and the menstrual cycle.

Lifetime psychopathology in individuals with low sexual desire.

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

Low sexual desire in women: the role of reproductive hormones.

Hormones and nocturnal penile tumescence in healthy aging men