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Androgens and male sexual dysfunction

Purpose of reviewIt is generally accepted that androgens are critical for mood, cognition, sex differentiation, development of male sexual characteristics and maintenance of bone density and muscle/fat ratio. Their role in sexual function and in particular in erectile physiology, however, remains controversial. A careful review of preclinical and clinical studies on the role of androgens and male sexual function was conducted. Recent findingsPreclinical studies suggest that androgens modulate penile trabecular smooth muscle, neural and extracellular matrix integrity and adipocyte accumulation and distribution. In addition, androgens upregulate neural and endothelial nitric oxide synthase and phosphodiesterase type 5. Clinical studies document a relationship between androgens and erectile function, nocturnal erections and sexual desire and activity. Androgen ablation results in decreased erectile function, sexual desire and activity in many men. Testosterone treatment may be able to restore male sexual function. In addition, testosterone replacement may be able to improve erectile function in men who have failed phosphodiesterase type 5 inhibitors. SummaryThe literature supports that androgens modulate male sexual function. The exact mechanisms by which androgens exert their activity is not completely understood, but it seems that androgens modulate penile tissue integrity as well as nitric oxide synthase and phosphodiesterase type 5 expression and activity.