The male endocrine system and the androgens in their bodies play an essential role in the male sexual response cycle. For men diagnosed with sexual dysfunction, testosterone replacement therapy (TRT) is the base on which erectile dysfunction can be managed.
Masters and Johnson developed a linear model and they based it on four stages. The first stage is excitement, derived from physical or mental stimulation of an erotic nature leading to sexual arousal. In the second stage, called The plateau phase it follows aforementioned stage and precedes sexual orgasm. The penis is erect and reaches the highest rigidity, Then the 3rd stage is the plateau phase and typically ends with orgasm, often characterized by ejaculation. Finally, the forth phase allows reaching the base line condition by which the penis returns to its natural flaccid state.
Evidence build from years of clinical studies have definitely shown that the male endocrine system plays a essential function in regulating every one of the phases involved in sexual activity. In the first phase, Adrenal pathway and human growth hormone are involved in the elements assisting the arousal phase, adding to the rise in heart and breathing rate and also to the increase in blood pressure, which are required for penis tumescence as well as pelvic vaso-congestion. In this process, thyroid hormones take part in the regulation of sexual desire and give rise to ejaculation control. Lastly, androgens, and testosterone particularly, take part in the regulation of all actions with the sexual response cycle. Consequently, Testosterone replacement therapy (TRT) connotes a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction (ED) or motivation disorders.
Factors in Sexual Dysfunction and a Warning
Some uncommon variables factor into male sexual health is that of E2 in the regulating male sexual behavior has also been confirmed. Particularly, an unforeseen improvement of sexual desire and frequency of sexual activity has been observed during transdermal E2 treatment. In certain instances of male subjects with natural aromatase deficiency or a deficiency deriving from exogenous aromatase inhibitors. Furthermore, a research study performed in healthy men with artificially induced hypogonadism documented that the simultaneous administration of anastrozole stopped the testosterone replacement therapy recovery of sexual desire.
Another study pointed out what experienced TRT practitioners already knew, that DHT blocking products (5-a reducatase inhibitors (5ARI)) such as Dutasteride, Finasteride, used for prostate cancer and baldness caused a reduction of sexual desire. One of the placebo-controlled trials documented that the usage of 5ARI triggered up to a 2 times elevated risk of reduced sexual desire when compared to a placebo. Not surprisingly, in some cases the decrease in sexual desire persisted even after 5ARI were withdrawn. Acidotically, there have been some cases of permanent erectile dysfunction, generally in cases where men took the 5ARI for over 200 days continuously and it was not dosage related.
Erectile Dysfunction and Testosterone Replacement Therapy
A large body of evidence documented that androgens modulate nearly every factor involved in regulating penile erection at a local level. Specifically, corpora cavernosa composition, function, and innervation, in addition to intercellular elements involved in the regulating erection and detumescence (subsidence of swelling ), are under men’s androgen control. Testosterone replacement therapy effects were lower in men that have a higher incidence of organic conditions, that underlines probable vascular deterioration such as obesity and type I or II diabetes, and higher in males with more significant hypogonadism. Additionally, patients with diabetes are more prone to depression, and with this additional complication, erectile dysfunction treatment can be more difficult to treat. As mentioned before, patients with diabetes are more prone to depression, and with this additional complication, erectile dysfunction treatment can be more difficult to treat. In addition, testosterone replacement therapy alone may be efficient at restoring only less severe forms of ED, whereas the blended therapy along with other drugs is required when more serious vascular damage exists.
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