Journal of Clinical Endocrinology & Metabolism, Vol 70, 792-797, Copyright © 1990 by Endocrine Society

ARTICLES

Testosterone replacement therapy and sleep-related erections in hypogonadal men

GR Cunningham, M Hirshkowitz, SG Korenman and I Karacan
Medical Services, Veterans Affairs Medical Center, Houston, Texas.

Hypogonadal men usually have diminished libido and erectile dysfunction, and testosterone replacement therapy in these men increases sexual activity, erotic thoughts, and self-reported nocturnal erections. The polygraphic assessment of nocturnal penile tumescence (NPT) provides an objective index of erectile capability and is useful for differentiating psychogenic from organic erectile dysfunction. In this study we evaluated NPT in six hypogonadal adult men during and after termination of androgen therapy. Multinight sleep studies were conducted within 1 week and 7-8 weeks after each man received 20 mg testosterone cypionate, im. The mean serum testosterone level 4-7 days after testosterone injection was 35.9 +/- 3.4 (+/- SE) nmol/L, and it fell to 2.3 +/- 0.9 nmol/L after 7-8 weeks. Significant declines (P less than 0.05) in the number of NPT episodes (3.7 to 2.0), maximum penile circumference increase (24 to 13 mm), and total tumescence time (107 to 55 min) accompanied the fall in the serum testosterone level. No androgen-related changes in the amount or integrity of rapid eye movement sleep were found. Finally, the mean penile rigidity (buckling pressure) decreased from 770 +/- 98 to 590 +/- 81 g (P less than 0.05). Comparison of these results to those in normal men revealed that none of these men met all diagnostic criteria for organic impotence, even 7- 8 weeks after discontinuation of testosterone administration. While men with androgen deficiency may have normal NPT, sleep-related erections increase in response to testosterone administration.

This article has been cited by other articles:

				S. Bhasin, G. R. Cunningham, F. J. Hayes, A. M. Matsumoto, P. J. Snyder, R. S. Swerdloff, and V. M. Montori Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 1995 - 2010. [Abstract] [Full Text] [PDF]

				V. Rochira, A. Balestrieri, B. Madeo, A. R. M. Granata, and C. Carani Sildenafil Improves Sleep-Related Erections in Hypogonadal Men: Evidence From a Randomized, Placebo-Controlled, Crossover Study of a Synergic Role for Both Testosterone and Sildenafil on Penile Erections J Androl, March 1, 2006; 27(2): 165 - 175. [Abstract] [Full Text] [PDF]

				A. L. Burnett Neurophysiology of Erectile Function: Androgenic Effects J Androl, November 1, 2003; 24(6_suppl): S2 - S5. [Full Text] [PDF]

				A. Ojumu and A. S. Dobs Is Hypogonadism a Risk Factor for Sexual Dysfunction? J Androl, November 1, 2003; 24(6_suppl): S46 - S51. [Full Text] [PDF]

				C. A. Thompson, T. D. Shanafelt, and C. L. Loprinzi Andropause: Symptom Management for Prostate Cancer Patients Treated With Hormonal Ablation Oncologist, October 1, 2003; 8(5): 474 - 487. [Abstract] [Full Text] [PDF]

				R. A. Anderson, A. M. Wallace, N. Sattar, N. Kumar, and K. Sundaram Evidence for Tissue Selectivity of the Synthetic Androgen 7{alpha}-Methyl-19-Nortestosterone in Hypogonadal Men J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2784 - 2793. [Abstract] [Full Text] [PDF]

				A. M. Matsumoto Andropause: Clinical Implications of the Decline in Serum Testosterone Levels With Aging in Men J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2002; 57(2): M76 - 99. [Full Text]

				S. Bhasin, L. Woodhouse, R. Casaburi, A. B. Singh, D. Bhasin, N. Berman, X. Chen, K. E. Yarasheski, L. Magliano, C. Dzekov, et al. Testosterone dose-response relationships in healthy young men Am J Physiol Endocrinol Metab, December 1, 2001; 281(6): E1172 - E1181. [Abstract] [Full Text] [PDF]

				F. R. Kandeel, V. K. T. Koussa, and R. S. Swerdloff Male Sexual Function and Its Disorders: Physiology, Pathophysiology, Clinical Investigation, and Treatment Endocr. Rev., June 1, 2001; 22(3): 342 - 388. [Abstract] [Full Text] [PDF]

				C. Wang, R. S. Swerdloff, A. Iranmanesh, A. Dobs, P. J. Snyder, G. Cunningham, A. M. Matsumoto, T. Weber, and N. Berman the Testosterone Gel Study Group Transdermal Testosterone Gel Improves Sexual Function, Mood, Muscle Strength, and Body Composition Parameters in Hypogonadal Men J. Clin. Endocrinol. Metab., August 1, 2000; 85(8): 2839 - 2853. [Abstract] [Full Text]

				J. D. Veldhuis, A. Iranmanesh, M. Godschalk, and T. Mulligan Older Men Manifest Multifold Synchrony Disruption of Reproductive Neurohormone Outflow J. Clin. Endocrinol. Metab., April 1, 2000; 85(4): 1477 - 1486. [Abstract] [Full Text]

				R. A. Anderson, C. W. Martin, A. W. C. Kung, D. Everington, T. C. Pun, K. C. B. Tan, J. Bancroft, K. Sundaram, A. J. Moo-Young, and D. T. Baird 7{alpha}-Methyl-19-Nortestosterone Maintains Sexual Behavior and Mood in Hypogonadal Men J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3556 - 3562. [Abstract] [Full Text] [PDF]

				H. Sternbach Age-Associated Testosterone Decline in Men: Clinical Issues for Psychiatry Am J Psychiatry, October 1, 1998; 155(10): 1310 - 1318. [Abstract] [Full Text]

				A. Rosler and E. Witztum Treatment of Men with Paraphilia with a Long-Acting Analogue of Gonadotropin-Releasing Hormone N. Engl. J. Med., February 12, 1998; 338(7): 416 - 422. [Abstract] [Full Text] [PDF]