PURPOSE: To characterize the population of hypogonadal men who presented to a tertiary academic urology clinic and evaluate risk factors for primary vs. secondary hypogonadism. MATERIALS AND METHODS: We evaluated all men with International Classification of Diseases-9 diagnosis codes R68.82 and 799.81 for low libido, 257.2 for testicular hypofunction, and E29.1 for other testicular hypofunction at a tertiary academic medical center from 2013 to 2017. We included men who had testosterone (T) and luteinizing hormone (LH) drawn on the same day. We classified men based on T and LH levels into eugonadal, primary, secondary, and compensated hypogonadism. Risk factors including age, body mass index (BMI) over 30 kg/m2, current smoking status, alcohol use greater than 5 days per week, and Charlson comorbidity index greater than or equal to 1 were investigated and measured in each group using the eugonadal group for reference. RESULTS: Among the 231 men who had both T and LH levels, 7.4%, 42.4%, and 7.4% were classified as primary, secondary, and compensated hypogonadism, respectively. Only elevated BMI was associated with secondary hypogonadism compared to eugonadal men (median BMI, 30.93 kg/m2 vs. 27.69 kg/m2, p=0.003). BMI, age, comorbidities, smoking, or alcohol use did not appear to predict diagnosis of secondary hypogonadism. CONCLUSIONS: Secondary hypogonadism appears to be the most common cause of hypogonadism among men complaining of low T and decreased libido at a tertiary academic medical center. Secondary hypogonadism is associated with elevated BMI and therefore obesity should be used as a marker to evaluate men for both T and LH levels.
Academic Medical Centers* ; Body Mass Index* ; Classification ; Clomiphene ; Comorbidity ; Diagnosis ; Humans ; Hypogonadism* ; Libido ; Luteinizing Hormone ; Male ; Obesity ; Risk Factors ; Smoke ; Smoking ; Tertiary Care Centers ; Testosterone ; Urology

Testosterone has a variety of functions and is commonly used in older men to treat symptoms of hypogonadism, such as decreased libido, decreased mood and erectile dysfunction. Despite its positive effects on sexual function, it has a negative effect on fertility. Exogenous testosterone therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone and luteinizing hormone. The purpose of this review is to discuss the contraceptive properties of testosterone therapy and to discuss strategies to increase testosterone in men with the desire to preserve fertility.
Contraception ; Erectile Dysfunction ; Family Planning Services ; Fertility* ; Follicle Stimulating Hormone ; Gonads ; Humans ; Hypogonadism ; Infertility ; Libido ; Luteinizing Hormone ; Male ; Testosterone*

Male sexual dysfunction refers to a phenomenon in which a man experiences difficulty at any stage during the process of sexual intercourse. In general, erectile dysfunction is regarded as the most representative form of sexual dysfunction, but various other diseases can also be categorized as male sexual dysfunction, including sexual arousal disorder, decreased libido, ejaculation disorder, and Peyronie's disease. Causes of sexual dysfunction include chronic diseases, such as diabetes, hypertension, dyslipidemia, and obesity. In addition, some medications, surgical procedures, and traumas can cause sexual dysfunction. However, aging is the most important cause of male sexual dysfunction. To diagnose and treat elderly patients who complain of male sexual dysfunction, it is first necessary to become familiar with the characteristics of sexual dysfunction in elderly men. The prevalence rates of metabolic syndrome, hypertension, diabetes, dyslipidemia, coronary artery disease, stroke, and depression are higher among elderly men than among younger men; furthermore, the elderly are at a higher risk for the development of kidney, hepatic, spinal cord, and neurological diseases. Notably, anti-hypertensive agents can affect erectile function in elderly men: sexual dysfunction may be severe or the response to treatment may be poor. For satisfactory treatment, spousal factors should also be considered.
Aged ; Aging ; Antihypertensive Agents ; Chronic Disease ; Coitus ; Coronary Artery Disease ; Depression ; Diagnosis ; Dyslipidemias ; Ejaculation ; Erectile Dysfunction ; Eunuchism ; Humans ; Hypertension ; Kidney ; Libido ; Male ; Obesity ; Penile Induration ; Prevalence ; Sexual Dysfunction, Physiological ; Sexual Dysfunctions, Psychological ; Spinal Cord ; Stroke ; Testosterone

Finasteride is primarily used to treat benign prostatic hyperplasia (BPH) and male androgenetic alopecia (MAA). Five-alpha reductase inhibitors (5α-RIs) could induce male sexual dysfunction due to their effects on testosterone and dihydrotestosterone. There is evidence suggesting that 5α-RIs may independently increase the risk of erectile dysfunction (ED). However, many investigators believe that side effects of 5α-RIs will disappear with continuous treatment. Considerable controversy exists regarding the severity and persistence of side effects of finasteride on ED. The aim of this review was to summarize current research studies on finasteride associated with ED. The search strategy used each term of finasteride and ED against PubMed database to identify related studies. ED data reported from available trials for finasteride were summarized and reviewed. Although there is not enough evidence to prove the relationship between finasteride and ED, most studies in this review found that finasteride for BPH was correlated with ED. However, most studies included in this review revealed that finasteride for MAA was not correlated with ED. On the other hand, some studies reported side effects of finasteride associated with sexual dysfunction, including ED, male infertility, ejaculation problem, and loss of libido, even in MAA patients. Well-designed randomized controlled trials are needed to further determine the mechanism and effects of finasteride on ED. However, physicians should discuss with their patients possible long-term effects of finasteride on sexual function, although we do not have evidence showing that adverse events of sexual dysfunction are absolutely associated with 5α-RIs.
Alopecia ; Dihydrotestosterone ; Ejaculation ; Erectile Dysfunction ; Finasteride ; Hand ; Humans ; Infertility, Male ; Libido ; Male ; Male ; Oxidoreductases ; Prostatic Hyperplasia ; Research Personnel ; Testosterone

OBJECTIVES: The present systematic review was conducted to compare the effect of lavender on the quality of sleep, sexual desire, and vasomotor, psychological and physical symptoms among menopausal and elderly women. METHODS: There were five electronic databases which selected to search respective articles which included were Scopus, PubMed, Web of Science, Google Scholar, and the Cochrane Library without any language restriction since the study inception to March 10, 2018. The quality of studies was assessed in accordance with a jaded scale. RESULTS: According to three trials, the lavender as utilized in a capsule form or aromatherapy could significantly improve the measured Pittsburgh Sleep Quality Index score (P < 0.05) in the menopausal and elderly women. The aromatherapy with lavender improved sexual function (P < 0.001), depression (P < 0.001), anxiety (P < 0.001), and physical (P < 0.001) symptoms. Based on a trial, 66.7%, 70.0%, and 53.3% of subjects reported feelings of relaxation, happiness, and cleanness effects of having used lavender respectively. CONCLUSIONS: The results suggested the effectiveness of the use of lavender either in capsule form or aromatherapy on the improved quality of sleep, depression, anxiety, sexual desire, and psychological and physical symptoms. These results, however, should be interpreted with caution considering the limitations of the study.
Aged ; Anxiety ; Aromatherapy ; Depression ; Female ; Happiness ; Hot Flashes ; Humans ; Lavandula ; Libido ; Menopause ; Relaxation

To review the contemporary knowledge regarding the dehydroepiandrosterone and erectile function. Medline was reviewed for English-language journal articles spanning the time between January 1990 and December 2017, using the terms ‘erectile function’, ‘dehydroepiandrosterone’. We used original articles and review articles that found to be relevant to the purpose of this review. Criteria included all pertinent review articles, randomized controlled trials with tight methodological design, cohort studies and retrospective analyses. We also manually revised references from selected articles. Several interesting studies have addressed the age-related decline in dehydroepiandrosterone levels with many age-related phenomena or deterioration in various physiological functions. Particularly, aging; neurological functions including decreased well-being, cognition, and memory; increased depression, decreased bone mineral density, obesity, diabetes, increased cardiovascular morbidity, erectile dysfunction (ED), and decreased libido. Supporting this result, some trials of dehydroepiandrosterone supplementation in healthy, middle-aged, and elderly subjects have reported improvements in different aspects of well-being. Several studies had demonstrated that dehydroepiandrosterone level is declined as a part of aging. Large-scale well-designed prospective studies are warranted to better define indications and therapeutic implications of dehydroepiandrosterone in men with ED.
Aged ; Aging ; Androgens ; Bone Density ; Cognition ; Cohort Studies ; Dehydroepiandrosterone* ; Depression ; Erectile Dysfunction ; Humans ; Libido ; Male ; Memory ; Obesity ; Prospective Studies ; Retrospective Studies ; Testosterone

Objective: To explore the factors influencing the sexual function of the male patients with obstructive sleep apnea (OSA). METHODS: Using Arizona Sexual Experience Scale (ASEX) and Epworth Sleepiness Scale (ESS), we conducted a questionnaire investigation among 81 male patients with OSA aged 40.5 ± 8.6 years and 35 healthy volunteers aged 38.8 ± 10 years. According to the sex drive (SD) score in ASEX, we divided the OSA patients into an SD reduction group (SD score = 4, n = 32) and a non-SD reduction group (SD score <4, n = 49), compared the clinical data and polysomnographic (PSG) indexes, and analyzed the factors influencing SD by evaluating the association of the PSG indexes with the SD score. RESULTS: The OSA patients scored significantly higher than the healthy controls in ESS (8 ± 5 vs 5 ± 4, P <0.05) and ASEX (15 ± 4 vs 10 ± 2, P <0.05), and so did the patients of the SD reduction group than those of the non-SD reduction group in ESS (9 ± 5 vs 6 ± 5, P <0.05) and saturation impair time below 90% (SIT90) (41.01 ± 26.95 vs 21.87 ± 19.03, P <0.05). Multivariate regression analysis revealed that the SD score was significantly correlated with age (β = 0.25, P <0.001) and SIT90 (β = 0.4, P <0.001) in the OSA patients. CONCLUSIONS OSA affects various aspects of the sexual function, particularly SD, of the patient. The duration of hypoxia and age of the patient are independent risk factors for SD reduction, which can be considered as a main clinical symptom of OSA.
Adult ; Age Factors ; Case-Control Studies ; Humans ; Hypoxia ; complications ; Libido ; physiology ; Male ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; Surveys and Questionnaires ; Time Factors

Objective: To investigate the relationship of erectile dysfunction (ED) with psychological factors in male patients with infertility. METHODS: We conducted a questionnaire investigation among 252 male patients with infertility, which involved the general condition, results of semen routine examination, sexual life, and scores in IIEF-5, self-reported 9-item patient health questionnaire (PHQ-9) and 7-item generalized anxiety disorder scale (GAD-7). We analyzed the prevalence of ED, depression, and anxiety and their correlations among the patients in comparison with 100 fertile male controls. RESULTS: In 245 of the infertility patients, the most common symptoms of depression and anxiety were "feeling tired or no vitality" and "easily getting worried or impatient", 20.4% of them with depression disorder and 42.9% with anxiety disorder. The PHQ-9 and GAD-7 scores were significantly higher in the infertile males than in the normal fertile controls (P <0.05), and so was the incidence of ED (28.6% vs 12.4%, P <0.05), while the IIEF-5 scores were markedly lower in the former than in the latter group (P <0.01), and so were sex frequency and sexual satisfaction (P <0.05). The PHQ-9 and GAD-7 scores were remarkably higher in the infertility patients with ED than in those without (P <0.01). Logistic regression analysis showed that the level of libido and results of semen routine examination were the risk factors for depression disorder, while age, education level, disease course and experience of assisted reproduction were those for anxiety disorder. CONCLUSIONS Male infertility patients have a poorer mental health and a higher incidence of ED than normal fertile men, and there is some interaction between psychological status and ED prevalence.
Anxiety ; epidemiology ; Depression ; epidemiology ; Erectile Dysfunction ; epidemiology ; psychology ; Humans ; Infertility, Male ; psychology ; Libido ; Male ; Patient Health Questionnaire ; Prevalence ; Risk Factors ; Semen Analysis ; Sexual Behavior

BACKGROUND: After the approval of dutastride for androgenic alopecia (AGA) in 2009, Korean authority required a post-marketing surveillance to obtain further data on its safety profile. OBJECTIVE: The objective was to monitor adverse events (AEs) of dutasteride 0.5 mg in Korean AGA male patients in a clinical practice environment. METHODS: Open label, multi-center, non-interventional observational study was done from July 2009 to July 2013. AGA subjects (18~41 years of age) with no experience of dutasteride were enrolled. Dosage regimen was recommended according to the prescribing information. The incidences of any AEs, serious adverse events (SAEs), and adverse drug reactions (ADRs) were evaluated. Multiple logistic regression method was used to identify risk factors related to ADRs. Effectiveness was generally evaluated by physicians. RESULTS: During study period, 712 subjects were enrolled. The subjects of 29.3±6.0 years old exposed to dutasteride for 204.7±161.5 days. One hundred and ten (15.4%) of subjects reported 138 AEs. Four subjects (0.6%) reported 5 SAEs (right radius fracture, 2 events of chronic follicular tonsillitis, influenza infection, and acute appendicitis). Sixty-six subjects (9.3%) reported 80 ADRs. Most frequent ADRs were libido decreased (9 subjects, 1.3%), dyspepsia (8 subjects, 1.1%), impotence (7 subjects, 1.0%), and fatigue (5 subjects, 0.7%). Other interested ADRs were sexual function abnormality (4 subjects, 0.6%), gynecomastia (2 subjects, 0.3%), and ejaculation disorder (1 subject, 0.1%). Most subjects (78.6%) showed overall improvement after treatment of dutasteride in the effectiveness. CONCLUSION: Dutasteride 0.5 mg is to be well-tolerated in 18 to 41 years old AGA patients in a clinical practice environment.
Alopecia* ; Drug-Related Side Effects and Adverse Reactions ; Dutasteride* ; Dyspepsia ; Ejaculation ; Erectile Dysfunction ; Fatigue ; Gynecomastia ; Humans ; Incidence ; Influenza, Human ; Libido ; Logistic Models ; Male ; Methods ; Observational Study ; Oxidoreductases* ; Palatine Tonsil ; Radius Fractures ; Risk Factors ; Tonsillitis ; Treatment Outcome

Apart from sleep wake disorders, nowadays, modafinil is being prescribed for several psychiatric disorders including depression. Despite being reported as to be having very low abuse potential, cases of modafinil dependence had come to the limelight. In this case report, we describe a 35 year old man with bipolar affective disorder while in remission who developed modafinil dependence and later on, had hypersexuality when he increased the dose of modafinil from 400 to 1,000 mg/day. Existing literature suggests that modafinil when taken above prescribed doses can cause many side effects ranging from nausea, vomiting to psychotic exacerbation and mania. However, hypersexuality as a side effect of modafinil overuse is not commonly seen. The exact pathophysiological mechanism of modafinil induced hypersexuality is not clear. Clinicians should be aware of possibility of modafinil leading to dependence and this rare significant side effect of modafinil.
Bipolar Disorder ; Depression ; Libido ; Mood Disorders ; Nausea ; Sleep Wake Disorders ; Substance-Related Disorders ; Vomiting