Background: Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinemia, but almost all extragonadal endocrinopathies (hyper- and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumors, etc.) may have a greater or lesser effect on sexual function. Methods: We analyzed scientific literature on the correlations between hormones and sexual behavior, analyzing the most important issue from a practical point of view. The aim of this review article was thus to summarize the sexual symptoms that may be observed with endocrine diseases. Results: Hormones directly or indirectly regulate all human sexual functions (desire, erection/lubrication, ejaculation, orgasm). Some sexual symptoms may occur as a psychosomatic consequence of hormonal impairment. However, in other cases, endocrine failure may be generated by the psychosomatic involvement. Conclusions: The endocrinologist, as an expert in body chemistry, is ideally positioned to identify and evaluate the full range of medical, physical, and psychiatric problems disrupting sexual function.

Morin LP, Dark J: Hormones and biological rhythms; in Becker JB, Breedlove SM, Crews D (eds): Behavioral Endocrinology. Cambridge, MIT Press, 1992, pp 473–504.
Oster H, Maronde E, Albrecht U: The circadian clock as a molecular calendar. Chronobiol Int 2002;19:507–516.
Malpaux B, Migaud M, Tricoire H, Chemineau P: Biology of mammalian photoperiodism and the critical role of the pineal gland and melatonin. J Biol Rhythms 2001;16:336–347.
Lombardo F, Gandini L, Santulli M, Jannini EA, Dondero F, Lenzi A: Endocrinological diagnosis in sexology. J Endocrinol Invest 2003;26(suppl 3):112–114.
Sobrinho LG: Psychopathology in endocrine disorders: why so persistent after the cure? Psychother Psychosom 2004;73:65–67.
Sonino N, Navarrini C, Ruini C, Ottolini F, Paoletta A, Fallo F, Boscaro M, Fava GA: Persistent psychological distress in patients treated for endocrine disease. Psychother Psychosom 2004;73:78–83.
Fabbri A, Jannini EA, Gnessi L, Moretti C, Ulisse S, Bonifacio V, Frajese G, Isidori A: Evidence for low bioactive LH in male impotence: possible relationship with altered GnRH pulsatility. J Clin Endocrinol Metab 1988;67:867–875.
Jannini EA, Screponi E, Carosa E, Pepe M, Lo Giudice F, Trimarchi F, Benvenga S: Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone. Int J Androl 1999;22:385–392.
Carosa E, Benvenga S, Trimarchi F, Lenzi A, Pepe M, Simonelli C, Jannini EA: Lack of sexual activity for erectile dysfunction causes a reversible reduction of LH bioavailability. Int J Impotence Res 2002;14:93–99.
Carosa E, Martini P, Brandetti F, Di Stasi SM, Lombardo F, Lenzi A, Jannini EA: Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin Endocrinol 2004;61:382–386.
Fabbri A, Jannini EA, Gnessi L, Moretti C, Ulisse S, Franzese A, Lazzari R, Fraioli F, Frajese G, Isidori A: Endorphins in male impotence: evidence for naltrexone stimulation of erectile activity in patient therapy. Psychoneuroendocrinology 1989;14:103–111.
Veldhuis JD, Rogol AD, Samojlik E, Ertel NH: Role of endogenous opiates in the expression of negative feedback actions of androgen and estrogen on pulsatile properties of luteinizing hormone secretion in man. J Clin Invest 1984;74:47–55.
Lightman SL, Jacobs HS, Maguire AK, McGarrick G, Jeffcoate WL: Constancy of opioid control of luteinizing hormone in different pathophysiological states. J Clin Endocrinol Metab 1981;52:1260–1263.
Plourde PV, Dufau ML, Plourde N, Santen RJ: Impotence associated with low biological to immunological ratio of luteinizing hormone in a man with a pituitary stone. J Clin Endocrinol Metab 1985;60:797–802.
Mohr BA, Guay AT, O’Donnell AB, McKinlay JB: Normal, bound and nonbound testosterone levels in normally ageing men: results from the Massachusetts Male Ageing Study. Clin Endocrinol 2005;62:64–73.
Carani C, Celani MF, Zini D, Baldini A, Della Casa L, Marrama P: Changes in the bioactivity to immunoreactivity ratio of circulating luteinizing hormone in impotent men treated with testosterone undecanoate. Acta Endocrinol 1989;120:284–288.
Rhoden EL, Teloken C, Mafessoni R, Vargas Souto CA: Is there a relation between serum levels of total testosterone and the severity of erectile dysfunction? Int J Impot Res 2002;14:167–171.
Anonymous: Effects of sexual activity on beard growth in man. Nature 1970;226:869–870.
Graham JM, Desjardins C: Classical conditioning: induction of luteinizing hormone and testosterone secretion in anticipation of sexual activity. Science 1980;210:1039–1041.
Fox CA, Ismail AA, Love DN, Kirkham KE, Loraine JA: Studies on the relationship between plasma testosterone levels and human sexual activity. J Endocrinol 1972;52:51–58.
Hirschenhauser K, Frigerio D, Grammer K, Magnusson MS: Monthly patterns of testosterone and behavior in prospective fathers. Horm Behav 2002;42:172–181.
Rubin H, Henson D, Falvo R, High RW: The relationship between men’s endogenous levels of testosterone and their penile response to erotic stimuli. Behav Res Ther 1979;17:305–312.
Lange JD, Brown WA, Wincze JP, Zwick W: Serum testosterone concentration and penile tumescence changes in men. Horm Behav 1980;14:267–270.
Stoleru SG, Ennaji A, Cournot A, Spira A: LH pulsatile secretion and testosterone levels are influenced by sexual arousal in human males. Psychoneuroendocrinology 1993;18:205–218.
Becker AJ, Uckert S, Stief CG, Truss MC, Machtens S, Sheller F, Knapp WH, Hartmann U, Jonas U: Cavernous and systemic testosterone levels in different phases of human penile erection. Urology 2000;56:125–129.
Becker AJ, Uckert S, Stief CG, Sheller F, Knapp WH, Hartmann U, Jonas U: Cavernous and systemic testosterone plasma levels during different conditions in healthy males and patients with erectile dysfunction. Urology 2001;58:435–440.
Ansong KS, Punwaney RB: An assessment of the clinical relevance of serum testosterone level determination in the evaluation of men with low sexual drive. J Urol 1999;162:719–721.
Ahn HS, Park CM, Lee SW: The clinical relevance of sex hormone levels and sexual activity in the ageing male. Br J Urol Intern 2002;9:526–530.
Tsitouras PD, Martin CE, Barman SM: Relationship of serum testosterone to sexual activity in healthy elderly me. J Gerontol 1982;37:288–293.
English KM, Mandour O, Steeds RP, Diver MJ, Jones TH, Channer KS: Men with coronary disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J 2000;21:890–894.
Fogari R, Zoppi A, Preti P, Rinaldi A, Marasi G, Vanesia A, Mugellini A: Sexual activity and plasma testosterone levels in hypertensive males. Am J Hypertens 2002;15:217–221.
Aversa A, Isidori AM, De Martino MU, Caprio M, Fabbrini E, Rocchietti-March M, Frajese G, Fabbri A: Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilatation in men with erectile dysfunction. Clin Endocrinol 2000;53:517–522.
Caruso A, Intelisano G, Farina M, Di Mari L, Agnello C, Giammusso B: Efficacy and safety of daily intake of apomorphine SL in men affected by erectile dysfunction and mild hyperprolactinemia: a prospective, open-label, pilot study. Urology 2003;62:922–927.
Jannini EA, Lenzi A, Wagner G: New perspectives in the pharmacotherapy of erectile dysfunction. IDrugs 2003;6:1165–1172.
Morelli A, Filippi S, Mancina R, Luconi M, Vignozzi L,Marini M, Orlando C, Vannelli GB, Aversa A, Natali A, Forti G, Giorni M, Jannini EA, Ledda F, Maggi M: Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology2004;145:2253–2263.
Foresta C, Caretta N, Rossato M, Garolla A, Ferlin A: Role of androgens in erectile function. J Urol2004;171:2358–2362.
Davidson JM, Camargo C, Smith ER: Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab 1979;48:955–958.
Nankin HR, Lin T, Osterman J: Chronic testosterone cypionate therapy in men with secondary impotence. Fertil Steril 1986;46:300–306.
Morales A, Johnston B, Heaton JWP, Clark A: Oral androgen in the treatment of hypogonadal impotent men. J Urol 1994;152:1115–1118.
Morales A, Johnston B, Heaton JPW, Lundie M: Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol 1998;157:849–854.
Guay AT, Bansal S, Heatley GJ: Effect of raising endogenous testosterone levels in impotent men with secondary hypogonadism: double blind placebo-controlled trial with clomiphene citrate. J Clin Endocrinol Metab 1995;80:3546–3552.
Anderson BA, Bancroft J, Wu FCW: The effects of exogenous testosterone on sexuality and mood in normal men. J Clin Endocrinol Metab 1992;75:1503–1507.
Greenstein A, Playmate SR, Katz PG: Visually stimulated erections in castrated men. J Urol 1995;153:650–652.
Finkelstein JW, Susman EJ, Chinchilli VM, Kunselman SJ, D’Arcangelo MR, Schwab J, Demers LM, Liben LS, Lookingbill G, Kulin HE: Estrogen or testosterone increases self-reported aggressive behaviors in hypogonadal adolescents. J Clin Endocrinol Metab 1997;82:2423–2438.
Swerdloff RS Wang C: Influence of pituitary disease on sexual development and functioning. Psychother Psychosom 1998;67:173–180.
Fava GA, Fava M, Kellner R, Serafini E, Mastrogiacomo J: Depression, hostility and anxiety in hyperprolactinemic amenorrea. Psychoter Psychosom 1981;36:122–128.
Buvat J: Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res 2003;15:373–377.
De Rosa M, Zarrilli S, Vitale G, Di Somma C, Orio F, Tauchmanova L, Lombardi G, Colao A: Six months of treatment wit cabergoline restores sexual potency in hyperprolactinemic males: an open longitudinal study monitoring nocturnal penile tumescence. J Clin Endocrinol Metab 2004;89:621–625.
Sonino N, Navarrini C, Ruini C, Fallo F, Boscaro M, Fava GA: Life events in the pathogenesis of hyperprolactinemia. Eur J Endocrinol 2004;151:61–65.
Barman AL: Acromegaly, diagnosis and therapy. Endocrinol Metab Clin 1989;18:277–310.
Rowles SV, Prieto L, Badia X, Shalet SM, Webb SM, Trainer PJ: Quality of life (QOL) in patients with acromegaly is severely impaired: use of a novel measure of QOL: acromegaly quality of life questionnaire. J Clin Endocrinol Metab 2005;90:3337–3341.
Becker AJ, Uckert S, Stief CG, Truss MC, Machtens S, Sheller F, Knapp WH, Hartmenn U, Jonas U: Possible role of human growth hormone in penile erection. J Urol 2000;164:2138–2142.
Jannini EA, Ulisse S, D’Armiento M: Thyroid hormone and male gonadal function. Endocrine Rev 1995;16:443–459.
Corona G, Petrone L, Mannucci E, Jannini EA, Mansani R, Magini A, Giommi R, Forti G, Maggi M: Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur Urol 2004;46:615–622.
Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, Jannini EA: Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 2005;90:6472–6479.
Sonino N, Fava GA: Psychiatric disorders associated with Cushing’s syndrome. Epidemiology, pathophysiology and treatment. CNS Drugs 2001;15:361–373.
Uckert S, Fuhlenriede MH, Becker AJ, Stief CG, Scheller F, Knapp WH, Jonas U: Is there an inhibitory role of cortisol in the mechanism of male sexual arousal and penile erection? Urol Res 2003;31:402–406.
Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, Wass JA, Herbert J, Chatterjee VK: Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison’s disease in a randomized, double blind trial. J Clin Endocrinol Metab 2000;85:4650–4656.
Jannini EA: Dehydroepiandrosterone treatment in the aging male – What should the urologist know – commentary. Eur Urol 2005;48:733.
Melman A, Gingell JC: The epidemiology and pathophysiology of erectile dysfunction. J Urol 1999;161:5–11.
Rosen RC: Assessment of female sexual dysfunction: review of validated methods. Fertil Steril 2002;77:S89–S93.
Traish AM, Kim N, Min K, Munarriz R, Goldstein I: Role of androgens in female genital sexual arousal: receptor expression, structure and function. Fertil Steril 2002;77:S11–S18.
Guay AT, Spark R: Pathophysiology of sex steroids in women; in Goldstein I, Meston CM, Davis SR, Traish AM (eds): Women’s Sexual Function and Dysfunction. London, Taylor & Francis, 2005, pp 218–227.
Sternbach H: Age-associated testosterone decline in men: clinical issues for psychiatry. Am J Psychiatry 1998;155:1310–1318.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.