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Sexual function in men undergoing androgen deprivation therapy

International Journal of Impotence Research volume 33, pages 439–447 (2021)Cite this article

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Abstract

Androgen deprivation therapy (ADT) has a deleterious effect on sexual functions and general well-being in men. Despite this evidence, however, patient and couple knowledge about ADT side effects as well as their management is poor. Similar considerations can be made for physician endorsement of management strategies. In this paper, we summarize and critically discuss available evidence regarding the possible associations between ADT and sexual dysfunction as well as the best therapeutical options. Preclinical data show that ADT is associated with penile contractility impairment as well as lower response to phosphodiesterase type 5 inhibitors (PDE5i). Available data indicate that ADT resulted in a five to sixfold increased risk of reduced libido and in a threefold increased risk of ED confirming the main role of testosterone in regulating sexual desire. Despite this evidence, sexuality remains an important aspect of health and well-being for men and their partner. The best therapeutical options depend on patient and couple desires and needs. When nonpenetrative erections are still possible, nonpenetrative activities should be encouraged to maintain sexual intimacy. A combined and personal educational program including the collaboration of different professional figures (including general physicians, oncologists, andrologists, sexologists, and psychologists) trained in sexual medicine is advisable in order to provide the best support to subjects undergoing ADT.

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Fig. 1: Curvilinear relationship between circulating testosterone concentration and maximal acetylcholine (Ach) responsiveness in control rabbits and in rabbits treated with the long-lasting GnRH analog (triptorelin pamoate) with or without testosterone supplementation (n = 57, p = 0.006).
Fig. 2: Effect of increasing concentrations of sildenafil on the response induced by electrical field stimulation (5 Hz, 10 V, 30 s) in rabbit corpora cavernosa preparations precontracted by phenylephrine.
Fig. 3: Area under the curve of penile strip relaxation induced by increasing concentration of the NO donor NCX-4040 in the presence of a fixed concentration of sildenafil in control rabbits (black bars), and in rabbits chronically treated with a GnRH analog with (white bars) and without (gray bars) testosterone supplementation.
Fig. 4: Weighted odds ratio (with 95% CI) for reduced libido or erectile dysfunction (ED) in patients under androgen deprivation therapy.

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Authors and Affiliations

  1. Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda USL Bologna, Bologna, Italy

    G. Corona, N. Bianchi, F. Frizza & A. Sforza

  2. Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy

    S. Filippi, P. Comelio, G. Rastrelli & L. Vignozzi

  3. Urology Unit, Surgical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy

    M. Dicuio & S. Concetti

  4. Department of Urology, Sahlgrenska University Hospital, Goteborg, Sweden

    M. Dicuio

  5. Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy

    M. Maggi

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Corona, G., Filippi, S., Comelio, P. et al. Sexual function in men undergoing androgen deprivation therapy. Int J Impot Res 33, 439–447 (2021). https://doi.org/10.1038/s41443-021-00418-7

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