Erectile dysfunction and testosterone replacement therapy: When, why and how

Testosterone deficiency (TD) is of growing concern to clinicians, as the prevalence has increased over time with increasing aging of the population in the western world. In this chapter we will show that both the biochemical and clinical diagnosis is difficult because in men with previously normal virilisation, symptoms of hypogonadism are relatively mild even if serum T concentrations are low. And, what makes it more difficult, hypogonadism mimics symptoms that go along with physiological aging, such as reduced libido, sexual dysfunction, asthenia, low energy, depressed mood, and more specific symptoms such as reduced volume of the ejaculate and slower grow of facial hair. The fact however that TD often occurs in combination with certain clinical conditions such as chronic disease in general, the metabolic syndrome in particular and certain medication makes it possible to a sketch a profile of a man with TD and to identify those who may benefit from testosterone replacement therapy (TRT). TRT is safe in the short term (long-term data are lacking), but conclusive evidence of effectiveness is lacking. Furthermore, there are more and more indications that a change to a healthy lifestyle, especially more physical activity, diet, stress reduction and social support, is a valid alternative

Application of correlation techniques in the analysis of corpus cavernosum electromyographic signals

Aim: To establish an objective, easy-to-use and comprehensive method to analyze corpus cavernosum electromyographic signals (CC-potentials). Methods: CC-potentials were recorded during flaccidity in 23 young healthy volunteers, with surface electrodes placed on the penile shaft bilaterally. Based on the correlation function of Matlab software, an application program for the analysis of CC-potentials was developed. Individual CC-potentials and their autocorrelation function were evaluated, yielding parameters amplitude (A), duration (D), and dominant frequency (DF). The cross-correlation function of both longitudinal and bilateral pairs of adjacent electrodes was calculated to assess the similarity and mutual delay of CC-potentials recorded simultaneously from different parts of the CC. The parameters derived were squared maximum cross-correlation coefficient (Rmax) and delay (τ). Based on the absolute value of τ and the corresponding inter-electrode distance, propagation velocity (PV) was calculated. Results: The values of the parameters were determined automatically. No significant difference related to the locations of the electrodes for parameters A, D, and DF was detected. The cross-correlation showed that both longitudinal and bilateral CC-potential pairs had highly similar waveforms (the absolute values of Rmax were 0.80 ± 0.05 and 0.87 ± 0.06, respectively). PV of longitudinal pairs was estimated as 6.15 ± 3.98 cm/s. Conclusion: The application program for correlation analysis of CC-potentials is a comprehensive and versatile method to analyze corpus cavernosum electromyographic recordings. Its objectiveness makes multi-center application possible

A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen

Background Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. Aim To evaluate motivations for and psychosexual outcomes after GCS. Methods A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Outcomes Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Results Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%). Clinical Implications The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and Limitations Study strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. Conclusion Counseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice. van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628

Quality of Life and Sexual Function Benefits of Long-Term Testosterone Treatment:Longitudinal Results From the Registry of Hypogonadism in Men (RHYME)

Background The benefits and risks of long-term testosterone administration have been a topic of much scientific and regulatory interest in recent years. Aim To assess long-term quality of life (QOL) and sexual function benefits of testosterone replacement therapy (TRT) prospectively in a diverse, multinational cohort of men with hypogonadism. Methods A multinational patient registry was used to assess long-term changes associated with TRT in middle-age and older men with hypogonadism. Comprehensive evaluations were conducted at 6, 12, 24, and 36 months after enrollment into the registry. Outcomes QOL and sexual function were evaluated by validated measures, including the Aging Malesâ\u80\u99 Symptom (AMS) Scale and the International Index of Erectile Function (IIEF). Results A total of 999 previously untreated men with hypogonadism were enrolled at 25 European centers, 750 of whom received TRT at at least one visit during the period of observation. Patients on TRT reported rapid and sustained improvements in QOL, with fewer sexual, psychological, and somatic symptoms. Modest improvements in QOL and sexual function, including erectile function, also were noted in RHYME patients not on TRT, although treated patients showed consistently greater benefit over time in all symptom domains compared with untreated patients. AMS total scores for patients on TRT were 32.8 (95% confidence interval = 31.3â\u80\u9334.4) compared with 36.6 (95% confidence interval = 34.8â\u80\u9338.5) for untreated patients (P <.001). Small but significant improvements in IIEF scores over time also were noted with TRT. Approximately 25% of treated and untreated men also used phosphodiesterase type 5 inhibitors, with notable differences in the frequency of phosphodiesterase type 5 inhibitor prescription use according to physician specialty and geographic site location. Clinical Implications TRT-related benefits in QOL and sexual function are well maintained for up to 36 months after initiation of treatment. Strengths and Limitations The major strengths are the large, diverse patient population being treated in multidisciplinary clinical settings. The major limitation is the frequency of switching from one formulation to another. Conclusion Overall, we confirmed the broad and sustained benefits of TRT across major QOL dimensions, including sexual, somatic, and psychological health, which were sustained over 36 months in our treatment cohort. Rosen RC, Wu F, Behre H, et al. Quality of Life and Sexual Function Benefits Effects of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME). J Sex Med 2017;14:1104â\u80\u931115