cvictorg
New Member
$cally - $ex, $cience, & $tocks: Estrogens in Men - Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency
Estrogens in Men - Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency
Estrogens have been known to be present in substantial concentrations in men for several decades, yet their role in male physiology remains an area of considerable uncertainty and controversy. As interest in testosterone (T) deficiency and T replacement therapy (TRT) has recently increased, there has been renewed interest in estrogens, particularly their role in sexual function. T and estrogen are inextricably linked, as T is a major source of estradiol (E2) via aromatization.
Whereas the importance of estrogens in bone health for both men and women is well established, other aspects of normal or abnormal estrogen function are less clear and merit examination. In particular, there is significant inconsistency and confusion over the clinical importance of estrogens with regard to sexual function. Although it is commonly believed that estrogens have a negative impact on male sexual function, in animals E2 appears to be essential for male sexual function. The evidence regarding the contribution of estrogen in human male sexuality is limited and less clear.
For clinicians, the optimal management of high-normal or elevated estrogens remains a point of controversy either for men with symptomatic T deficiency or men with increased estrogen levels after TRT. Through this review, investigators aim to better understand the clinical implications of estrogens in the treatment of sexual dysfunction and T deficiency in men.
E2 is essential to normal male sexual function in animals, however the data are inconclusive as to its effect in humans. There is some evidence that estrogens may contribute to the persistence of sexually stimulated erectile function when serum T is severely depressed, such as in men who have undergone castration for advanced prostate cancer men. It does not appear that naturally occurring elevations in E2 are harmful with respect to T levels or sexual function. E2 may increase during TRT, but elevations above the normal range are uncommon. Elevations in E2 may resolve with prolonged TRT. Symptoms of estrogen excess, such as gynecomastia or nipple tenderness, are rare.
Men who experience such symptoms should consider temporary or permanent discontinuation of TRT, or the addition of an aromatase inhibitor. They do not recommend the routine use of aromatase inhibitors with TRT. In the absence of signs of estrogen excess, we also find no reason to recommend the use of aromatase inhibitors in men who experience positive benefits from TRT despite elevated or high-normal E2 concentrations. When an aromatase inhibitor is used, it should be titrated so that E2 levels remain above 40 pmol/L to preserve bone health, and monitoring of bone mineral density with DXA is recommended.
Kacker R, Traish AM, Morgentaler A. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. J Sex Med. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency - Kacker - 2012 - The Journal of Sexual Medicine - Wiley Online Library
Introduction. The role of estrogens in male sexual function and the pathogenesis of testosterone deficiency remain controversial and poorly understood.
Aims. To review the distribution of estrogens in normal and testosterone deficient men, their potential role in sexual function, and the clinical implications of elevated estrogens during testosterone therapy.
Methods. A comprehensive, broad-based literature review was conducted on the role of estrogens in male sexual function and testosterone deficiency.
Results. Estrogens elicit a variety of physiological responses in men and may contribute to modulation of sexual function. In the absence of testosterone deficiency, elevations in estrogens do not appear to be harmful and estrogens may help maintain some, but not all, sexual function in castrated men. While the therapeutic use of estrogens at pharmacologic doses has been used to suppress serum testosterone, naturally occurring elevations of estrogens do not appear to be a cause of low testosterone. During testosterone replacement, estrogens may rise and occasionally reach elevated levels. There is a lack of evidence that treatment of elevated estrogen levels during testosterone replacement has benefit in terms of male sexuality.
Conclusion. Further research on the importance of estrogens in male sexual function is needed. Current evidence does not support a role of naturally occurring estrogen elevations in testosterone deficiency or the treatment of elevated estrogens during testosterone therapy.
Estrogens in Men - Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency
Estrogens have been known to be present in substantial concentrations in men for several decades, yet their role in male physiology remains an area of considerable uncertainty and controversy. As interest in testosterone (T) deficiency and T replacement therapy (TRT) has recently increased, there has been renewed interest in estrogens, particularly their role in sexual function. T and estrogen are inextricably linked, as T is a major source of estradiol (E2) via aromatization.
Whereas the importance of estrogens in bone health for both men and women is well established, other aspects of normal or abnormal estrogen function are less clear and merit examination. In particular, there is significant inconsistency and confusion over the clinical importance of estrogens with regard to sexual function. Although it is commonly believed that estrogens have a negative impact on male sexual function, in animals E2 appears to be essential for male sexual function. The evidence regarding the contribution of estrogen in human male sexuality is limited and less clear.
For clinicians, the optimal management of high-normal or elevated estrogens remains a point of controversy either for men with symptomatic T deficiency or men with increased estrogen levels after TRT. Through this review, investigators aim to better understand the clinical implications of estrogens in the treatment of sexual dysfunction and T deficiency in men.
E2 is essential to normal male sexual function in animals, however the data are inconclusive as to its effect in humans. There is some evidence that estrogens may contribute to the persistence of sexually stimulated erectile function when serum T is severely depressed, such as in men who have undergone castration for advanced prostate cancer men. It does not appear that naturally occurring elevations in E2 are harmful with respect to T levels or sexual function. E2 may increase during TRT, but elevations above the normal range are uncommon. Elevations in E2 may resolve with prolonged TRT. Symptoms of estrogen excess, such as gynecomastia or nipple tenderness, are rare.
Men who experience such symptoms should consider temporary or permanent discontinuation of TRT, or the addition of an aromatase inhibitor. They do not recommend the routine use of aromatase inhibitors with TRT. In the absence of signs of estrogen excess, we also find no reason to recommend the use of aromatase inhibitors in men who experience positive benefits from TRT despite elevated or high-normal E2 concentrations. When an aromatase inhibitor is used, it should be titrated so that E2 levels remain above 40 pmol/L to preserve bone health, and monitoring of bone mineral density with DXA is recommended.
Kacker R, Traish AM, Morgentaler A. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. J Sex Med. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency - Kacker - 2012 - The Journal of Sexual Medicine - Wiley Online Library
Introduction. The role of estrogens in male sexual function and the pathogenesis of testosterone deficiency remain controversial and poorly understood.
Aims. To review the distribution of estrogens in normal and testosterone deficient men, their potential role in sexual function, and the clinical implications of elevated estrogens during testosterone therapy.
Methods. A comprehensive, broad-based literature review was conducted on the role of estrogens in male sexual function and testosterone deficiency.
Results. Estrogens elicit a variety of physiological responses in men and may contribute to modulation of sexual function. In the absence of testosterone deficiency, elevations in estrogens do not appear to be harmful and estrogens may help maintain some, but not all, sexual function in castrated men. While the therapeutic use of estrogens at pharmacologic doses has been used to suppress serum testosterone, naturally occurring elevations of estrogens do not appear to be a cause of low testosterone. During testosterone replacement, estrogens may rise and occasionally reach elevated levels. There is a lack of evidence that treatment of elevated estrogen levels during testosterone replacement has benefit in terms of male sexuality.
Conclusion. Further research on the importance of estrogens in male sexual function is needed. Current evidence does not support a role of naturally occurring estrogen elevations in testosterone deficiency or the treatment of elevated estrogens during testosterone therapy.
