The influence of hormones on erection

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Testosterone (T)

Both fetal and later phallic growth are dependent on T and DHT tissue concentrations and androgen receptor density. At the cerebral level, testosterone stimulates the synthesis, storage and release of pro-erectile neurotransmitters such as dopamine, NO and oxytocin [14,24,46,47]. At the spinal level the somatic motoneurons of the bulbo- and ischiocavernous muscles are T dependent (Fig. 3.8).

At the corpus cavernosum level, NOS-containing parasympathetic nerves are T dependent [48]. Recent studies in animals have shown that T has a considerable effect on relaxation of cavernous smooth musculature and that T sites of action are also distal to the cGMP level [49]. Density and sensitivity of a-adrenoceptors are T dependent with an increase following T deprivation by castration [50]. Androgen (T) withdrawal is followed by programmed cell death (apoptosis) of the cavernous smooth musculature [51].

Dehydroepiandrosterone(sulfate) (DHEA(S)) DHEA(S) is an intermediate product of T biosynthesis. It is synthesized in significant amounts in the adrenal cortex. Although the serum concentrations of this androgen are a thousand-fold higher in primates than those of T, the importance of DHEA(S) is not yet well defined or understood. DHEA replacement therapy in men with proven DHEA deficiency resulted in increased vitality and

Brain (T, DHT, E2) Modulation of neuronal activity, receptor sensitivity and neurotransmitter release socio-sexual behaviour Libido t

Daily testosterone-production: 6-10mg (95% testicle, 5% adrenal)

Daily testosterone-production: 6-10mg (95% testicle, 5% adrenal)

Brain (T, DHT, E2) Modulation of neuronal activity, receptor sensitivity and neurotransmitter release socio-sexual behaviour Libido t

Penis Size Hormone Blocker Patient

T+FSH for spermiogenesis

Penis

NOS-containing nerve fibers! a,-receptor sensitivity Smooth muscle cells

Spinal cord

Androgen-sensitive motoneurons (Bulbo-ischiocavernous muscles) Androgen receptors in parasympathetic

Castration, severe hypogonadism:

- NOS-containing nerve fibers!

- Rigidity!

- Apoptosis of smooth muscle cells (shrinking of penis)

Spinal cord

Androgen-sensitive motoneurons (Bulbo-ischiocavernous muscles) Androgen receptors in parasympathetic

T+FSH for spermiogenesis

Penis

NOS-containing nerve fibers! a,-receptor sensitivity Smooth muscle cells

Castration, severe hypogonadism:

- NOS-containing nerve fibers!

- Rigidity!

- Apoptosis of smooth muscle cells (shrinking of penis)

Fig. 3.8 Impact of testosterone on male sexual function.

well-being after oral administration of 50 mg DHEA/day [52], or in improvement of ED in impotent men [53].

Growth Hormone (GH) and insulin-like growth factor (IGF-1)

It has been proven that GH and IGF-1 affect penis growth and androgen production [54]. In cases with isolated GH deficiency and micropenis, continuous treatment with recombinant growth hormone normalizes the penile size [54]. Recently it has been suggested that GH also plays a role in erection [55]. Recombinant GH caused dose-dependent relaxation of cavernous smooth musculature by increasing intracellular cGMP levels. During erection a 90% increase in intracavernous GH concentration occurred in the tumescence stage.

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