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 therapy (TTh) 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 TTh. Through this review, we aim to better understand the clinical implications of estrogens in the treatment of sexual dysfunction and T deficiency in men.

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