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Testosterone and Sexual Desire: A Review of the Evidence (2022)
Vi Nguyen, MD,* Austin Leonard, BA, and Tung-Chin Hsieh, MD
Abstract
Sexual desire is driven by complex interactions between various biopsychosocial factors including neuroendocrine regulation, mental state, and cultural values. Herein we perform a narrative review to describe the underlying physiology of sexual desire and summarize the current literature linking testosterone to sexual function. The following search terms were used to identify articles on the Medline and PubMed databases: ‘‘libido,’’ ‘‘testosterone replacement therapy,’’ ‘‘androgen receptor,’’ and ‘‘sexual desire.’’ Only articles in English were included. Several animal and human studies have implicated the pivotal role of testosterone (T) in regulating the physiological pathways underlying sexual desire. Functional imaging studies have identified several regions in the brain that are activated by sexual stimuli and these androgenic pathways. A strong correlation between serum T levels and libido in men has been reliably and repeatedly demonstrated. An important clinical application of this association is the improvement of sexual desire secondary to testosterone replacement therapy in hypogonadal men. We summarize the current literature on the neuroendocrine role of testosterone in sexual desire and its dose-dependent relationship with libido.
Introduction
The male sexual response cycle was first conceptualized by Kaplan in 1974 as four distinct phases: desire, arousal, orgasm, and resolution.1 Sexual desire is defined as the forces that lead an individual to initiate and maintain human sexual behavior and can be triggered by both intrinsic and external stimuli.2 Desire has been further categorized into three separate components, including drive (biological factors including the neuroendocrine system), motive (psychological factors including mental and relationship state), and wish (cultural factors including ideals and values).3
From a biological perspective, several studies have demonstrated that hormones, particularly androgens, play a critical role in regulating sexual desire.4,5 Testosterone (T) has been shown to account for variations in sexual desire between the genders as well as among individuals of the same gender.6 Although sexual desire is a multifactorial process, herein we aim to summarize the physiology of T in male sexual desire and describe the current literature regarding the role of T in libido, sexual desire, and replacement therapy. We hypothesized that current literature adequately describes the physiological mechanisms of desire, but that further research is required to fully explore the relationship between T and sexual function.
*Physiological Pathways of Sexual Desire
*Testosterone and Sexual Desire
*Testosterone Replacement Therapy and Libido
Conclusions
In conclusion, this review summarizes the endogenous androgen neuroendocrine system and describes studies evaluating the role of T in human sexual desire and function. Limitations of this review include study inclusion criteria, which did not analyze studies published in languages other than English. Future systematic reviews should be conducted to further analyze the current literature in a regimented manner. Sexual desire is a sequela of complex multifactorial interactions among various biopsychosocial influences.
Both animal and human studies have solidified the role of androgens in the neuroendocrine pathways that regulate sexual desire, and this association has been validated in numerous clinical studies. The strong relationship between T and sexual desire underlies the clinical foundation of TRT in hypogonadal men, with data suggesting increased efficacy in a dose-dependent manner and with the superiority of gel over patch application.
Vi Nguyen, MD,* Austin Leonard, BA, and Tung-Chin Hsieh, MD
Abstract
Sexual desire is driven by complex interactions between various biopsychosocial factors including neuroendocrine regulation, mental state, and cultural values. Herein we perform a narrative review to describe the underlying physiology of sexual desire and summarize the current literature linking testosterone to sexual function. The following search terms were used to identify articles on the Medline and PubMed databases: ‘‘libido,’’ ‘‘testosterone replacement therapy,’’ ‘‘androgen receptor,’’ and ‘‘sexual desire.’’ Only articles in English were included. Several animal and human studies have implicated the pivotal role of testosterone (T) in regulating the physiological pathways underlying sexual desire. Functional imaging studies have identified several regions in the brain that are activated by sexual stimuli and these androgenic pathways. A strong correlation between serum T levels and libido in men has been reliably and repeatedly demonstrated. An important clinical application of this association is the improvement of sexual desire secondary to testosterone replacement therapy in hypogonadal men. We summarize the current literature on the neuroendocrine role of testosterone in sexual desire and its dose-dependent relationship with libido.
Introduction
The male sexual response cycle was first conceptualized by Kaplan in 1974 as four distinct phases: desire, arousal, orgasm, and resolution.1 Sexual desire is defined as the forces that lead an individual to initiate and maintain human sexual behavior and can be triggered by both intrinsic and external stimuli.2 Desire has been further categorized into three separate components, including drive (biological factors including the neuroendocrine system), motive (psychological factors including mental and relationship state), and wish (cultural factors including ideals and values).3
From a biological perspective, several studies have demonstrated that hormones, particularly androgens, play a critical role in regulating sexual desire.4,5 Testosterone (T) has been shown to account for variations in sexual desire between the genders as well as among individuals of the same gender.6 Although sexual desire is a multifactorial process, herein we aim to summarize the physiology of T in male sexual desire and describe the current literature regarding the role of T in libido, sexual desire, and replacement therapy. We hypothesized that current literature adequately describes the physiological mechanisms of desire, but that further research is required to fully explore the relationship between T and sexual function.
*Physiological Pathways of Sexual Desire
*Testosterone and Sexual Desire
*Testosterone Replacement Therapy and Libido
Conclusions
In conclusion, this review summarizes the endogenous androgen neuroendocrine system and describes studies evaluating the role of T in human sexual desire and function. Limitations of this review include study inclusion criteria, which did not analyze studies published in languages other than English. Future systematic reviews should be conducted to further analyze the current literature in a regimented manner. Sexual desire is a sequela of complex multifactorial interactions among various biopsychosocial influences.
Both animal and human studies have solidified the role of androgens in the neuroendocrine pathways that regulate sexual desire, and this association has been validated in numerous clinical studies. The strong relationship between T and sexual desire underlies the clinical foundation of TRT in hypogonadal men, with data suggesting increased efficacy in a dose-dependent manner and with the superiority of gel over patch application.
