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Hormone and metabolic disorders feature strongly in male sexual function and dysfunction This chapter will discuss the direct implications of androgens in the areas of sexual desire and erectile function Androgens are also implicated indirectly in sexual disorders through other metabolic derangements, such as obesity, insulin resistance, and the metabolic syndrome We shall review the dif culties of de ning androgen de ciency in aging men, when normal aging may produce similar symptoms, as may other aging changes, such as decreasing growth hormone levels Diabetes mellitus is a hormonal disorder that embodies many hormonal and metabolic factors that may cause sexual dysfunction, such as hypertension, hyperlipidemia, obesity, and insulin resistance It is little wonder, therefore, that the prevalence of sexual disorders is so high in this condition Thyroid and adrenal disorders have a de nite, though less pronounced and controversial role in the etiology of sexual dysfunction The pituitary hormone prolactin when in excess, has a number of effects on sexual desire, erectile function, and androgen secretion This review will attempt, in an evidence-based manner, to outline what is known, what is controversial, and what direction future research should take to understand these mechanisms better

10

responds to that of male sexual potency and activity However the possibility of minimally-impaired sexual function in men with very low levels of testosterone (T), as well as the often disappointing results of T therapy used alone in men with sexual dysfunction and moderate hypogonadism, have cast doubt on the importance of androgens in sexual function Actually the androgen de ciency that may be found during the work-up of a sexual dysfunction more often than not is only one element of a multifactorial causality On the other hand, it is now well established that the mean T level progressively decreases in healthy elderly men The extent to which this contributes to clinical signs and symptoms of aging, and the potential merits of androgen replacement in aging men, constitute a very exciting but still much debated eld The two main sections of this chapter are thus controversial areas Evidence-based knowledge has considerably increased during the last few decades Guidelines have been developed to help in practical management of the aspects which remain uncertain Levels of T are expressed either in pmol or nmol/L or in pg or ng/mL (1000 pg or pmol = respectively 1 ng or nmol The conversion factors are nmol/L or pmol/L 02884 = respectively ng/mL or pg/mL, and ng/ml or pg/ml 3467 = respectively nmol/L or pmol/L

1 2 3 4

Many observations suggest that androgens play a critical role in human sexual behavior Throughout life, the general pattern of their rise and decline cor-

Unlike powers of attorney, a will valid in your place of residence at the time of your death is valid in all other jurisdictions Assets in other jurisdictions, including the United States, would typically fall under the terms of that will Two documents could actually confuse matters and expose your estate to litigation, so limit yourself to a single will Obtain reliable legal advice for your specific circumstances Don t even think of writing your own will! It could be the kiss of death for your estate The potential legal and tax risks could jeopardize your efforts to develop a successful real estate portfolio Paying a lawyer who specializes in preparing wills and estate planning can save your heirs grief and prevent the government from becoming a main beneficiary of your estate One of the best things you can do for those taking care of your estate is to leave a record of your investments Although they might seem obvious to you, not everyone knows where to look for the information you take for granted Statistically, one out of four people die suddenly, which gives no time to get your financial affairs in order Take time to create, and regularly update, a list of your properties and investments and make at least two copies Keep one copy in a convenient location your executor knows, and the other with your will

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Hypogonadism in men is de cient function of the testes In this chapter its reproductive aspects will not be considered This term will be used in the sense of