Abstract
It makes me smile to be able to present to the world, on behalf of Androgens: Clinical Research and Therapeutics (The Journal), this special volume on Testosterone and Sexual Dysfunction, edited by Faysal Yafi, MD, and Lawrence Jenkins, MD. Although the field of male sexual medicine had already been well established by the time I graduated from urology training in the late 1980s, there was almost no awareness at that time that testosterone deficiency (TD) could be a cause of sexual issues in men, and even less appreciation for the benefits of testosterone therapy (TTh) in addressing these issues. 1 Today, the remarkable advances in understanding the role of TD in sexual dysfunction are well represented by the depth and breadth of articles that appear in this volume.
When I began my urological career in 1988 specializing in male sexual dysfunction and infertility, there was no training in the diagnosis and management of TD, and TTh was not even considered among treatment options. 2 Indeed, the medical community had no appreciation for the effects of testosterone on human sexuality apart from the loss of libido and consequently erectile dysfunction that occurred in men undergoing castration as treatment for advanced prostate cancer. The diagnosis of hypogonadism was made rarely, and was generally restricted to cases of pubertal delays in boys, men with pituitary or hypothalamic tumors, after pituitary resection, genetic disorders such as Klinefelters, or in males with atrophic or absent testicles. 1
As a new clinician treating patients a full decade before the introduction of Viagra, I was frustrated by the limited treatment options for sexual issues, and I wondered whether TTh might be helpful in men, based on my prior research placing intracranial testosterone pellets in castrated male lizards. 3 It became obvious after treating just a handful of patients that TTh was indeed helpful in men with low serum levels of total or free testosterone. However, my use of TTh in men was tempered by the universal belief that raising serum testosterone would precipitate aggressive prostate cancer. It would take ∼20 years before relevant medical societies acknowledged the value of TTh for the treatment of symptomatic men with low serum values of testosterone, most often presenting with sexual symptoms.
As evidence mounted that TTh did not cause prostate cancer or lead to its rapid progression, the use of TTh became more frequently prescribed, and investigation of testosterone into sexual function increased in parallel. Today, as evidenced by the range of articles in this special edition, we see testosterone implicated in a wide range of sexual issues, including erectile function, ejaculatory issues, libido, and even Peyronie's disease. There can no longer be any question that sexual symptoms often accompany TD in men, and, in fact, the presence of three sexual symptoms (reduced morning erections, erectile dysfunction, and decreased libido) has been shown to be the best predictors of having TD. 4
Readers of the Journal will find it interesting to learn that some of the most important basic research regarding androgens and sexual function was performed by our own Editor-in-Chief, Abdul Traish, PhD, and his coinvestigators. Using a rabbit model, Dr. Traish showed that castration abolished erections mediated by direct stimulation of the cavernosal nerve, and injections of testosterone restored normal erections in this model. 5 In another study, Dr. Traish and colleagues demonstrated that de novo appearance of lipocytes was found in the subtunical space of the corpora cavernosa after castration, replacing cavernosal smooth muscle that normally is present throughout this area. 6 This fascinating observation has provided a possible mechanism for the veno-occlusive dysfunction that so often accompanies erectile dysfunction in men with TD.
Although there is now a rich literature on sexual function and testosterone in the literature, there has been little attempt to put together a series of articles reviewing various aspects of this relationship. Until now, Drs. Yafi and Jenkins have recruited top experts in the field and overseen an impressive array of articles that make up this special volume. The Journal extends its sincere appreciation to the guest editors for their outstanding efforts in making this special volume a reality, and we thank all our authors in this volume for their contributions.
We also acknowledge the enormous efforts of the reviewers who provided their careful assessment of these articles. To our knowledge, this collection of articles reviewing the research on testosterone and such a wide range of sexual issues is the most comprehensive collection of such articles that have appeared together.
This special volume represents an important step forward in the evolution of the Journal. It is the mission of the Journal to become the pre-eminent platform for testosterone-related research, and providing this concentrated expertise in the relationship between testosterone and sexual function brings us closer to our goal. The open-access format of the Journal allows everyone to learn from the articles we publish, furthering androgen-related education around the world.
I wish to thank Abdul Traish, PhD, for his vision and leadership as editor-in-chief, and the entire team at Mary Ann Liebert for their support and execution, with special thanks to Sophie Reisz and Rosemary Drake. We encourage readers of this special volume to check back regularly for additional androgen-related content, including original research, reviews, editorials, and interviews. There is no better place to learn about research and clinical expertise regarding androgens.