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Androgènes et sexualité masculine

Androgens and male sexuality

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La testostérone (T) est indispensable au maintien de la fonction sexuelle chez l'homme. Elle agit sur toutes les composantes de l'acte sexuel: libido, érection et éjaculation. Au niveau de l'érection, seules les érections spontanées nocturnes sont androgénodépendantes à l'inverse de celles provoquées par fantasmes ou par stimulation visuelle.

C'est essentiellement sous forme de dihydrotestostérone (DHT) que l'hormone mâle semble exercer ses actions aussi bien au niveau central que périphérique. Une intervention au niveau cérébral des estrogènes (E) produits localement ne peut cependant pas être formellement écartée.

Les concentrations de T requises pour le rétablissement de la fonction sexuelle en cas d'hypogonadisme sont proches de la limite inférieure des valeurs normales. le seuil supérieur d'action de la T sur la sexualité-s'il existe- se situerait à des niveaux supraphysiologiques.

L'androgénothérapie des dysfonctionnements sexuels est en pleine évolution. De nouveaux produits plus performants et de nouvelles voies d'administration moins astreignantes et plus physiologiques sont en cours d'évaluation. De plus l'affinement de l'exploration des androgènes plasmatiques associé à une meilleure compréhension des effets secondaires de la thérapeutique androgénique laissent espérer l'obtention dans un proche avenir d'un consensus autour de l'élargissement du champ d'indications de l'androgénothérapie.

Abstract

Testosteron is known to be critical for the right maintenance of masculin sexuality. It acts on all components of sexuality: libido, erection and ejaculation. As far as erection is concerned, one has to emphasize on the fact that only spontaneous nocturnal erections are androgen-dependent unlike erectile responses to visual erotic stimuli

The T can act, at the level of target organes, either as unchanged or as more often observed after reduction to DHT or aromatisation to E2. It is essencially as DHT that the male hormone seems to act on the sexuality at both the central and peripherical levels. The oestrogens even if now shown to have no peripherical action, are still subject to controversy as far as their central action is concerned. Therefore an action at the cerebral level of the oestrogens produced locally can not be definitively eliminated.

The concentrations of T required for the re-establishment of the sexual function in case of hypogonadism are closer to the lower limits of normal values. The upper treshold of the action of T on the sexuality, if any, would be at supra-physiological levels.

Androgenotherapy of sexual dysfonctionnalities is wittnissing a constant evolution. New and more performing products, as well as novel and less astreignant ways of administration, are already disponible or under evaluation. Moreover, the improvement of plasmic androgen exploration (dosage of free and non-sex hormone-binding globulin bound testosterone) associated to a better understanding of side effects of the androgenic therapeutics may allow in the near futur to reach a consensus on the androgenotherapy indications. As a matter of fact among the population of patients considered eugonadic (based on normal levels of T) and showing a sexual dysfonctionality, two subgroups might be interested: That of elderly patients displaying either an increase of the hormone-binding globulin (SHBG) or a decrease of the non-sex hormone-binding globulin bound testosterone levels and that of young patients suffering from idiopathic impotence. It should be, however, pointed at that the recent character of the different physiopathologic and therapeutic acquisitions requires a validation through larger series and long term studies.

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Hafidi, A., Gharbi, M.H. Androgènes et sexualité masculine. Androl. 6 (Suppl 4), 387–397 (1996). https://doi.org/10.1007/BF03034459

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