EFFECTS OF TESTOSTERONE (T) REPLACEMENT ON MALE SEXUALITY IN HYPOGONADOTROPIC HYPOGONADISM (HH)

T 3-4 weeks after an i.m. dose of T, many of our HH patients deny a decline in sexuality so soon. To evaluate the effects of T replacement, 9 patients with HH, 18-30 years of age, were studied. Following an i.m. dose of 250 ng T propionate/enanthate they were studied at the 2nd, 4th, 6th and 8 weeks, then received a placebo dose and were reevaluated 1 week later. At each overnight study, they underwent a set of penile tumescence (PT) recordings during a pornographic film and slides, self-induced erotic fantasy and nocturnal PT, as well as self-report of a 10-point questionnaire. Results were compared to those of 10 volunteers. Serum T declined to subnormal levels by the 4th week. On the self-report, sexual drive and fantasies were comparable to controls, but rating of sexual relations, erection time and ejaculations were significantly lower (p<0.01). Self-rating of erection strength showed a gradual decline (p<0.05) and became subnormal by the 8th week. Nocturnal PT and erotic-response PT were normal throughout the 9 weeks of the study and did not drop to subnormal values. It is concluded that the stimulatory effects of T replacement in HH involve mainly libido factors and extend beyond the period of normal serum T. Therapy must be evaluated by these criteria and can be administered bimonthly.