The Nature of Androgen Action on Male Sexuality: A Combined Laboratory-Self-Report Study on Hypogonadal Men*

Sexual function and the effects thereon of testosterone enanthate were studied in six hypogonadal men with the objective of delineating the specific components of male sexuality affected by androgen. To obtain a detailed picture of these components, prospective self-report data (from daily logs) of sexual activity and feelings, recordings of all night penile tumescence, and laboratory psychophysiological data were assessed. Double blind placebo experiments with cross-over design were used to compare the effects of placebo and 200- and 400-mg doses of testosterone enanthate. Erectile responses to erotic film and fantasy were not lower in the hypogonadal patients than in normal men and, in fact, were higher on some parameters, especially prolongation of detumescence time after exposure to film or fantasy. Three subjects who kept consistent daily logs had increased frequencies of sexual acts and feelings, orgasms, and spontaneous erections after testosterone administration. Nocturnal penile tumescence and spontaneous daytime erections were reduced in untreated hypogonadal men and were significantly increased after testosterone treatment, but the laboratory-tested erectile responses to film and fantasy were not affected by testosterone. These data and previous findings lead to the conclusion that the major androgen action on male sexuality involves libido factors (i.e. sexual motivation/interest). Though stimulus-bound erections elicited in the laboratory were not reduced in hypogonadal men, spontaneous (sleep or waking) erections were clearly testosterone dependent.