The hormonal regulation of men’s sexual desire, arousal, and penile erection: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)
Bibliographic record
Abstract
INTRODUCTION: The sexual response, including sexual desire and arousal/penile erection in men, is affected by several hormones and neurotransmitters. OBJECTIVES: To give resources to understand the usefulness to assess different hormones when considering a man with hypoactive sexual desire or erectile dysfunction and to provide evidence-based recommendations for clinical practice. A level of evidence grading system was used to provide strong, moderate, or conditional recommendations. METHODS: An extensive revision of the scientific literature was performed by the subcommittee of the International Consultation of Sexual Medicine. The results were first extensively discussed by the sub-committee members and presented publicly for further discussion with other experts. The roles of hypothalamic (kisspeptin, α-melanocyte-stimulating hormone), pituitary (prolactin, oxytocin [OT], and growth hormone), thyroid, adrenal (dehydroepiandrosterone, glucocorticoids, and mineralocorticoids) and sex hormones were considered. RESULTS: Testosterone has a primary role in controlling and coordinating male sexual desire and arousal, acting at multiple levels. Accordingly, meta-analysis indicates that testosterone therapy for hypogonadal individuals can improve low desire and erectile dysfunction. Hyperprolactinemia is associated with low desire which can be successfully corrected by appropriate treatments. OT, α-melanocyte-stimulating hormone, and kisspeptin are important in eliciting sexual arousal; however, the use of these peptides or their analogs, for stimulating sexual arousal is still under investigation. Evaluation and treatment of other endocrine disorders are suggested only in selected cases. CONCLUSIONS: Endocrine abnormalities are common in patients with sexual dysfunction. The identification of some of these is mandatory (ie, testosterone, prolactin), whereas, for others, it is known that their disorders may cause sexual dysfunction without, however, being frequently recognized in subjects consulting for sexual dysfunction (ie, thyroid and growth hormones). Others may be important, but the clinical use is limited by issues with their measurement (ie, estradiol, dihydrotestosterone), whereas for some hormones or neuropeptides, the clinical usefulness for diagnostic and/or therapeutic purposes should still be established.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.073 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.013 |
| Bibliometrics | 0.010 | 0.006 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.007 | 0.003 |
| Research integrity | 0.010 | 0.007 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".