As you probably already know, erection (erectile function) is a very complex process that depends on different mechanisms.
This starts from a sexual stimulus (visual, auditory, olfactory, idea, etc.) influenced by the testosterone, which is integrated into the brain. Here a signal is initiated that travels through the spinal cord, promoting the release of neurotransmitters in the nerve terminals of the penis. They act on the tissue of the cavernous bodies of the penis, formed by a series of cells (sinusoids), like a sponge, surrounded by muscle that has contracted in a flaccid state and therefore, the cells are closed. The neurotransmitters, mainly nitric oxide, cause the muscles of the cells to relax, promoting the entry of blood into the penis and therefore, giving rise to its rigidity.
What does Testosterone do?
La testosterone It appears to regulate the neurological mechanisms of erection at both central and peripheral levels., in addition, it regulates nitric oxide, a mediator that allows for erection. In castrated animals, testosterone or dihydrotestosterone (DHT) supplements restored erectile function and nitric oxide expression in the corpus cavernosum.
Testosterone would regulate both the onset of erection (through the activation of nitric oxide) and its termination.. Although both actions seem contradictory, they have been interpreted as part of the same homeostasis process to maintain adequate levels of enzymes in the physiology of erection (2).
In addition to the role in biochemical regulation in the physiological process of erection, structural changes have also been observed in the cavernous tissue in castrated rabbits, which especially affect the activation and maintenance of the mechanism. veno-occlusive, since there is a reduction in smooth muscle tissue and an increase in connective tissue, with accumulations of adipocytes in the subtunical space, which contribute to the failure of this mechanism.
What is erectile dysfunction?
La erectile dysfunction It is the permanent or temporary inability to achieve and/or maintain a good quality erection that allows for a satisfactory sexual relationship.
What are the causes of erection problems?: Anything that affects one or more of the elements involved in erection can cause erectile dysfunction (impotence):
- Organic causes: when the vessels, nerves or cavernous bodies of the penis are altered.
- Psychogenic causes: When the origin is in the brain (depression, bad relationship, work problems or other problems)
In many cases, both organic and psychogenic causes can be found in the same individual.
Among the organic causes, the most frequent are those that affect the blood vessels, making it difficult for blood to enter or maintain the penis. This may be due to obstructions (arteriosclerosis), trauma or injuries to the arteries. Since the penis is like a large blood vessel, it shares all the risk factors for cardiovascular disease (high cholesterol, smoking, high blood pressure, diabetes, obesity).
Certain diseases, trauma, or other nerve damage can also cause erectile dysfunction. A common condition is when the prostate is completely removed for cancer, which damages the erectile nerves attached to the prostate.
There are a large number of medications (antihypertensives, antidepressants, etc.), drugs and other toxins that can affect erection by acting at different levels.
Certain penile diseases such as Peyronie's disease (penile fibrosis) can also cause dysfunction.
Lastly, Decreased testosterone levels can also affect erectile function..
The influence of Testosterone on erectile function and dysfunction
In humans, there has not been such firm evidence of the influence of testosterone on erectile function as at the experimental level. However, studies carried out on men with severe hypogonadism suggest that Sexual desire, frequency of sexual activity and spontaneous nocturnal erections are clearly dependent on testosterone. In contrast, psychogenic erections, ejaculation and orgasm would be only partially dependent on testosterone (1,2).
In some studies with hypogonadal and elderly patients, a relationship has been detected between the severity of erectile dysfunction and decreased serum levels of free testosterone but not with serum levels of total testosterone.
The actual prevalence of testosterone deficiency syndrome is unknown. But it isIt is estimated that between 5-15% of men with erectile dysfunction have decreased serum levels of testosterone..
In patients who consult for erectile dysfunction, it is highly recommended to perform testosterone level determinations. Replacement treatment allows, in a large proportion of patients, to improve erections and sexual desire. In addition, this treatment can improve the rest of the symptoms of testosterone deficiency syndrome or hypogonadism.
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