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Hyperprolactinemia and male sexual function: focus on erectile dysfunction and sexual desire

Abstract

The present paper aims to analyze and discuss the available evidence supporting the relationship between male sexual function and elevated prolactin (PRL) levels (HPRL). Two different sources of data were analyzed. Clinical data were derived from a series of patients seeking medical care for sexual dysfunction at our Unit. Out of 418 studies, 25 papers were used with a meta-analytic approach to evaluate the overall prevalence of HPRL in patients with erectile dysfunction (ED) and to study the influence of HPRL and its treatment on male sexual function. Among 4215 patients (mean age 51.6 ± 13.1 years) consulting for sexual dysfunction at our Unit, 176 (4.2%) showed PRL levels above the normal range. Meta-analytic data showed that HPRL is a rare condition among patients with ED (2 [1;3]%). Either clinical and meta-analytic data confirm a stepwise negative influence of PRL on male sexual desire (S = 0.00004 [0.00003; 0.00006]; I = −0.58915 [−0.78438; −0.39392]; both p < 0.0001 from meta-regression analysis). Normalization of PRL levels is able to improve libido. The role of HPRL in ED remains inconclusive. Data from a meta-analytic approach showed that either HPRL or reduced T levels were independently associated with ED rates. The normalization of PRL levels only partially restored ED. HPRL did not significantly contribute to ED severity, in our clinical setting. In conclusion, treating HPRL can restore normal sexual desire, whereas its effect on erection is limited.

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Fig. 1: Influence of prolactin levels on pituitary testis axis.
Fig. 2: Sexual desire and prolactin levels.
Fig. 3: Hyperprolactinemia erectile dysfunction and reduced sexual desire.
Fig. 4: Impact of prolactin and total testosterone on erectile dysfunction.
Fig. 5: Impact of medical or surgical treatment in patients with hyperprolactinemia.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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The paper was partially supported by an unrestricted grant “PE8 -Conseguenze e sfidedell’invecchiamento -AGE-IT –CUP B83C22004800006.

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Each author has contributed sufficiently to the intellectual content of the submission. In particular, MM and GC conceived and/or designed the work; AF, NB, and CS acquired data, GR, GC, LV, and MM played an important role in interpreting the results; GC and MM drafted or revised the manuscript. All authors approved the final version. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Corona, G., Rastrelli, G., Bianchi, N. et al. Hyperprolactinemia and male sexual function: focus on erectile dysfunction and sexual desire. Int J Impot Res 36, 324–332 (2024). https://doi.org/10.1038/s41443-023-00717-1

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