Molecules promoting sexual drive in .NET framework

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Molecules promoting sexual drive
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Table 133 presents, in a short format, the various molecules that are thought to participate in the regulation of the biologic component of sexual desire, after a review by Meston [12]
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Hypoactive Sexual Desire in Men
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Table 133 Molecules that have been reported to in uence sexual desire (modi ed after Meston and Frohlich) [12] Effect on sexual desire: = increase 0 = no change = decrease
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Class
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Molecule
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Kind of population studied
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Author/year
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Reference number
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Hormones Testosterone
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Hypogonadal or castrated men
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Davidson, et al 1982 Kwan M, et al 1983 Skakkeoaek NE, et al 1981 Halpern CT, et al 1994 Udry JR, et al 1985 Schiavi RC & White D, 1976
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13,14,15
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Testosterone
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16,17
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Testosterone
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Normal range testosterone levels Sex offenders Normal males and hyperactive sexual desire males Hyperprolactinemia
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Estrogen Progesterone
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Bancroft J, et al 1974 Heller CG, et al 1958 Money J, 1970
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19 20,21
Prolactin
Bancroft J, 1984 Bancroft J, et al 1984 Buckman MT & Kellner R, 1984 Dornan WA & Malsbury CW, 1989 Muller P, et al 1979
22,23,24,25,26
Cortisol Pheromones Neurotransmitters Serotonin
Cushing syndrome Normal men
Starkman MN, et al 1981 Cutler WB, et al 1998
27 28
0, reported as probably because of interference with arousal and orgasm
Use of Monoamine oxidase inhibitors, Selective serotonin reuptake inhibitors and antipsychotic medication users Apomorphine/levodopa Parkinson disease patients Cimetidine and ranitidine users
Montejo-Gonzalez AL, et al 1997
Dopamine
Uitti RJ, et al 1989
Histamine
White JM & Rumbold GR, 1988
13
Sexual inciters
Sexual suppressors
Physiologic inciters
Testosterone Aphrodisiac drugs Physical / genital stimulation
HYPOTHALAMIC AND LIMBIC SEX REGULATING CENTERS
Physiologic suppressors
Hormone disorders Drugs with sexual side effects Depression
Psychologic inciters
Attractive partner Erotic stimulation Fantasy Love Courtship
SUBJECTIVE EXPERIENCE OF
Psychologic inhibitors
LUST
Unattractive partner Negative thoughts Anti-fantasies Negative emotions Stress and anger
Fig 132 A conceptual model of the integration of biologic and psychologic factors in sexual desire (after Kaplan, 1995) [35]
Sexual desire
Sexual avoidance
The role of testosterone, and perhaps several other androgens, appears to be necessary for the experience of sexual desire in its drive component [32] It appears that a minimum level of androgen is required for the man to be able to experience sexual desire; however the relationship is not completely linear, as the higher level of androgen in blood does not correlate with higher level of sexual desire [18] In addition to the molecules mentioned in Table 133, there has been some speculation on the role of oxytocin [33] and, in a recent report [34], the role of thyroid hormone has been suggested
Integrating the components of desire
One conceptual model that is helpful to integrate both physiologic and psychologic factors of sexual desire has been proposed by Helen Kaplan [35] Although this model still requires empirical validation, it represents an interesting tool for the understanding of the dynamics of a man with HSD The model is summarized in Figure 132
Etiology of Hypoactive Sexual Desire
Hypoactive sexual desire is a condition that many times is part of another disease or disorder Other
times, the decrease or absence of sexual desire occurs with no other sexual dysfunction or recognizable pathology In any event, it is critical that the clinician identi es this condition; lack of success in treatment of other sexual dysfunctions, like erectile dysfunction, can sometimes be explained by the presence and lack of proper treatment of HSD The list included in Table 134, taken from Meuleman & Van Lankvled (2005) [2], is a summary of the causes of HSD seen frequently in clinical practice Hypoactive sexual desire is frequent in men with erectile dysfunction In a series of 428 men with erectile dysfunction, Corona and co-workers (2004) [5] reported that 433% of their participants had the condition This group found no correlation for patient or partner s age Men with HSD in this study were not diagnosed as hypogonadic more frequently than men without HSD; however ANOVA showed a signi cant (P < 0005) difference of total, free testosterone and prolactin levels among patients with different severities of HSD No signi cant correlation was found for: follicle-stimulating hormone (FSH) (r = 004), luteinizing hormone (LH) (r = 004), thyroid-stimulating hormone (TSH) (r = 006), or testis volume (r = 008) No correlation was found for: prostate speci c antigen (PSA), blood pressure, lipid pro le, glycemia, and parameters derived from
Hypoactive Sexual Desire in Men
Table 134 List of medical and psychologic factors that can
cause HSD [2]
Androgen de ciency Hyperprolactinemia Anger and anxiety Depression Relationship con ict Stroke Antidepressant therapy Epilepsy Post-traumatic stress syndrome Renal failure Coronary disease and heart failure Ageing HIV Body-building and eating disorders
Table 135 Clinical indicators of sexual desire Sexual frequency However, sometimes frequency desire: activity can occur with no desire Sexual fantasies Sexual thoughts Initiation of sexual activity
ports in the literature give some light to this In a group of non-dysfunctional couples, LoPiccolo and Friedman reported that the majority of the participants both desired and had sexual activity between once and four times a week [36] In a research setting, Schiavi [37] suggested a criteria of sexual activity occurring less than once every two weeks, for persons 55 years or younger, suggests HSD Some patients present themselves as having low sexual desire, which in fact is a result of another sexual dysfunction Erectile dysfunction is sometimes confused by the patient as a sign of diminished desire Likewise, the avoidance pattern that follows the frustration generated by a persistent dysfunction, like severe premature ejaculation or erectile dysfunction, can also be reported as absence of desire These clinical situations demand a careful evaluation from the clinician before arriving at a clinical diagnosis