Experience with the complex use of testosterone and L-arginine in men with sexual dysfunction and androgen deficiency

Currently, the problem of androgen deficiency in men is well studied, taking into account the age aspect of this pathology. At the same time, data from some epidemiological studies indicate its prevalence among young people. Thus, the number of men with androgen deficiency aged 20-29 in Great Britain is 2-3%, 40-49 years - 10% of the total number of patients. In the USA, 5% of young men aged 30-39 have symptoms of this pathology, and in Canada, 14.2% of men under 39 receive androgen therapy.

According to the recommendations of the European Association of Endocrinologists, the diagnosis of androgen deficiency is established in the presence of specific or non-specific symptoms and signs that are accompanied by an unambiguous decrease in testosterone (T) levels in the blood. Some of the specific symptoms are sexual dysfunctions, in particular decreased libido (LD) and sexual activity, as well as adequate erections. In addition, a number of authors include a decrease in biologically active fractions of testosterone in the concept of androgen deficiency and consider all variants of erectile dysfunction (ED) as specific manifestations of androgen deficiency.

Our previous studies have established that in some young men without clinical signs of hypogonadism against the background of hypotestosteronemia, in addition to these disorders, one of the common forms of sexual dysfunction (SD) is also observed - premature ejaculation (PE).

One of the treatment options in this case is the prescription of testosterone preparations. In addition, sometimes to enhance the therapeutic effect, particularly in older men, it is recommended to combine this therapy with the prescription of drugs from the group of phosphodiesterase type 5 inhibitors (PDE-5). The use of such therapeutic regimens in young men had a more pronounced therapeutic effect, as evidenced by our previous studies.

Today, some authors highlight normalization of nitrogen balance as one of the criteria for successful treatment of hypogonadism, which is a classic manifestation of androgen deficiency. It has been established that in men with hypogonadotropic hypogonadism, the level of the conditionally essential amino acid L-arginine (L-Apr), necessary for the synthesis of nitric oxide (NO), in the blood is higher, and NO is lower than in practically healthy men, and against the background of testosterone therapy, an increase in the concentration of NO in the blood and a decrease in the concentration of L-arginine are noted.

Another study found that the concentration of L-arginine in cavernous blood is significantly lower in men with erectile dysfunction than in healthy individuals. This is also significant for the vascular supply of erectile function, which is confirmed by the participation of testosterone in the activation of the NOS enzyme, which is necessary for stimulating the release of NO from the cavernous bodies of the penis.

Experimental data have shown that the combined use of testosterone and L-arginine leads to an increase in intracavernous pressure in castrated rats, despite the competing interaction of L-arginine and NOS, which is explained by the existence of other androgen-dependent mechanisms of vascular support of erection.

At the same time, the effect of this complex therapy on sexual dysfunctions in young men with androgen deficiency has not been studied to date, which was the goal of our study.

A total of 34 men aged 22-42 years were observed in the andrology office. They were diagnosed with androgen deficiency due to a decrease in total testosterone (Ttot) corresponding to borderline values (8.0-12.0 nmol/l) and a decrease in free testosterone (Tfree) below 31.0 pmol/l. Complaints of erectile dysfunction, premature ejaculation, and decreased libido were noted, which allowed them to be considered as manifestations of androgen deficiency. Twenty-six of the examined men had combined pathology (a combination of erectile dysfunction and decreased libido or erectile dysfunction and premature ejaculation), and 8 had monopathology.

As a control group, 21 men with normal sexual function (SF) and normotestosteronemia were examined.

All patients were recommended to apply 1% testosterone gel to the shoulder area, 5 g once a day in the morning, in combination with an L-arginine-containing dietary food supplement recommended for use in men's diets as an additional source of amino acids, nicotinic acid and fructose, 1 packet once a day in the morning for one month. This supplement contains: L-arginine - 2500 mg, fructose - 1375 mg, propionyl-b-carnitine - 250 mg and vitamin B3 - 20 mg. In addition to the above-mentioned key properties of L-arginine, this combination of nutrients has metabolic and antioxidant properties, which is essential in conditions of hypoandrogenemia.

The andrological status of all patients was examined using the generally accepted method.

The diagnosis of premature ejaculation was established based on measuring the duration of sexual intercourse, which, according to existing recommendations, exceeds one minute in healthy men.

Total Ttot and Tfree levels in the blood were determined using enzyme immunoassay kits.

Before and one month after treatment, we studied the state of sexual function based on the anamnesis, complaints, as well as an analysis of the results of the questionnaire “International Index of Erectile Function” (IIEF-15) and a study of the duration of sexual intercourse.

Statistical processing of the obtained data was carried out using the Statistica software package using Student's t-test and the x2 method.

The clinical examination did not reveal hypogonadism, traumatic, inflammatory lesions of the genitals, varicocele, pathology of the central nervous system, mental illnesses and severe somatic pathology, i.e. conditions that may be accompanied by hypoandrogenemia and/or affect the results of the study. They also did not take medications that could affect the state of sexual function.

Hormonal examination data revealed a decrease in the levels of total T in 34 men (mean values were 10.8±0.8 nmol/l) and free T in 21 men (8.1±0.9 pg/ml), and in accordance with the recommendations, androgen therapy was prescribed in the case of a decrease in total T or both androgens. The levels of total T and free T in men in the control group were within the normal range and were significantly higher than in the main group (22.3±1.4 nmol/l and 88.0±7.0 pg/ml, respectively; p < 0.001).

These results of the IIEF-15 questionnaire, characterizing the symptoms under study, and the total indicator determining the state of sexual function as a whole, made it possible to establish a reliable increase in the total score at the end of therapy compared with the indicators before therapy, which did not differ significantly from the control values.

At the end of therapy, against the background of normalization of androgen levels in the blood of all men, the restoration of erectile function and libido, as well as an increase in the duration of sexual intercourse were noted in the overwhelming majority of men, which indicated a significant effect of this therapy. In our opinion, the use of L-arginine, which is a donor of NO, is necessary for the timely replenishment and normalization of nitrogen balance in the body under conditions of increasing concentration and can be considered as an option for supplementing the diet in the treatment of sexual dysfunctions in young men with androgen deficiency.

Thus, the combined use of testosterone and L-arginine-containing dietary supplement for one month in men with sexual dysfunctions and androgen deficiency in most cases leads to the normalization of their sexual function.

Cand. Sci. (Medicine) A. S. Minukhin, Dr. Sci. (Medicine) V. A. Bondarenko, Prof. E. V. Kristal. Experience of complex use of testosterone and L-arginine in young men with sexual dysfunctions and androgen deficiency // International Medical Journal - No. 4 - 2012

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