Effect of hyperprolactinemia in male patients consulting for sexual dysfunction

The physiological role of prolactin (PRL) in male sexual function has not been completely clarified.

The aim of this study is the assessment of clinical features and of conditions associated with hyperprolactinemia in male patients consulting for sexual dysfunction.

A consecutive series of 2,146 (mean age 52.2 +/- 12.8 years) male patients with sexual dysfunction was studied.

Several hormonal and biochemical parameters were studied along with validated structured interviews (ANDROTEST and the Structured Interview on Erectile Dysfunction [SIEDY]). Mild hyperprolactinemia (MHPRL; PRL levels of 420-735 mU/L or 20-35 ng/mL) and severe hyperprolactinemia (SHPRL, PRL levels >735 mU/L, 35 ng/mL) were considered.

MHPRL and SHPRL were found in 69 (3.3%) and in 32 (1.5%) patients, respectively. Mean age and the prevalence of gynecomastia were similar in the two groups and in subjects with normal prolactin values. MHPRL was not confirmed in almost one-half of the patients after repetitive venous sampling. Hyperprolactinemia was associated with the current use of antidepressants, antipsychotic drugs, and benzamides. SHPRL was also associated with hypoactive sexual desire (HSD), elevated thyrotropin (TSH), and hypogonadism. The association between HSD and SHPRL was confirmed after adjustment for testosterone and TSH levels, and use of psychotropic drugs (hazard ratio [HR] = 8.60[3.85-19.23]; P < 0.0001). In a 6-month follow-up of patients with SHPRL, testosterone levels and sexual desire were significantly improved by the treatment.

Our data indicate that SHPRL, but not MHPRL, is a relevant determinant of HSD. Gynecomastia does not help in recognizing hyperprolactinemic subjects, while the use of psychotropic medications and HSD are possible markers of disease. In the case of MHPRL, repetitive venous sampling is strongly encouraged.