Original Article

Aromatase Inhibition for the Treatment of Idiopathic Hypogonadotropic Hypogonadism in Men with Premature Ejaculation

Authors: John M. Holbrook, PHD, Paul G. Cohen, MD

Abstract

Background: Idiopathic hypogonadotropic hypogonadism (IHH) has been observed to occur in men with premature ejaculation (PE). Common IHH therapies include testosterone replacement, which increases testosterone levels but suppresses gonadotropin release; and gonadotropin-releasing hormone supplementation, which restores gonadotropin levels but is impractical for chronic use. Hormonal imbalances associated with IHH/PE are thought to be related to hyperactivity of the cytochrome P-450 enzyme aromatase.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Cohen PG. The association of premature ejaculation and hypogonadotropic hypogonadism. J Sex Marital Ther 1997; 23: 208–211.
 
2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.
 
3. White BJ, Rogol AD, Brown KS, Lieblich JM, Rosen SW. The syndrome of anosmia with hypogonadotropic hypogonadism: A genetic study of 18 new families and a review. Am J Med Genet 1983; 15: 417–435.
 
4. Winter JS, Faiman C. Serum gonadotropin in concentrations in agonadal children and adults. J Clin Endocrinol Metab 1972; 35: 561–564.
 
5. Crowley WF, Whitcomb RW. Gonadotropin-releasing hormone deficiency in men: Diagnosis and treatment with exogenous gonadotropin-releasing hormone. Am J Obstet Gynecol 1990; 163: 1752–1758.
 
6. Cohen PG. The hypogonadal obesity cycle: Role of aromatase in modulating the testosterone-estradiol shunt—major factor in the genesis of morbid obesity. Med Hypotheses 1999; 52: 49–51.
 
7. Simpson ER, Mahendroo MS, Means GD, Kilgore MW, Hinshelwood MM, Graham-Lorence S, et al. Aromatase cytochrome P450, the enzyme responsible for estrogen biosynthesis. Endocr Rev 1994; 15: 342–355.
 
8. Bhatnagar AS, Muller P, Schenkel L, Trunet PF, Beh I, Schieweck K. Inhibition of estrogen biosynthesis and its consequences on gonadotrophin secretion in the male. J Steroid Biochem Mol Biol 1992; 41: 437–443.
 
9. Matsumoto AM. Hormonal therapy of male hypogonadism. Endocrinol Metab Clin North Am 1994; 28: 857–875.
 
10. Tenover JL. Male hormone replacement therapy including “andropause.” Endocrinol Metab Clin North Am 1998; 27: 969–987.
 
11. Wang C, Swerdloff RS. Androgen replacement therapy. Ann Med 1997; 29: 365–370.
 
12. Barkan AL, Reame NE, Kelch RP, Marshall JC. Idiopathic hypogonadotropic hypogonadism in men: Dependence of the hormone responses to gonadotropin-releasing hormone (GnRH) on the magnitude of the endogenous GnRH secretory defect. J Clin Endocrinol Metab 1985; 61: 1118–1125.
 
13. Nachtigall LB, Boepple PA, Pralong FP, Crowley WF Jr. Adult-onset idiopathic hypogonadotropic hypogonadism: A treatable form of male infertility. N Engl J Med 1997; 336: 410–415.
 
14. Plourde PV, Dyroff M, Dowsett M, Demers L, Yates R, Webster A. ARIMIDEX: A new oral, once-a-day aromatase inhibitor. J Steroid Biochem Mol Biol 1995; 53: 175–179.
 
15. Finkelstein JS, Whitcomb RW, O'Dea LS, Longcope C, Schoenfeld DA, Crowley WF Jr. Sex steroid control of gonadotropin secretion in the human male: Part I—Effects of testosterone administration in normal and gonadotropin-releasing hormone-deficient men. J Clin Endocrinol Metab 1991; 73: 609–620.
 
16. Cohen PG, Holbrook JM. Effects of fenfluramine on ejaculatory function, luteinizing hormone and testosterone levels in men with hypogonadotropic hypogonadism and premature ejaculation. Int Clin Psychopharmacol 1999; 14: 91–94.
 
17. Wang C, Iranmanesh A, Berman N, McDonald V, Steiner B, Ziel F, et al. Comparative pharmacokinetics of three doses of percutaneous dihydrotestosterone gel in healthy elderly men: A clinical research center study. J Clin Endocrinol Metab 1998; 83: 2749–2757.
 
18. Cooper AJ, Cernovsky ZZ, Colussi K. Some clinical and psychometric characteristics of primary and secondary premature ejaculators. J Sex Marital Ther 1993; 19: 276–288.
 
19. Hayes FJ, DeCruz S, Seminara SB, Boepple PA, Crowley WF Jr. Differential regulation of gonadotropin secretion by testosterone in the human male: Absence of a negative feedback effect of testosterone on follicle-stimulating hormone secretion. J Clin Endocrinol Metab 2001; 86: 53–58.
 
20. Kim SC, Sec KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: A double-blind, placebo controlled study. J Urol 1998; 159: 425–427.
 
21. Cohen PG. Aromatase, adiposity, aging and disease: The hypogonadal-metabolic-atherogenic-disease and aging connection. Med Hypotheses 2001; 56: 702–706.