Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses. Although testosterone has a role in erections, its importance in erectile dysfunction (ED) has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate, but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of 178 men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Sexual function improved in 75%, with no change in 25%, while significant increases in luteinizing hormone (P<) and free testosterone (P<) occurred in all patients. Multivariable analysis showed that responses decreased significantly with aging (P<). Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use. Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.
These findings provide support for the controversial ‘extreme male brain’ theory of autism, a disorder characterized by impairments in social interaction and a tendency to engage in repetitive behaviours. This theory posits that autism represents an extreme version of the normal male brain profile that is characterized by an increased systematizing ability and a reduced empathizing ability in comparison to females. The pathological impairment of empathy in autism may therefore arise from excessive “male” hormone levels during development. Accordingly, reduced 2D:4D ratios have been observed in autistic individuals and in their first-degree relatives.