Premature Ejaculation and Its Association with Serum Testosterone Levels: A Comprehensive Review

Abstract

Premature ejaculation (PE) is the most common form of male sexual dysfunction. Various hormonal and nutritional deficiencies have been implicated in PE, although conflicting data exist. We sought to determine if androgen levels, particularly testosterone, correlate with PE. A comprehensive narrative review was performed by using PubMed. Exclusion criteria included review articles and articles addressing nonandrogenic hormones. Sixty articles met our inclusion criteria and 165 were excluded. Relatively high testosterone levels were associated with PE, including men with specific medical histories (e.g., emotional trauma and infertility). On a molecular level, increased trinucleotide CAG repeats within the androgen receptor gene contributed to the relationship between high testosterone and PE. Elevated fetal androgen exposure was also linked to increased risk of PE, although the data were contradictory. In addition, although not explicitly related to high testosterone, lowering testosterone via various interventions was associated with PE improvement. Conversely, relatively low testosterone was also associated with increased risk of PE, especially when increasing testosterone through medical or surgical treatments helped alleviate PE in both human- and animal-based models. Finally, numerous studies showed no association between testosterone levels and PE, including in patients with normal or low testosterone, concurrent sexual pathologies (e.g., infertility and chronic prostatitis), comorbid chronic diseases, or various nutritional deficiencies or toxicities. The association between testosterone and PE remains controversial. Relatively high and low testosterone both appear to be associated with PE, although strong evidence exists that PE is not affected by testosterone levels. Thus, the physiologic mechanism behind PE is multifactorial and cannot be attributed solely to testosterone levels.