Testosterone and Sexual Desire: A Review of the Evidence

Abstract

Sexual desire is driven by complex interactions between various biopsychosocial factors including neuroendocrine regulation, mental state, and cultural values. Herein we perform a narrative review to describe the underlying physiology of sexual desire and summarize the current literature linking testosterone to sexual function. The following search terms were used to identify articles on the Medline and PubMed databases: “libido,” “testosterone replacement therapy,” “androgen receptor,” and “sexual desire.” Only articles in English were included. Several animal and human studies have implicated the pivotal role of testosterone (T) in regulating the physiological pathways underlying sexual desire. Functional imaging studies have identified several regions in the brain that are activated by sexual stimuli and these androgenic pathways. A strong correlation between serum T levels and libido in men has been reliably and repeatedly demonstrated. An important clinical application of this association is the improvement of sexual desire secondary to testosterone replacement therapy in hypogonadal men. We summarize the current literature on the neuroendocrine role of testosterone in sexual desire and its dose-dependent relationship with libido.