Testosterone/Estradiol Ratio: The Hidden Key to Low Libido in Men with Sexual Dysfunction?

Poster 149: Testosterone/Estradiol Ratio and Low Libido in Men with Sexual Dysfunction

Title

TESTOSTERONE: ESTRADIOL RATIO A STEP FORWARD TOWARDS THE UNDERSTANDING OF LOW LIBIDO IN MEN WITH SEXUAL DYSFUNCTION

Authors


Rodrigo Freddi, Rubens Neto, Joao Gismondi, Romulo Nunes, Jose de Bessa Jr., Thiago Teixeira, William Nahas, Bruno Nascimento, Jorge Hallak

Affiliations

Division of Urology, Department of Surgery, Hospital das Clinicas, University of Sao Paulo Medical School, Brazil

Division of Urology, State University of Feira de Santana, Bahia, Brazil

Department of Surgery, Division of Urology, Amapa Federal University, Brazil

Androscience – Science and Innovation Center, Sao Paulo, Brazil

Department of Pathology, Reproductive Toxicology Unit, University of Sao Paulo Medical School, Brazil

Institute for Advanced Studies, University of Sao Paulo, Brazil

Introduction & Objective

Sexual desire (libido) is important for men's quality of life, cognitive function, and emotional balance.

Many factors influence libido, including cognitive, neurophysiological, and affective factors.

Hormonal balance, especially the equilibrium between testosterone (T) and estradiol (E), is also important.

The study aimed to evaluate the correlation between loss of libido and hormonal profiles, specifically the testosterone/estradiol (T/E) ratio, in men attending a tertiary center for andrology and sexual medicine in Brazil.

Methods

Retrospective analysis of medical records from a tertiary care center in Sao Paulo, Brazil.

Patients were asked if they perceived a decrease in libido or sexual desire in recent months.

All had morning hormone profiles checked (total testosterone, prolactin, estradiol, LH).

Hormonal profiles categorized into:

Low Testosterone (T < 300 ng/dl)

Normal Testosterone (T ≥ 300 ng/dl)

Standard T/E ratio (>100)

Low T/E ratio (≤100)

Patients with insufficient data or hyperprolactinemia were excluded.

Compared hormonal profiles between men with and without decreased libido, using univariate and multivariate analysis.

Results

Total patients evaluated:
228

Mean age: 61 ± 10 years

Prevalence: 30% complained of low libido

Hormonal findings:

25% had low T levels

22% had a low T/E ratio

Associations:

Among men with low T, 42% reported low libido (Odds Ratio [OR] 1.99; 95% CI: 1.08–3.73; p=0.01)

Among men with low T/E ratio, 52% reported decreased sexual desire (OR 3.47; 95% CI: 1.79–6.46; p=0.001)

In multivariate analysis, low T/E ratio was associated with decreased libido, regardless of T status.

Conclusion

Both low testosterone and low T/E ratios are strongly correlated with decreased libido in men with sexual dysfunction.

The T/E ratio is an independent predictor of decreased libido, irrespective of testosterone status.

Findings suggest that therapies aiming to increase T or decrease E, as well as lifestyle modifications (diet, exercise, metabolic control), may help improve libido in affected men.




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Frequency of decreased libido based on hormonal profile

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Conference Details:

  • Event: ASA & ICA 2025 Annual Meeting
  • Location: Washington, D.C., USA
  • Dates: March 29 – April 1, 2025
  • Poster Session: I
  • Date/Time: Sunday, March 30, 2025, 1:30 PM – 3:00 PM
  • Poster Number: 149
Official Citation Format (suggested):
Freddi R, Neto R, Gismondi J, Nunes R, de Bessa Jr J, Teixeira T, Nahas W, Nascimento B, Hallak J. Testosterone: Estradiol Ratio – A Step Forward Towards the Understanding of Low Libido in Men with Sexual Dysfunction. Poster 149. Presented at: ASA & ICA 2025 Annual Meeting; March 29–April 1, 2025; Washington, D.C., USA.
 
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