When men present with Premature Ejaculation (PE), I tell them that it may not be a psychological problem and many a time hormones are involved. The male sexual response has four phases, namely, excitement phase, plateau phase, orgasm phase and resolution phase . PE occurs because there is steep excitement and a very short plateau which leads on to quick ejaculation. Hormones play a vital role in the male sexual response. The key hormones which need to be evaluated in men with Ejaculatory dysfunction are testosterone, prolactin and thyroid hormones. Testosterone is the male sex hormone which is responsible for strength, vigor, vitality, muscle mass and the feel good factor. It is predominantly produced by the testis and also in small amounts by the adrenals. While a low testosterone level is associated with delayed ejaculation, an increase in testosterone may be responsible for Premature Ejaculation.
Prolactin is another key hormone which plays a vital role in ejaculatory function. Prolactin is produced by the Brain and is an inhibitory sex hormone. An increase in prolactin levels are associated with delayed ejaculation. Though there are plenty of reasons for increased prolactin levels, not infrequently a prolactin secreting tumor in the brain may be responsible for producing prolactin. These men have difficulty in sustaining their erection as they are not able to ejaculate even after performing for a prolonged period of time.
The thyroid gland in the region of the neck is responsible for all the metabolic functions in the body. When there is deceased secretion of thyroid hormone (thyroxine) as in hypothyroidism, there is listlessness, lethargy
and delayed ejaculation. An increased secretion of thyroxine (hyperthyroidism) is associated with premature ejaculation. Hence, after taking a thorough history it becomes mandatory for evaluating most patients with PE with a hormonal profile to rule out abnormal levels of these hormones.