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October 3, 1980

Impotence Is Not Always Psychogenic-Reply

Author Affiliations

Beth Israel Hospital Harvard Medical School Boston

JAMA. 1980;244(14):1559. doi:10.1001/jama.1980.03310140018014

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In Reply.—  The purpose of our article was to alert physicians to the frequency with which disorders of the hypothalamic-pituitary-gonadal axis occur in patients whose initial complaint is impotence.Parenthetically, the word impotence, defined in Merriam-Webster's as "a physical or psychological abnormal state of a male characterized by inability to copulate," is perfectly clear, understood by all, and preferable to the currently trendy bland euphemism "erection problems."Dr Kavich-Sharon's contention that we need more information to fully understand the biochemistry of sexual function and dysfunction is, of course, correct. We neither recommend nor condone the use of a therapeutic trial of testosterone therapy in impotent patients who have normal serum testosterone values. The treatment is reserved for those who, for one reason or another, are unable to produce adequate amounts of testosterone spontaneously.The reference to our patients as last resort is unwarranted. We did have some concern that the