MODULASI NEUROENDOKRIN TERHADAP FREKUENSI EJAKULASI: TINJAUAN SISTEMATIS TENTANG KINETIKA ANDROGEN, SENSITIVITAS RESEPTOR ANDROGEN, DAN IMPLIKASI METABOLIK
NEUROENDOCRINE MODULATIONS OF EJACULATORY FREQUENCY: A SYSTEMATIC REVIEW OF ANDROGEN KINETICS, ANDROGEN RECEPTOR SENSITIVITY, AND METABOLIC IMPLICATIONS
Abstract
This systematic review aims to critically evaluate the physiological impacts of ejaculatory abstinence (semen retention) versus frequent ejaculation on the Hypothalamic-Pituitary-Gonadal (HPG) axis, serum testosterone levels, and androgen receptor (AR) density. A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD42024336252). Electronic searches were performed across seven databases: PubMed/MEDLINE, Scopus, EMBASE, Google Scholar, ScienceDirect, Cochrane Library, and Web of Science, from inception to December 2024. Grey literature was also searched via OpenGrey and ProQuest Dissertations. Two independent reviewers screened studies and extracted data. Risk of bias was assessed using RoB 2 for RCTs, Newcastle-Ottawa Scale for observational studies, and SYRCLE for animal studies. Fifteen studies met the inclusion criteria. Short-term abstinence (7 days) induces a transient supraphysiological testosterone spike (~145% of baseline), which returns to homeostasis thereafter. Sexual satiety reversibly downregulates androgen receptors in the hypothalamic medial preoptic area (MPOA), with recovery within 72 hours. Frequent ejaculation correlates with reduced testosterone synthesis only in dietary zinc deficiency. Frequent ejaculation (≥21/month) was associated with a 20% reduction in prostate cancer risk. The relationship between ejaculation and androgen status is biphasic and homeostatic. Periodic short-term abstinence may resensitize neuroendocrine pathways, whereas regular ejaculation supports prostate health. Clinicians should consider these findings when counseling patients regarding sexual and hormonal health.
Abstrak
Tinjauan sistematis ini bertujuan untuk mengevaluasi secara kritis dampak fisiologis dari pantang ejakulasi (penahanan semen) dibandingkan dengan ejakulasi yang sering terhadap sumbu Hipotalamus-Hipofisis-Gonad (HPG), kadar testosteron serum, dan kepadatan reseptor androgen (AR). Tinjauan sistematis ini dilakukan sesuai dengan pedoman PRISMA 2020 dan terdaftar di PROSPERO (CRD42024336252). Pencarian elektronik dilakukan di tujuh basis data: PubMed/MEDLINE, Scopus, EMBASE, Google Scholar, ScienceDirect, Cochrane Library, dan Web of Science, sejak awal hingga Desember 2024. Literatur abu-abu juga dicari melalui OpenGrey dan ProQuest Dissertations. Dua peninjau independen menyaring studi dan mengekstrak data. Risiko bias dievaluasi menggunakan RoB 2 untuk uji klinis terkontrol acak (RCT), Skala Newcastle-Ottawa untuk studi observasional, dan SYRCLE untuk studi pada hewan. Lima belas studi memenuhi kriteria inklusi. Abstinensi jangka pendek (7 hari) memicu lonjakan testosteron di atas fisiologis yang sementara (~145% dari baseline), yang kembali ke homeostasis setelahnya. Kepuasan seksual secara reversibel menurunkan ekspresi reseptor androgen di area preoptik medial hipotalamus (MPOA), dengan pemulihan dalam 72 jam. Ejakulasi yang sering hanya berkorelasi dengan penurunan sintesis testosteron pada defisiensi seng diet. Ejakulasi yang sering (≥21 kali/bulan) dikaitkan dengan penurunan risiko kanker prostat sebesar 20%. Hubungan antara ejakulasi dan status androgen bersifat biphasik dan homeostasis. Pantang seksual jangka pendek secara berkala dapat meningkatkan sensitivitas jalur neuroendokrin, sementara ejakulasi secara teratur mendukung kesehatan prostat. Para tenaga medis sebaiknya mempertimbangkan temuan ini saat memberikan konseling kepada pasien mengenai kesehatan seksual dan hormonal.
References
Archives of Sexual Behavior. Semen retention and the 'NoFap' movement: A qualitative analysis. Arch Sex Behav. 2016;45(3):625-632.
Exton MS, Krüger TH, Bursch N, et al. Endocrine response to masturbation-induced orgasm in healthy men following a 3-week sexual abstinence. World J Urol. 2001;19(5):377-382. doi:10.1007/s003450100222
Smith JT, Clarke IJ. Kisspeptin expression in the brain: catalyst for the initiation of puberty. Rev Endocr Metab Disord. 2007;8(1):1-9. doi:10.1007/s11154-007-9026-0
Gonzales GF. Function of seminal vesicles and their role on male fertility. Asian J Androl. 2001;3(4):251-258.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
Jiang M, Xin J, Zou Q, Shen JW. A research on the relationship between ejaculation and serum testosterone level in men. J Zhejiang Univ Sci A. 2003;4(2):236-240. doi:10.1631/jzus.2003.0236
Exton MS, Bindert A, Krüger T, et al. Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med. 1999;61(3):280-289.
Fernández-Guasti A, Phillips-Farfán BV, Swaab D. Sexual behavior reduces hypothalamic androgen receptor immunoreactivity. Neuroendocrinology. 2007;86(3):212-222. doi:10.1159/000108304
Phillips-Farfán BV, Fernández-Guasti A. Endocrine manipulation of the refractory period and sexual satiety in the male rat. Horm Behav. 2009;55(1):196-203.
Brody S, Krüger TH. The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety. Biol Psychol. 2006;71(3):312-315. doi:10.1016/j.biopsycho.2005.06.008
Salamone JD, Pardo M, Yohn SE, et al. Mesolimbic dopamine and the regulation of effort-based decision making. Front Behav Neurosci. 2016;10:52. doi:10.3389/fnbeh.2016.00052
Costello LC, Franklin RB, Feng P. Zinc and prostate cancer: a critical scientific review of risk. J Inorg Biochem. 2016;111:23-37. doi:10.1016/j.jinorgbio.2016.02.002
Hunt CD, Johnson PE, Herbel J, Mullen LK. Effects of dietary zinc depletion on seminal volume and zinc loss, serum testosterone concentrations, and sperm morphology in young men. Am J Clin Nutr. 1992;56(1):148-157. doi:10.1093/ajcn/56.1.148
Kilic M, Baltaci AK, Gunay M, et al. The effect of exhaustion exercise on thyroid hormones and testosterone levels of elite athletes receiving oral zinc. Neuro Endocrinol Lett. 2006;27(1-2):247-252.
Rider JR, Wilson KM, Sinnott JA, et al. Ejaculation frequency and risk of prostate cancer: Updated results with an additional decade of follow-up. Eur Urol. 2016;70(6):974-981. doi:10.1016/j.eururo.2016.03.027
Sztajzel J, Périat M, Marti V, et al. Effect of sexual activity on cycle ergometer stress test parameters, on plasmatic testosterone levels and on concentration capacity. J Sports Med Phys Fitness. 2000;40(3):233-239.
Zavorsky GS, Brooks LR. The influence of sexual activity on athletic performance: A systematic review and meta-analysis. Sci Rep. 2022;12:16127. doi:10.1038/s41598-022-19803-9
Ditzen B, Schaer M, Gabriel B, et al. Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict. Biol Psychiatry. 2009;65(9):728-731. doi:10.1016/j.biopsych.2008.10.011
Liu Q, Miyasaka A, et al. Dopamine-acetylcholine interaction in the regulation of male sexual behavior in mice. Neuron. 2025;113(6):945-958. doi:10.1016/j.neuron.2025.01.015
Hull EM, Rodríguez-Manzo G. Male sexual behavior. In: Pfaff DW, Arnold AP, et al., eds. Hormones, Brain and Behavior. 2nd ed. San Diego: Academic Press; 2009:1-54.
Ouzzani M, Hammady H, Fedorowicz Z, Moher D. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. doi:10.1186/s13643-016-0384-4
Copyright (c) 2026 Muhammad Arief Pratama, Rosa Zorayatamin Damanik, Zanurul Rifhan
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
