Testosterone Replacement Therapy for Men with Erectile Dysfunction

Low serum testosterone (clinically referred to as hypogonadism) is commonly associated with erectile dysfunction (ED). There are merits to treating hypogonadism versus prescribing oral phosphodiesterase (PDE-5) inhibitors (such as Viagra™, Cialis™, and Levitra™) for sexual dysfunction. Testosterone-replacement therapy (TRT) may be the best treatment for men with ED when the presentation includes diminished libido or other sexual symptoms or when non-sexual symptoms such as depressed mood, decreased sense of vitality, and increased fatigue also exist. The health benefits of TRT also include improvements in body composition, bone density, cognition, and sense of well-being. Thus, there may be good reasons to use TRT as first-line therapy for the man with ED. Concerns regarding prostatic and cardiovascular risks of TRT have not been supported by the medical literature. Nevertheless, men receiving TRT must be monitored at regular intervals with digital rectal examination and blood testing for prostate-specific antigen. Hematocrit or hemoglobin also should be obtained regularly due to the risk of erythrocytosis. Awareness of the benefits of TRT in the man with ED may improve clinical outcomes.

Current Urol Reports 2005 Nov;6(6):476-81

According to the Department of Urology, Columbia University, New York, NY, there are benefits to using a combination of testosterone and PDE-5 inhibitors. A recently published multicenter, randomized, placebo-controlled study evaluated the safety and efficacy of testosterone gel 1% plus sildenafil (Viagra™), vs. placebo gel plus sildenafil, in producing an erectile response in men with low serum testosterone who had not responded to treatment with sildenafil alone for ED. Therapy with testosterone gel significantly improved erectile function in response to sildenafil. The combination therapy also significantly improved orgasmic function and patient satisfaction.

J Sex Med 2005 Nov;2(6):785-92

Do you have low Testosterone? Take the ADAM questionnaire ?