Abstract
Although testosterone therapy is enough to restore normal erectile function in the rare young man who presents with severe testosterone deficiency (TD), it often fails when administered alone in middle-aged and older men with low serum testosterone discovered following a consultation for erectile dysfunction (ED). Comorbidities, especially penile vascular damage, are associated with TD in most ED cases and prevent testosterone therapy from improving erections. Conversely, phosphodiesterase type V inhibitor (PDE5I) therapy alone cannot improve reduced sexual desire, which is often associated with ED in the case of TD. Therefore, there is often an indication for combination therapy with PDE5I and testosterone in men with ED who are older than age 50. A minimum serum testosterone level may also be required to achieve the full efficacy of PDE5Is. This was demonstrated in laboratory animals but has not yet been fully confirmed in men.
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References and Recommended Reading
Buvat J, Bou Jaoudé G: Significance of hypogonadism in erectile dysfunction: World J Urol 2006, 24:657–667.
Bolona ER, Uraga MV, Haddad RM, et al.: Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc 2007, 82::20–28.
Isidori AM, Gianetta E, Gianfrilli D, et al.: Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005, 63:381–394.
Greenstein A, Mabjeesh NJ, Sofer M, et al.: Does sildenafil combined with testosterone gel improve erectile dysfunction in hypogonadal men in whom testosterone supplement therapy alone failed? J Urol 2005, 173:530–532.
Suzuki N, Sato Y, Hisasue SI, et al.: Effect of testosterone on intracavernous pressure elicited with electrical stimulation of the medial preoptic area and cavernous nerve in male rats. J Androl 2007, 28:218–222.
Traish A, Goldstein I, Kim NN: Testosterone and erectile function: from basic research to new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. Eur Urol 2007, 52:54–70.
Morelli A, Filippi S, Mancina R, et al.: Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology 2004, 145:2253–2263.
Zhang XH, Morelli A, Luconi M, et al.: Testosterone regulates PDE5 expression and in vivo responsiveness to tadalafil in rat corpus cavernosum. Eur Urol 2005, 47:409–416.
Zhang XH, Filippi S, Morelli A, et al.: Testosterone restores diabetes-induced erectile dysfunction and sildenafil responsiveness in two distinct animal models of chemical diabetes. J Sex Med 2006, 3:253–264.
Vignozzi L, Morelli A, Filippi S, et al.: Testosterone regulates RhoA/Rho-kinase signaling in two distinct animal models of chemical diabetes. J Sex Med 2007, 4:620–630.
Armagan A, Kim NN, Goldstein I, et al.: Dose-response relationship between testosterone an erectile function: evidence for the existence of a critical threshold. J Androl 2006, 27:517–526.
Schultheiss D, Badalyan R, Pilatz A, et al.: Androgen and estrogen receptors in the human corpus cavernosum penis: immunohistochemical and cell culture results. World J Urol 2003, 21:320–324.
Foresta C, Caretta N, Rossato M, et al.: Role of androgens in erectile function. J Urol 2004, 171:2358–2362.
Aversa A, Isidori AM, De Martino MU, et al.: Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf) 2000, 53:517–522.
Aversa A, Isidori AM, Spera G, et al.: Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol (Oxf) 2003, 58:632–638.
Rochira V, Balestrieri A, Madeo B, et al.: Sildenafil improves sleep-related erections in hypogonadal men: evidence from a randomized, placebo-controlled, cross-over study of a synergistic role of both testosterone and sildenafil on penile erections. J Androl 2006, 27:165–175.
Rosenthal BD, May NR, Metro MJ, et al.: Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone. Urology 2006, 67:571–574.
Guay AT, Perez JB, Jacobson J, et al.: Efficacy and safety of Sildenafil citrate for treatment of Erectile Dysfunction in a population with associated organic risk factors. J Androl 2001, 22:793–797.
Kalinchenko SY, Kozlov GI, Gontcharov NP, et al.: Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone. Aging Male 2003, 6:94–99.
Teloken PE, Ohebshalom M, Mohideen N, et al.: Analysis of the impact of androgen deprivation therapy on sildenafil citrate response following radiation therapy for prostate cancer. J Urol 2007, 178:2521–2525.
Koulikov D, Fridmans A, Chertin B, et al.: Is sildenafil citrate associated with an amelioration of the symptomatology of androgen decline in the aging male? J Urol 2007, 177:2267–2271.
Park K, Ku JH, Kim SW, et al.: Risk factors in predicting a poor response to sildenafil citrate in elderly men with erectile dysfunction. BJU Int 2005, 95:366–370.
Wespes E, Rammal A, Garbar C: Sildenafil non responders: hemodynamic and morphometric studies. Eur Urol 2005, 48:136–139.
Shamloul R, Ghanem H, Fahmy I, et al.: Testosterone therapy can enhance erectile function response to sildenafil in patients with PADAM: a pilot study. J Sex Med 2005, 2:559–564.
Hwang TI, Chen HE, Tsai TF, et al.: Combined use of androgen and sildenafil for hypogonadal patients non responsive to sildenafil alone. Int J Impot Res 2006, 18:400–404.
Yassin AA, Saad F, Diede HE: Testosterone and erectile function in hypogonadal men unresponsive to tadalafil. Results from an open-label uncontrolled study. Andrologia 2006, 38:61–66.
Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan: Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004, 172:658–663.
Carosa E, Martini P, Brandetti F, et al.: Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin Endocrinol (Oxf) 2004, 61:382–386.
Greco EA, Pili M, Bruzziches R, et al.: Testosterone:estradiol ratio changes with long-term tadalafil administration: a pilot study. J Sex Med 2006, 3:716–722.
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Buvat, J., Jaoudé, G.B. Combination therapy with phosphodiesterase type V inhibitors and testosterone. Curr sex health rep 5, 135–140 (2008). https://doi.org/10.1007/s11930-008-0024-7
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DOI: https://doi.org/10.1007/s11930-008-0024-7