Testosterone for Erectile Dysfunction

The specific issue of whether exogenous testosterone can be considered as a primary treatment for ED regardless of etiology is difficult. In clinical practice, there is no need to look to testosterone as first-line therapy when there are disease-specific alternatives. Although there has been a meta-analysis no studies exist to assess testosterone vs. placebo for therapy of ED of wide-spectrum etiology using good numbers and careful design comparable to modern clinical trials. A double-blind, placebo-controlled trial was conducted to examine whether testosterone therapy could salvage sildenafil citrate in Canada failure in men with ED and hypogonadism.

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A total of 75 men were included in the study and were treated with 50 mg/d of testosterone in the form of 1% testosterone gel. Using the International Index of Erectile Function as an assessment tool, following 4 wk of therapy, erectile function was shown to be significantly improved compared with placebo (p = 0.0290). Significant improvements were also reported in orgasmic function (p = 0.009), overall satisfaction (p = 0.02), and the total score of the sexual function questionnaire (p = 0.011). Serum testosterone levels increased from 300 ng/dL at baseline to 500 to 600 ng/dL in the testosterone group. Kalinchenko et al.reported similar results.

Testosterone-replacement therapy for the treatment of ED should be reserved for clear or reasonable biochemical or clinical indications suggesting that androgen abnormali-ties are a contributing cause and that testosterone replacement will not be harmful. The 2nd International Consultation on Erectile Dysfunction (2003) recommended that it is important to screen men who present with ED for low serum testosterone and hypogonad-ism, particularly if they fail treatment with phosphodiesterase-5 inhibitors or if they are in at-risk populations, such as those with diabetes, metabolic syndrome, or chronic renal failure.

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