The Evolving Role Of Testosterone In The Treatment Of Erectile Dysfunction

Summary and Introduction

Summary

Hypogonadism may play a significant role in the pathophysiology of erectile dysfunction (ED). A threshold level of testosterone may be necessary for normal erectile function. Testosterone replacement therapy is indicated in hypogonadal patients and is beneficial in patients with ED and hypogonadism. Monotherapy with testosterone for ED is of limited effectiveness and may be most promising in young patients with hypogonadism and without vascular risk factors for ED. A number of laboratory and human studies have shown the combination of testosterone and other ED treatments, such as phosphodiesterase type 5 (PDE5) inhibitors, to be beneficial in patients with ED and hypogonadism, who fail PDE5 inhibitor therapy alone. There is increasing evidence that combination therapy is effective in treating the symptoms of ED in patients for whom treatment failed with testosterone or PDE5 inhibitors alone. Testosterone replacement therapy has potentially evolved from a monotherapy for ED in cases of low testosterone, to a combination therapy with PDE5 inhibitors. Screening for hypogonadism may be useful in men with ED who fail prior PDE5 inhibitors, especially in populations at risk for hypogonadism such as type 2 diabetes and the metabolic syndrome.Introduction

The pathophysiology of erectile dysfunction (ED) is multifactorial, involving vascular, neurologic, hormonal and/or psychological causes. The prevalence of hypogonadism in men with ED varies depending on the study populations, comorbidities and diagnosis methods. Approximately 12% of patients with ED may have hypogonadism.[1] Hypogonadism is defined as a state of deficiency in gonadal function manifested by deficient secretion of gonadal hormones and/or gametogenesis.[2] For the purpose of this paper, review and discussion will be limited to hypogonadism as testosterone deficiency. Reduced production of testosterone may increase the risk of osteoporosis, sexual dysfunction, fatigue, cardiovascular disease and mood disturbances, and may decrease muscle mass.[2] Hypogonadism may be classified as hypergonadotrophic in cases of testicular failure or hypogonadotrophic in cases of hypothalamic/pituitary failure.[2] Ageing is associated with gradually declining levels of testosterone (late-onset hypogonadism or androgen decline in the ageing male).[3] In addition, chronic medical disorders are also frequently associated with hypogonadism, such as type 2 diabetes,[4] the metabolic syndrome, chronic renal failure and chronic hepatic failure. The International Consultation on Sexual and Erectile Dysfunction recommended that adult-onset hypogonadism be defined as a clinical and biochemical syndrome.[3]

Testosterone plays a key role in the central and peripheral modulation of erectile function[5] New research in the laboratory and in humans is shaping a refinement of the role of testosterone replacement therapy in ED. This paper will address the evolving role of testosterone in the treatment of ED, both as a monotherapy and in combination with phosphodiesterase type 5 (PDE5) inhibitors.  Printer- Friendly Email This

Int J Clin Pract.  2006;60(9):1087-1092.  ©2006 Blackwell Publishing
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