Modifying Risk Factors in the Management of Erectile Dysfunction: A Review
OBJECTIVES To evaluate the impact of normalization of testosterone levels in men with documented hypogonadism and erectile dysfunction on erectile function and sexual satisfaction. Although the data support the role of testosterone in the preservation of libido and nocturnal erectile function, the evidence supporting the use of testosterone supplementation in hypogonadal men with erectile dysfunction is weak. METHODS This analysis used two validated questionnaires, the International Index of Erectile Function and the Erectile Dysfunction Inventory of Treatment Satisfaction, in a serial fashion at baseline (before treatment) and 1, 3, and 6 months after the achievement of a therapeutic testosterone level. RESULTS A total of 32 men met all inclusion criteria; 69% of men achieved therapeutic testosterone levels using transdermal testosterone gel, 19% required a transdermal patch, and 12% required intramuscular delivery. Statistical significance was reached for the difference between the baseline and 1-month International Index of Erectile Function erectile function domain score and all post-treatment International Index of Erectile Function libido scores. A steady decrease occurred in the Erectile Dysfunction Inventory of Treatment Satisfaction scores from the 1 to 6-month values that reached statistical significance. CONCLUSIONS In men with documented hypogonadism and erectile dysfunction, normalization of serum testosterone levels was associated with only short-term improvement in erectile function and sexual satisfaction. The use of testosterone supplementation in this population for the treatment of erectile dysfunction is questionable.