Management of Erectile Dysfunction With Hypogonadism

As men age, the risk of developing hypogonadism and erectile dysfunction (ED) increases, especially after the age of 40. Previous animal and human studies have provided strong evidence that testosterone plays an important role in erectile function. In clinical practice, it is necessary to screen for the risk of hypogonadism in men with ED, and testosterone therapy might be considered as first-line therapy for those with both ED and hypogonadism. If erections remain insufficient after 3 months of testosterone therapy alone, then the combination of testosterone and phosphodiesterase type 5 (PDE-5) inhibitor may be suggested. In addition, testosterone therapy has been demonstrated to facilitate the effect of PDE-5 inhibitors in men with ED, especially those who have failed to respond to PDE-5 inhibitors alone. However, the minimal threshold level of serum testosterone necessary to maintain erectile function is still unknown and may vary among individuals. In addition, the potential risks and benefits of testosterone therapy should be assessed and discussed with patients before treatment, and the safety and efficacy of testosterone therapy should be monitored regularly during treatment.