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Erectile dysfunction in aging men: testosterone role in therapeutic protocols

N Caretta1, A Ferlin, P F Palego

  • 1Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padua, 35128 Padua, Italy.

Journal of Endocrinological Investigation
|June 9, 2006
PubMed

Insights

Low testosterone levels (hypogonadism) are common in older men with erectile dysfunction (ED). Testosterone therapy may improve erectile function, especially when combined with PDE5 inhibitors for men unresponsive to these drugs alone.

Area of Science:

  • Andrology
  • Urology
  • Endocrinology

Background:

  • Aging in men is linked to decreased libido and sexual activity.
  • Biochemical hypogonadism (low testosterone) affects a significant proportion of men over 60.
  • Hypoandrogenism may contribute to erectile dysfunction (ED) and reduced response to PDE5 inhibitors.

Purpose of the Study:

  • To investigate the role of testosterone in aging men with ED.
  • To evaluate the efficacy of testosterone treatment in hypogonadal men with ED.
  • To determine if testosterone therapy improves response to PDE5 inhibitors.

Main Methods:

  • Assessed erectile function in hypogonadal men before and after testosterone treatment.
  • Evaluated response to sildenafil and apomorphine in hypogonadal men.
  • Measured nitric oxide (NO) production and endothelial progenitor cell (EPC) numbers.

Main Results:

  • Testosterone treatment stimulated nitric oxide (NO) production and improved endothelial repair via increased endothelial progenitor cells (EPCs).
  • Hypogonadal men treated with testosterone showed normal erectile responses to apomorphine and sildenafil.
  • Testosterone therapy positively influenced central and peripheral erection control, endothelial function, and PDE5 expression.

Conclusions:

  • Plasma testosterone levels should be measured in aged men with ED.
  • Testosterone replacement therapy is recommended for hypogonadal men with ED, barring contraindications.
  • Combining testosterone with PDE5 inhibitors may benefit hypogonadal men with ED unresponsive to PDE5 inhibitors alone.

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