[Testosterone deficit syndrome and erectile dysfunction]

To analyze the relationship between testosterone deficit syndrome (TDS)and erectile dysfunction and its diagnostic and therapeutic implications.

Bibliographic review in the Pub Med database of the US National Library of Medicine

The real TDS is unknown, due to the lack of uniform diagnostic criteria on what fraction should be measured (total, free or bioavailable) and what the diagnostic values are. Despite this fact, it is estimated that between 5-15% of males with erectile dysfunction show diminished testosterone levels. There is a solid research base demonstrating that testosterone plays an essential role in the physiology of erection, both at central and peripheral levels. Nevertheless, evidence obtained in human studies is not that strong, mainly in old patients with TDS. The results of some metaanalysis show that substitutive treatment with testosterone improves erections and sexual desire. However, not every patient with TDS will benefit from testosterone substitution therapy, probably because in some cases the origin of erectile dysfunction is multifactorial. Combined treatment with testosterone plus phosphodiesterase 5 (PDE 5)seems to be an adequate alternative to rescue patients with erectile dysfunction and hypogonadism not responding to monotherapy, be it with testosterone alone or PDE 5 inhibitors alone.

Systematic determination of serum testosterone in patients consulting for erectile dysfunction is highly recommendable, because testosterone substitution therapy enables, in a number of patients, improvement of erections and sexual desire. Moreover, testosterone substitution therapy may improve the other symptoms of TDS and increase the efficacy of PDE5 inhibitors when they are not effective in monotherapy.