[Treatment of erectile disorders with androgens: When? How?]

Erectile dysfunction associated to low circulating androgens is characterized by a low testosterone due to hypogonadism of hypothalamic-pituitary or testicular origin. Long term androgen administration is unacceptable unless biology has demonstrated hypogonadism with a low testosterone level not related to hyperpolactinemia. Intramuscular testosterone or transdermal dihydrotestosterone can be used with a similar clinical effect but a different biological impact regarding aromatase activity. Whatever may be the type of androgen supplementation, one should use low dosage with frequent administration in order to obtain stable and physiologic plasmatic values. On account of androgen impact on prostate and cardiovascular system, careful pretreatment screening should eliminate an occult prostate cancer and a vascular thrombosis risk in a complaining and informed patient. Clinical and biological parameters should be periodically followed throughout androgen therapy.