Does testosterone supplementation increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients?

Abstract

Introduction: Men with erectile dysfunction (ED) considered challenging-totreat with PDE-5 inhibitors (PDE5i) include patients with severe neurological damage (e.g., due to radical prostatectomy), diabetes and severe vascular disease. Another factor that may limit PDE5i efficacy is the age-related decline of testosterone (T), occurring in 3 --35% of older men depending on different cut-offs chosen. T regulation of PDE5 expression has been accepted as one of the major mechanisms controlling vasodilator mechanisms in penile tissue. Areas covered: We reviewed data regarding the use of T as a salvage therapy in PDE5i nonresponders. Expert opinion: Guidelines recommend that hypogonadal men with ED should commence therapy with PDE5i due to time course effects of T on erection that needs 6 --12 weeks to occur. The possibility to 'salvage' some patients with low T not responding to PDE5i alone by adding T therapy should consider correct cut-off values, plasma T levels attained and androgen receptor (AR) polymorphism. Meta-analyses suggest that T treatment plus PDE5i yielded more effective results in noncontrolled versus controlled studies. We recommend T assay in all men with ED not responsive to PDE5i. Before commencing T treatment, side effects and consequent higher mortality in older frail men have to be avoided.

Erectile dysfunction, physical activity and physical exercise: Recommendations for clinical practice

“…These data indicate a mutual relationship between testosterone, ED and physical performance: regular exercise is important for maintaining a good erection but if testosterone levels are not adequate the patient may not be able to reach appropriate fitness levels. Furthermore, decreased testosterone levels could make less effective the action of the drugs used for ED treatment, such as phosphodiesterase‐5 inhibitors (PDE5i; Aversa, Francomano, & Lenzi, ).…”

Effect of low androgen levels on the sulphur dioxide signalling pathway in rat penile corpus cavernosum

“…Moreover, it increases the responses of the penile corpus cavernosum to mediators (such as α‐adrenergic mediators) leading to vasoconstriction and smooth muscle contraction, and reduces NO‐mediated smooth muscle relaxation under sexual stimulation, etc. (Aversa, Francomano, & Lenzi, ), which eventually inhibits erectile function.…”

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

“…Международное многоцентровое про-спективное исследование с участием 1493 мужчин пока-зало, что ТЗТ достоверно улучшает либидо, эректильную функцию и ответ на терапию ингибиторами фосфодиэ-стеразы 5 типа, часто используемыми при лечении ЭД на фоне СД [18,78,79]. Следует отметить, что при СД наряду с гипогонадизмом причинами ЭД являются ней-ропатия и васкулопатия, а снижение либидо может быть психогенным [18].…”