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The association of hormonal alteration and erectile dysfunction (ED) is well recognized. There is, however, a significant reluctance by physicians to consider testosterone deficiency in the diagnostic procedures and also for therapy of ED. Nevertheless, international guidelines emphasize the need for screening for hypogonadism in patients with erectile dysfunction.
Evaluating the impact of testosterone therapy on 1) erectile dysfunction, 2) on improving the therapeutic effect of PDE-5 inhibitors in case of non-responders, 3) impact of the testosterone therapy on veno-occlusive insufficiency (venous leakage) including cavernosographic changes in ED patients with obesity and metabolic syndrome, 4) comparison of the clinical features of a new tong acting testosterone ester i. m. preparation (Nebido®) with other testosterone formulations.
1) Evaluation and critical comparison of the two studies of Alexander Greenstein et al. "Does sildenafil combined with testosterone gel improve erectile dysfunction in hypogonadal men in whom testosterone supplement therapy alone failed?" J. Urol 2005; 173:530-532 and of Aksam Yassin and Farid Saad "Modulation of erectile function with tong-acting testosterone injection (Nebido®) 1000 mg im. in hypogonadal patients. Intl Androl 2005; 28, Suppl1:63.
2) Evaluation and critical comparison of the two studies of Ridwan Shabsigh et al. "Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone". J. Urol 2004; 172: 658-663 and of Aksam Yassin et al. "Combination therapy with testosterone and tadalafil in hypogonadal patients with erectile dysfunction who do not respond to tadalafil as monotherapy" [in German]. "Blickpunkt Der Mann" 2003; 2:37-39.3) Discussion of the findings by Aksam Yassin and Farid Saad "Changes in penile cavernosography and venous leakage under testosterone therapy with Nebido® in hypogonadal patients with erectile dysfunction "case report", Intl Androl 2005; 28, Suppl 1:53.
1) More than 50 % of hypogonadal ED patients reported restored erectile function sufficient for sexual intercourse after 10 resp. 12 weeks of testosterone therapy alone.
2) Testosterone given as adjunctive therapy with PDE-5 inhibitors converts more than 60% of hypogonadal non-responders to monotherapy with POE-5 inhibitors into responders within 10 to 12 weeks of added androgen therapy.
3) Patients with DM type II or metabolic syndrome and severe ED due to venous leakage could improve their sexual function within 9-12 weeks under Nebido®. Interestingly, the pharmaco-cavernosography showed no venous leakage after 12 weeks' treatment with long-acting formulation.
Testosterone therapy alone can restore the erectile function in the majority of the hypogonadal patients. Further evaluations would enlighten the influence of testosterone alone in the follow-up reports. In correspondence to experimental findings, the presented initial clinical results suggest that testosterone has a positive impact on the penile haemodynamic processes including the veno-occlusive properties.
We can suggest or hypothesize that penile venous leak could be a metabolic disorder—which can be reversible in some cases under testosterone substitution—rather than a pure mechanical lesion.
This hypothesis should be tested in further studies.
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