title: Does testosterone supplementation increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients?
abstract: BACKGROUND
  Men with erectile dysfunction (ED) considered challenging-to-treat 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.
  
  
  METHODS
  We reviewed data regarding the use of T as a salvage therapy in PDE5i nonresponders.
  
  
  CONCLUSIONS
  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.
authors: Department of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology Section,"Sapienza" University of Rome, Viale Regina Elena , 324, 00161 Rome , Italy +39 06 49970721 ; +39 06 4461450 ; antonio.aversa@uniroma1.it.
authors: Antonio
authors: A
authors: Aversa
authors: Davide
authors: D
authors: Francomano
authors: Andrea
authors: A
authors: Lenzi
mesh_terms: D004359:Drug Therapy, Combination; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000187:drug effects; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D013739:Testosterone / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D013739:Testosterone
keywords: aging male; androgens; erection; frail; sexual function