Our male patients will often ask, “Will Testosterone help with my erectile dysfunction (ED)?” Our physicians, specializing in hormone therapy, will often advise many patients that testosterone replacement may often help to increase your desire for sexual activity and improve your erectile dysfunction (ED). Although the primary treatment for ED is not testosterone replacement, testosterone does play a pivotal role to maintain penile tissue health and function.
We know that some men do see a significant improvement in their erectile function while on testosterone therapy. This may be due to several factors. Testosterone replacement improves insulin sensitivity, reduces obesity, improves body composition, encourages a healthier lifestyle change and reverses metabolic derangements. This process may assist in improving erectile function.
Secondly, testosterone does have an effect on erectile tissues (cavernosa). Within the cavernosa of the penis are androgen receptors. Testosterone replacement therapy enhances activation of androgen receptors, upregulating nitric oxide synthase (NOS) and promoting new DNA synthesis. NOS is the principle enzyme responsible for penile smooth muscle relaxation and achievement of tumescence (engorgement of blood within the penis to achieve an erection).
Men, who are hypogonadal, have erectile dysfunction and do not respond to PDE5 inhibitors may improve their erectile function with testosterone replacement. However, men with more severe ED may not have that same response. A meta-analysis of the results of testosterone replacement therapy on sexual function as measured by the International Index of erectile function scores (IIEF) found an increase in IIEF scores with a mean difference of 2.31 in men with testosterone therapy replacement. Furthermore, other aspects of the IIEF score domains were also improved including libido, intercourse satisfaction, orgasm, and overall sexual satisfaction.
We do find many men with hypogonadism to have other associated conditions that can cause ED which include diabetes, hypertension, elevated lipid profiles, and obesity.
The work up for E.D, in short, begins with history and physician examination to define the cause of the condition. Defining the cause for ED will direct the proper treatment.