Effects of testosterone therapy on erection in hypogonadal men

Since the early beginning of testosterone therapy of hypogonadal patients it has been known that testosterone restores normal male sexual behaviour and erectile function (see Chapter 4). A meta-analysis on testosterone therapy for erectile dysfunction in hypogonadal patients confirmed the significant improvement of erections after initiation of testosterone therapy (Jain et al. 2000). It should be noted that most of the clinical trials included only small numbers of patients, in most cases fewer than 20. Pooled data on placebo-controlled studies showed an improvement of erectile function in 36 of 55 men treated with testosterone, whereas significantly fewer men responded to placebo treatment (9 out of 45) (Jain et al. 2000).

A recent large study involving 227 hypogonadal men randomly assigned to therapy with non-scrotal testosterone patches (two testosterone patches per day) or testosterone gel (5-10 g testosterone gel per day) demonstrated significant improvement of erectile function during a treatment period of up to 42 months (Wang et al. 2000; 2002). Sexual performance, "per-cent full erection" and satisfaction with erection were assessed by a simple self-report diary (Lee etal. 2003). Overall, testosterone replacement improved sexual performance, "per-cent full erection" and erection satisfaction significantly. Maximal increases were observed at the first assessment 30 days after initiation of therapy, and erectile function remained constantly improved thereafter. No significant differences were detected between treatment groups (Fig. 11.1).

Early studies on the relationship between androgens and erectile response in men have postulated a difference between spontaneous, sleep-related erections (nocturnal penile tumescence, NPT), which are impaired in terms of duration and degree in hypogonadism and enhanced by testosterone replacement therapy, and erections in response to visual erotic stimuli (VES), which have not been influenced by testosterone withdrawal or replacement (Bancroft and Wu 1983; Kwan et al. 1983). In a later study, nine hypogonadal men showed not only significant increases of penile circumference and rigidity of sleep-related erections after three months of androgen replacement, but also a minor, but significant improvement of both duration of erection and maximum level of rigidity following visual erotic stimuli (Carani etal. 1995).

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