Treatment of Impotence of Organic Origin with Testosterone Deficiency (Morning Total T < 300 ng/dL)
Clinical scenario
This protocol addresses men with organic erectile dysfunction who have a morning serum total testosterone below 300 ng/dL and present with symptoms and signs of testosterone deficiency. Measuring morning serum total testosterone is recommended in all men with erectile dysfunction to identify this specific contributing factor.
Treatment goal
Achieving penile erection sufficient for satisfactory sexual performance.
Treatment approach
When testosterone deficiency is confirmed, the evidence-based approach involves testosterone therapy in combination with an oral phosphodiesterase type 5 inhibitor, alongside lifestyle modifications — the specific agent selection, regimen, and titration strategy are detailed in the full protocol.
References
DOI: 10.1016/j.juro.2018.05.004
Serum total testosterone should be measured in all men with ED to determine if testosterone deficiency (TD), defined as total testosterone <300 ng/dL with the presence of symptoms and signs, is present.
Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy.
If a man with ED is also diagnosed with TD, then he should be counseled that testosterone therapy in combination with a PDE5i is more likely to be effective than the PDE5i alone.
Testosterone therapy is not an effective monotherapy for ED.
Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function.
Erectile dysfunction (ED) can be conceptualized as an impairment in the arousal phase of sexual response and is defined as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.
View source ↗