Treatment of Organic ED in Testosterone Deficiency When Testosterone Therapy and PDE5 Inhibitors Have Not Achieved Adequate Erections
Clinical scenario
This protocol applies to men with impotence of organic origin and confirmed testosterone deficiency — defined as a morning serum total testosterone below 300 ng/dL in the presence of symptoms and signs — whose erectile function remained insufficient for satisfactory sexual performance despite a full first-line trial.
First-line treatment did not achieve the target
A prior regimen of testosterone therapy combined with oral PDE5 inhibitors (sildenafil, tadalafil on demand or once daily, vardenafil, or avanafil), alongside lifestyle modifications including dietary changes and increased physical activity, was undertaken. The clinical goal — penile erection sufficient for satisfactory sexual performance — was not reached, indicating escalation to this next-line protocol.
Next-line approach (partial overview)
The structured protocol for this situation encompasses device-based options and locally administered therapeutic approaches, with formulation and titration individualised to the patient …
Treatment target
Penile erection sufficient for successful intercourse.
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.
- Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens.
- Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens.
- Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens.
- The most commonly used outcome measure in ICI studies is the percentage of men who reported achieving an erection sufficient for successful intercourse.
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