Erectile dysfunction testosterone therapy

Testosterone therapy may be indicated for the treatment of erectile dysfunction in which of the following situations ... 

Finasteride (Propecia) is a 5 -reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone, the androgen responsible for androgenic alopecia in genetically predisposed men. Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss in a significant proportion of men with androgenic alopecia. Treatment for at least 3-6 months is necessary to see increased hair growth or prevent further hair loss. Continued treatment with finasteride is necessary to sustain benefit. Reported side effects include decreased libido, ejaculation disorders, and erectile dysfunction, which resolve in most men who remain on therapy and in all men who discontinue finasteride. 

Shabsigh R, Kaufman JM, Steidle C, et al. Randomised study of testosterone gel as adjunctive therapy to sildenafil in hypogo-nadal men with erectile dysfunction who do not response to sildenafil alone. J Urol 2004 172 658-663. 

For the man with symptomatic hypogonadism (decreased libido, energy loss, and erectile dysfunction), a normal prostate examination, and a normal serum prostate-specific antigen, testosterone can be considered as adjunctive therapy. Testosterone patches (2.5-5 mg daily), intramuscular injections (10 to 400 mg every 2 to 4 weeks), 1% topical gel, pellet implants (150 50 mg every 3-6 months), and a buccal formulation are available (see Table 88-6). Testosterone replacement increases bone density in men. The benefits of therapy need to be... 

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