In response. Effects of testosterone replacement on response to sildenafil citrate

Annals of internal medicine (Impact Factor: 17.81). 04/2013; 158(7):570-1. DOI: 10.7326/0003-4819-158-7-201304020-00019
Source: PubMed
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    • "Even the T combination with phosphodiesterase type 5 inhibitors as a possible treatment for phosphodiesterase type 5 inhibitor-resistant ED men has been questioned.51 Recently, Spitzer et al.52 did not document any additional effect on ED subjects of T supplementation to sildenafil. However, in the Spitzer trial, T supplementation was initiated after a sildenafil alone run-in period leading to increased T levels up to the normal range (about 12.0 nmol l−1 (345 ng dl−1)).53 "
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    ABSTRACT: Erectile dysfunction (ED) is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone (T) levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health.
    Asian Journal of Andrology 03/2014; 16(4). DOI:10.4103/1008-682X.126386 · 2.60 Impact Factor
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    • "Considering the androgen-dependency of PDE5 (see above), in the last decade it has been suggested that the combination of TRT and PDE5 inhibitors (PDE5i) can be used to improve PDE5i outcomes in hypogonadal men.62 Accordingly, current guidelines emphasize the concept that hypogonadism must be ruled out or, if present, adequately treated, before prescribing PDE5i.6 Despite this evidence, in a double-blind, parallel, placebo-controlled trial, involving 140 hypogonadal individuals, Spitzer et al63 were unable to document any additional effect on erection by T in men treated for ED with the PDE5i sildenafil. However, it should be recognized that in this trial, TRT was initiated after a sildenafil-alone run-in period characterized by the increase of T levels already within the normal range (about 12.0 nmol/L [345 ng/dl]) in line with previous reports.64 "
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    ABSTRACT: Late-onset hypogonadism (LOH) is a syndromic condition that has a well-recognized association with sexual and reproductive failure. LOH is frequently associated with chronic conditions including cardiovascular diseases (CVD), obesity, osteoporosis, HIV infection, renal failure, and obstructive pulmonary diseases. Despite this evidence, in patients with these conditions, LOH is still only rarely investigated and testosterone replacement therapy (TRT) rarely considered. In this paper, we critically reviewed the available evidence on LOH treatment focusing on possible risks and benefits. Medical therapy of LOH should be individualized depending on the etiology of the disease and the patient's expectations. The fear of prostate cancer and the risk of erythrocytosis probably represent the main limitations of TRT in aging men. However, TRT in healthy older men in near physiological doses does not appear to incur serious adverse events, although regular monitoring of prostate-specific antigen and hematocrit levels is required. Available evidence also suggests that TRT might ameliorate central obesity and glycometabolic control in patients with metabolic syndrome and type 2 diabetes. In addition, TRT has been associated with an increase in bone mineral density in men with osteoporosis, with an improvement in lean body mass in subjects with human immunodeficiency virus infection or chronic obstructive pulmonary disease, as well as with peripheral oxygenation in patients with chronic kidney diseases. Despite this evidence, however, it should be recognized that the results of these trials were heterogeneous and limited by small sample sizes. Hence, further research is required regarding the long-term benefits and adverse effects of TRT in LOH.
    08/2013; 31(2):103-125. DOI:10.5534/wjmh.2013.31.2.103
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    ABSTRACT: With the progressive increase in the proportion of older people, there is an increasing interest in characterizing the modifications of sexual health and the effect of its perturbations as a function of the aging process. The aim of this review is to summarize the available evidence regarding the age-dependent modifications of male sexual function and their interaction with general health and age-dependent modification of endocrine function. Elderly patients are often affected by multiple organic diseases which can interfere with sexual function. Despite this evidence, several studies have indicated that, with advancing age, normal erections are not an absolute prerequisite to remain sexually active. Good physical health, the availability of a partner, and a regular and stable pattern of sexual activity earlier in life predict the maintenance of sexual activity in old age. Conversely, there are no convincing data that hormonal changes, associated with aging, have a primary role in underlying changes in sexual function in healthy aging men. Nonetheless, sexual dysfunctions especially in elderly people are poor investigated. Asking about sexual health remains difficult or embarrassing for many primary care physicians. In addition, many patients find it difficult to raise sexual issues with their doctor. This situation often results in sexual issues not being adequately addressed thus resulting in depression, social withdrawal and delayed diagnosis of underlying medical conditions often resulting in forthcoming cardiovascular events. Education and permission from a health care professional may help to alter such misconceptions. Information from physicians regarding normal age-related changes in sexuality and encouragement, together with advice on how to continue meaningful sexual relations, may play a key role in altering such negative attitudes.
    08/2013; 27(4):581-601. DOI:10.1016/j.beem.2013.05.007