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Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction
Abstract
Summary: objectives We have recently shown that, in men with erectile dysfunction (ED), free testosterone (FT) directly correlates with penile arterial inflow. This led us to further investigate the effect(s) of androgen administration on cavernous arteries in patients failing sildenafil treatment. design Prospective randomized placebo‐controlled pilot study. patients Twenty patients with arteriogenic ED as evaluated by dynamic colour duplex ultrasound (D‐CDU) studies, normal sexual desire but testosterone (T) and FT in the lower quartile of normal range (low‐normal), not responding to sildenafil treatment (100 mg) on six consecutive attempts. measurements All patients had D‐CDU, hormonal [LH, prostate‐specific antigen (PSA), total and free testosterone, sex hormone‐binding protein (SHBG), oestradiol], biochemical [haematocrit, low‐density lipoprotein (LDL) and HDL cholesterol, triglycerides], and sexual evaluations [International Index of Erectile Function (IIEF)] before and after 1 month of therapy with transdermal testosterone (5 mg/day, n = 10) or placebo along with sildenafil treatment on demand. Measurement of flow parameters by D‐CDU on cavernous arteries was the primary endpoint of the study. Improvement of erectile function was assessed using the IIEF questionnaire and the Global Assessment Question (GAQ). results One month treatment with transdermal testosterone led to a significant increase in T and FT levels (23·7 ± 3·3 SD vs. 12·8 ± 2·1 nmol/l and 473 ± 40·2 vs. 260 ± 18·1 pmol/l, P < 0·01, respectively). In addition testosterone administration induced a significant increase in arterial inflow to cavernous arteries measured by D‐CDU (32 ± 3·6 vs. 25·2 ± 4 cm/s, P < 0·05), with no adverse effects. Also, a significant improvement in erectile function domain score at IIEF was found in the androgen but not in the placebo‐treated patients (21·8 ± 2·1 vs. 14·4 ± 1·4, P < 0·05) which was associated with significant changes in the GAQ score (80%vs. 10%, P < 0·01). conclusions In patients with arteriogenic ED and low‐normal androgen levels, short‐term testosterone administration increases T and FT levels and improves the erectile response to sildenafil likely by increasing arterial inflow to the penis during sexual stimulation.
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“Testosterone replacement therapy in two studies was found to convert sildenafil nonresponders to responders (18,19).”
From Clinical and Biochemical Assessment of Hypogonadism in Men With Type 2 Diabetes (2007) · cites this paper as [19]
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Bhasin, S., & Basson, R. J. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-29738-7.00020-4 · Cited by 15
Testosterone Substitution: Current Modalities and Perspectives
Zitzmann, M., & Nieschlag, E. (2006) · Journal für Kardiologie (Krause & Pachernegg GmbH) · Cited by 12
Evaluation of androgen receptor markers in erectile dysfunction
Khodamoradi, K., Campbell, K., Arora, H., & Ramasamy, R. (2023) · Andrology · doi:10.1111/andr.13507 · Cited by 11
Testosterone Replacement Therapy: What We Know Is Not Yet Enough
Isidori, A. M., & Lenzi, A. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)60960-9 · Cited by 11
Self-citationTestosterone replacement therapy for late-onset hypogonadism: current trends in Korea
Ko, Y. H., & Kim, J. J. (2011) · Asian Journal of Andrology · doi:10.1038/aja.2010.124 · Cited by 11
Metadata
- Authors
- Aversa, A., Isidori, A. M., Spera, G., Lenzi, A., & Fabbri, A.
- Affiliations
- Sapienza University of Rome (IT)
- University of Rome Tor Vergata (IT)
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2003-05
- Volume
- 58
- Issue
- 5
- Pages
- 632-638
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1994273184
- Cited by
- 343
- References
- 38
- Citations by year
- 2025: 7 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 4 · 2019: 10 · 2018: 5 · 2017: 2 · 2016: 9 · 2015: 7 · 2014: 15 · 2013: 11 · 2012: 15
- FWCI
- 22.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Ministero dell'Università e della Ricerca
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Keywords
- erectile dysfunction, arteriogenic erectile dysfunction, transdermal testosterone, androgen therapy, free testosterone, erectile function, sex hormone-binding globulin, International Index of Erectile Function, sex hormones, estradiol
- MeSH terms
- Sildenafil Citrate, Aged, Androgens, Arteries, Humans, Male, Middle Aged, Penile Erection, Penis, Pilot Projects, Piperazines, Prospective Studies, Purines, Regional Blood Flow, Sulfones, Testosterone, Vasodilation, Vasodilator Agents, Treatment Failure, Impotence, Vasculogenic
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