Androgens and Erectile Function: A Case for Early Androgen Use in Postprostatectomy Hypogonadal Men

Abstract

Erectile dysfunction affects up to 80% of men following a radical prostatectomy (RP) and is a common concern for these patients. Currently, hypogonadal men are not treated with testosterone after a RP for fear of stimulating dormant prostate cancer cells even though there is little evidence to support this hesitancy. There is data, however, to support the use of testosterone to aid in faster and better recovery of erections following RP. The aim of this article is to explore the relationship between testosterone replacement therapy (TRT) and erectile preservation following RP. The results of findings in the literature on the association between testosterone and its role in preserving erectile function, particularly in men following RP. This article reviews and evaluates the literature that demonstrates the role of testosterone in obtaining erections and preserving erectile function. Additional articles were reviewed to assess the role of testosterone in erectile preservation following RP. This review demonstrates that testosterone does play a role in erectile function, particularly for men who have undergone a RP. Testosterone has been shown to have an effect on nitric oxide synthase release, phosphodiesterase type 5 expression and activity, and in cavernosal nerve function, and to contribute to venoocclusive disease in the penis. All of these effects are of particular importance to men attempting to preserve erectile function following RP. While the relationship between TRT and improvement in erectile function has been well established, the role of testosterone in men following RP may be of even greater significance. However, further studies are needed to assess the true safety of TRT following RP.