Abstract
Although testosterone therapy is enough to restore normal erectile function in the rare young man who presents with severe testosterone deficiency (TD), it often fails when administered alone in middle-aged and older men with low serum testosterone discovered following a consultation for erectile dysfunction (ED). Comorbidities, especially penile vascular damage, are associated with TD in most ED cases and prevent testosterone therapy from improving erections. Conversely, phosphodiesterase type V inhibitor (PDE5I) therapy alone cannot improve reduced sexual desire, which is often associated with ED in the case of TD. Therefore, there is often an indication for combination therapy with PDE5I and testosterone in men with ED who are older than age 50. A minimum serum testosterone level may also be required to achieve the full efficacy of PDE5Is. This was demonstrated in laboratory animals but has not yet been fully confirmed in men.
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