Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The role of testosterone in erectile dysfunction

Abstract

Erectile dysfunction (ED) is a clinical disorder that results from a continuous spectrum of clinical factors, including physical illness (comprising the organic component of ED), reaction to stress (the intrapsychic component of ED) and relationship difficulties (the relationship component of ED). Testosterone clearly has a relevant role in all three causes of ED; the usefulness of this hormone in the treatment of ED has not, however, been completely clarified. The main physiological action of testosterone in the male sexual response is to regulate the timing of the erectile process as a function of sexual desire, thereby coordinating penile erection with sex. The link between ED, hypogonadism and underlying disorders (such as metabolic syndrome and type 2 diabetes mellitus) is nowadays well documented. The recognition of underlying disorders might be useful in motivating men with ED to improve their health-related lifestyle choices. Hence, patients with ED might be considered 'lucky', because their disorder offers the opportunity to undergo medical examinations to detect underlying disease. Both ED and hypogonadism are treatable conditions. A range of testosterone preparations are available for supplementation; their combination with phosphodiesterase 5 inhibitors might improve outcomes in some cases.

Key Points

  • Testosterone levels can reflect perturbations in all three dimensions (organic, intrapsychic and relationship) of erectile dysfunction (ED)

  • Testosterone is important not only in controlling the mechanical process of penile erection, but it also controls male sexual behavior and attitudes

  • Testosterone replacement therapy (TRT) should be considered the first-line treatment in hypogonadal patients with ED

  • TRT monotherapy might not be adequate in all cases of ED because of the multifactorial pathophysiology of this disorder

  • In these cases, combination therapy with phosphodiesterase 5 inhibitors might improve outcomes

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1: Correlation between testosterone plasma levels and different clinical, instrumental and sexual parameters.
Figure 2: The putative role of testosterone in the mechanism of penile flaccidity and erection.
Figure 3: Correlation between testosterone plasma levels and different clinical, instrumental and sexual parameters.
Figure 4: Prevalence of hypogonadism according to different definitions.
Figure 5

References

  1. Golden, S. H., Robinson, K. A., Saldanha, I., Anton, B. & Ladenson, P. W. Clinical review: prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J. Clin. Endocrinol. Metab. 94, 1853–1878 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Corona, G. et al. Age related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J. Sex. Med. doi:10.1111/j.1743-6109.2009.01601.x

  3. [No authors listed] NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 270, 83–90 (1993).

  4. Petrone, L. et al. Structured interview on erectile dysfunction (SIEDY): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction. Int. J. Impot. Res. 15, 210–220 (2003).

    Article  CAS  PubMed  Google Scholar 

  5. Traish, A. M., Saad, F., Feeley, R. J. & Guay, A. T. The dark side of testosterone deficiency: III. cardiovascular disease. J. Androl. 30, 477–494 (2009).

    Article  CAS  PubMed  Google Scholar 

  6. Corona, G., Mannucci, E., Forti, G. & Maggi, M. Hypogonadism, ED, metabolic syndrome and obesity: a pathological link supporting cardiovascular diseases. Int. J. Androl. 32, 587–598 (2009).

    Article  CAS  PubMed  Google Scholar 

  7. Diaz-Arjonilla, M., Schwarcz, M., Swerdloff, R. S. & Wang, C. Obesity, low testosterone levels and erectile dysfunction. Int. J. Impot. Res. 21, 89–98 (2009).

    Article  CAS  PubMed  Google Scholar 

  8. Yassin, A. A., Saad, F. & Gooren, L. J. Metabolic syndrome, testosterone deficiency and erectile dysfunction never come alone. Andrologia 40, 259–264 (2008).

    Article  CAS  PubMed  Google Scholar 

  9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285, 2486–2497 (2001).

  10. Corona, G. et al. Psycho-biologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur. Urol. 50, 595–604 (2006).

    Article  PubMed  Google Scholar 

  11. Corona, G. et al. ANDROTEST: a structured interview for the screening of hypogonadism in patients with sexual dysfunction. J. Sex. Med. 3, 706–715 (2006).

    Article  PubMed  Google Scholar 

  12. Corona, G., Forti, G. & Maggi, M. Why can patients with erectile dysfunction be considered lucky? The association with testosterone deficiency and metabolic syndrome. Aging Male 11, 193–199 (2008).

    Article  CAS  PubMed  Google Scholar 

  13. Filippi, S. et al. Testosterone partially ameliorates metabolic profile and metabolic responsiveness to PDE5 inhibitors in an animal model of metabolic syndrome. J. Sex. Med. doi:10.1111/j.1743-6109.2009.01467.x

  14. Burcelin, R., Thorens, B., Glauser, M., Gaillard, R. C. & Pralong, F. P. Gonadotropin-releasing hormone secretion from hypothalamic neurons: stimulation by insulin and potentiation by leptin. Endocrinology 144, 4484–4491 (2003).

    Article  CAS  PubMed  Google Scholar 

  15. Dhindsa, S. et al. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J. Clin. Endocrinol. Metab. 89, 5462–5468 (2004).

    Article  CAS  PubMed  Google Scholar 

  16. Corona, G. et al. Association of hypogonadism and type 2 diabetes in men attending an outpatient erectile dysfunction clinic. Int. J. Impot. Res. 18, 190–197 (2006).

    Article  CAS  PubMed  Google Scholar 

  17. Brüning, J. C. et al. Role of brain insulin receptor in control of body weight and reproduction. Science 289, 2122–2125 (2000).

    Article  PubMed  Google Scholar 

  18. Traish, A. M., Toselli, P., Jeong, S. J. & Kim, N. N. Adipocyte accumulation in penile corpus cavernosum of the orchiectomized rabbit: a potential mechanism for veno-occlusive dysfunction in androgen deficiency. J. Androl. 26, 242–248 (2005).

    Article  PubMed  Google Scholar 

  19. Morelli, A. et al. Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J. Endocrinol. Invest. 30, 880–888 (2007).

    Article  CAS  PubMed  Google Scholar 

  20. Yassin, A. A. & Saad, F. Testosterone and erectile dysfunction. J. Androl. 29, 593–604 (2008).

    Article  CAS  PubMed  Google Scholar 

  21. Chamness, S. L. et al. The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat. Fertil. Steril. 63, 1101–1107 (1995).

    Article  CAS  PubMed  Google Scholar 

  22. Lugg, J. A., Rajfer, J. & Gonzalez-Cadavid, N. F. Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat. Endocrinology 136, 1495–1501 (1995).

    Article  CAS  PubMed  Google Scholar 

  23. Park, K. H., Kim, S. W., Kim, K. D. & Paick, J. S. Effects of androgens on the expression of nitric oxide synthase mRNAs in rat corpus cavernosum. BJU Int. 83, 327–333 (1999).

    Article  CAS  PubMed  Google Scholar 

  24. Vignozzi, L. et al. Testosterone and sexual activity. J. Endocrinol. Invest. 28 (3 Suppl.), 39–44 (2005).

    CAS  PubMed  Google Scholar 

  25. Zhang, X. H. et al. Testosterone restores diabetes-induced erectile dysfunction and sildenafil responsiveness in two distinct animal models of chemical diabetes. J. Sex. Med. 3, 253–264 (2006).

    Article  CAS  PubMed  Google Scholar 

  26. Wingard, C. J., Johnson, J. A., Holmes, A. & Prikosh, A. Improved erectile function after Rho-kinase inhibition in a rat castrate model of erectile dysfunction. Am. J. Physiol. Regul. Integr. Comp. Physiol. 284, R1572–R1579 (2003).

    Article  CAS  PubMed  Google Scholar 

  27. Vignozzi, L. et al. Testosterone regulates RhoA/Rho-kinase signaling in two distinct animal models of chemical diabetes. J. Sex. Med. 4, 620–630 (2007).

    Article  CAS  Google Scholar 

  28. Morelli, A. et al. Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology 145, 2253–2263 (2004).

    Article  CAS  Google Scholar 

  29. Zhang, X. H. et al. Testosterone regulates PDE5 expression and in vivo responsiveness to tadalafil in rat corpus cavernosum. Eur. Urol. 47, 409–416 (2005).

    Article  CAS  Google Scholar 

  30. Traish, A. M. et al. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology 140, 1861–1868 (1999).

    Article  CAS  Google Scholar 

  31. Rhoden, E. L., Telöken, C., Sogari, P. R. & Souto, C. A. The relationship of serum testosterone to erectile function in normal aging men. J. Urol. 167, 1745–1748 (2002).

    Article  CAS  PubMed  Google Scholar 

  32. Dettenhofer, M. H. in Rome and China: Comparative Perspective Ancient World Empire (ed. Sheidel, W.) 83–89 (Oxford University Press, 2009).

    Google Scholar 

  33. Swaab, D. F. Sexual differentiation of the brain and behavior. Best Pract. Res. Clin. Endocrinol. Metab. 21, 431–444 (2007).

    Article  PubMed  Google Scholar 

  34. Bancroft, J. The endocrinology of sexual arousal. J. Endocrinol. 186, 411–427 (2005).

    Article  CAS  PubMed  Google Scholar 

  35. Anderson, R. A., Bancroft, J. & Wu, F. C. The effects of exogenous testosterone on sexuality and mood of normal men. J. Clin. Endocrinol. Metab. 75, 1503–1507 (1992).

    CAS  PubMed  Google Scholar 

  36. Wang, C. et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA Recommendations. Eur. Urol. 55, 121–130 (2009).

    Article  PubMed  Google Scholar 

  37. Corona, G. et al. Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int. J. Impot. Res. 16, 275–281 (2004).

    Article  CAS  PubMed  Google Scholar 

  38. Buvat, J. Hyperprolactinemia and sexual function in men: a short review. Int. J. Impot. Res. 15, 373–377 (2003).

    Article  CAS  PubMed  Google Scholar 

  39. Corona, G. et al. The impotent couple: low desire. Int. J. Androl. 28, 46–52 (2005).

    Article  PubMed  Google Scholar 

  40. Corona, G. et al. Effect of hyperprolactinemia in male patients consulting for sexual dysfunction. J. Sex. Med. 4, 1485–1493 (2007).

    Article  CAS  PubMed  Google Scholar 

  41. Morales, A. et al. Endocrine aspects of sexual dysfunction in men. J. Sex. Med. 1, 69–81 (2004).

    Article  CAS  PubMed  Google Scholar 

  42. Carter, J. N. et al. Prolactin-screening tumours and hypogonadism in 22 men. N. Engl. J. Med. 299, 847–852 (1978).

    Article  CAS  PubMed  Google Scholar 

  43. Ciccarelli, A. et al. PRL secreting adenomas in male patients. Pituitary 8, 39–42 (2005).

    Article  PubMed  Google Scholar 

  44. Corona, G. et al. Autoeroticism, mental health and organic disturbances in patients with erectile dysfunction. J. Sex. Med. doi:10.1111/j.1743-6109.2009.01497.x

  45. Fisher, A. D. et al. Psychobiological correlates of extramarital affairs and differences between stable and occasional infidelity among men with sexual dysfunctions. J. Sex. Med. 6, 666–675 (2009).

    Google Scholar 

  46. Van Anders, S. M., Hamilton, L. D. & Watson, N. V. Multiple partners are associated with higher testosterone in North American men and women. Horm. Behav. 51, 454–459 (2007).

    Article  CAS  PubMed  Google Scholar 

  47. Bell, R. R., Turner, S. & Rosen, L. A multivariate analysis of female extramarital coitus. J. Marriage Fam. 37, 375–384 (1975).

    Article  Google Scholar 

  48. Treas, J. & Giesen, D. Sexual infidelity among married and cohabiting Americans. J. Marriage Fam. 62, 48–60 (2000).

    Article  Google Scholar 

  49. Mehta, P. H., Jones, A. C. & Josephs, R. A. The social endocrinology of dominance: basal testosterone predicts cortisol changes and behavior following victory and defeat. J. Pers. Soc. Psychol. 94, 1078–1093 (2008).

    Article  PubMed  Google Scholar 

  50. Archer, J. Testosterone and human aggression: an evaluation of the challenge hypothesis. Neurosci. Biobehav. Rev. 30, 319–345 (2006).

    Article  CAS  PubMed  Google Scholar 

  51. O'Connor, D. B., Archer, J. & Wu, F. C. Effects of testosterone on mood, aggression, and sexual behavior in young men: a double-blind, placebo-controlled, cross-over study. J. Clin. Endocrinol. Metab. 89, 2837–2845 (2004).

    Article  CAS  PubMed  Google Scholar 

  52. Mazur, A. & Booth, A. Testosterone and dominance in men. Behav. Brain Sci. 21, 353–363 (1998).

    Article  CAS  PubMed  Google Scholar 

  53. Bandini, E. et al. Hysterical traits are not from the uterus but from the testis: a study in men with sexual dysfunction. J. Sex. Med. 6, 321–331 (2009).

    Article  Google Scholar 

  54. Corona, G. et al. Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism. J. Sex. Med. 6, 2591–2600 (2009).

    Article  Google Scholar 

  55. No authors listed] Effects of sexual activity on beard growth in man. Nature 226, 869–870 (1970).

  56. Jannini, E. A. et al. Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone. Int. J. Androl. 22, 385–392 (1999).

    Article  CAS  PubMed  Google Scholar 

  57. Carosa, E. et al. Sexual inactivity results in reversible reduction of LH bioavailability. Int. J. Impot. Res. 14, 93–99 (2002).

    Article  CAS  PubMed  Google Scholar 

  58. Carosa, E. et al. Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin. Endocrinol. (Oxf.) 61, 382–386 (2004).

    Article  CAS  Google Scholar 

  59. Fabbri, A. et al. A. Low serum bioactive luteinizing hormone in nonorganic male impotence: possible relationship with altered gonadotropin-releasing hormone pulsatility. J. Clin. Endocrinol. Metab. 67, 867–875 (1988).

    Article  CAS  PubMed  Google Scholar 

  60. Vignozzi, L. et al. Cavernous neurotomy in the rat is associated with the onset of an overt condition of hypogonadism. J. Sex. Med. 6, 1270–1283 (2009).

    Article  CAS  PubMed  Google Scholar 

  61. Luboshitzky, R. et al. Decreased pituitary–gonadal secretion in men with obstructive sleep apnea. J. Clin. Endocrinol. Metab. 87, 3394–3398 (2002).

    Article  CAS  PubMed  Google Scholar 

  62. Bhasin, S. et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 91, 1995–2010 (2006).

    Article  CAS  PubMed  Google Scholar 

  63. Petak, S. M., Nankin, H. R., Spark, R. F., Swerdloff, R. S. & Rodriguez-Rigau, L. J. American Association of Clinical Endocrinologists. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients—2002 Update. Endocr. Pract. 8, 440–446 (2002).

    PubMed  Google Scholar 

  64. Vermeulen, A., Verdonck, L. & Kaufman, J. M. A critical evaluation of simple methods for the estimation of free testosterone in serum. J. Clin. Endocrinol. Metab. 84, 3666–3672 (1999).

    Article  CAS  PubMed  Google Scholar 

  65. Corona, G., Ferruccio, N., Morittu, S., Forti, G. & Maggi, M. Recognizing late-onset hypogonadism: a difficult task for sexual health care. J. Mens Health Gend. 6, 210–218 (2009).

    Article  Google Scholar 

  66. Traish, A. M., Guay, A., Feeley, R. & Saad, F. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J. Androl. 30, 10–22 (2009).

    Article  CAS  PubMed  Google Scholar 

  67. Morley, J. E. et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 49, 1239–1242 (2000).

    Article  CAS  PubMed  Google Scholar 

  68. Heinemann, L. A., Saad, F., Heinemann, K. & Thai, D. M. Can results of the Aging Males' Symptoms (AMS) scale predict those of screening scales for androgen deficiency? Aging Male 7, 211–218 (2004).

    Article  CAS  PubMed  Google Scholar 

  69. Smith, K. W., Feldman, H. A. & McKinlay, J. B. Construction and field validation of a self-administered screener for testosterone deficiency (hypogonadism) in ageing men. Clin. Endocrinol. (Oxf.) 53, 703–711 (2000).

    Article  CAS  Google Scholar 

  70. Morley, J. E., Perry, H. M. III, Kevorkian, R. T. & Patrick, P. Comparison of screening questionnaires for the diagnosis of hypogonadism. Maturitas 53, 424–429 (2006).

    Article  PubMed  Google Scholar 

  71. Qoubaitary, A., Swerdloff, R. S. & Wang, C. Advances in male hormone substitution therapy. Expert Opin. Pharmacother. 6, 1493–1506 (2005).

    Article  CAS  PubMed  Google Scholar 

  72. Seftel, A. Testosterone replacement therapy for male hypogonadism: part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int. J. Impot. Res. 19, 2–24 (2007).

    Article  CAS  PubMed  Google Scholar 

  73. Edelstein, D., Sivanandy, M., Shahani, S. & Basaria, S. The latest options and future agents for treating male hypogonadism. Expert Opin. Pharmacother. 8, 2991–3008 (2007).

    Article  CAS  PubMed  Google Scholar 

  74. Pfeil, E. & Dobs, A. S. Current and future testosterone delivery systems for treatment of the hypogonadal male. Expert Opin. Drug Deliv. 5, 471–481 (2008).

    Article  CAS  PubMed  Google Scholar 

  75. Behre, H. M., Wang, C., Handelsman, D. I. & Nieshlag, E. in Testosterone: Action, Deficiency, Substitution, 3rd edn (eds Nieschlag, E. & Behre, H. M.) 405–444 (Cambridge University Press, 2004).

    Book  Google Scholar 

  76. Jain, P., Rademaker, A. W. & McVary, K. T. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J. Urol. 164, 371–375 (2000).

    Article  CAS  PubMed  Google Scholar 

  77. Ebert, T., Jockenhövel, F., Morales, A. & Shabsigh, R. The current status of therapy for symptomatic late-onset hypogonadism with transdermal testosterone gel. Eur. Urol. 47, 137–146 (2005).

    Article  CAS  PubMed  Google Scholar 

  78. Hwang, T. I. & Lin, Y. C. The relationship between hypogonadism and erectile dysfunction. Int. J. Impot. Res. 20, 231–235 (2008).

    Article  CAS  PubMed  Google Scholar 

  79. Isidori, A. M. et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin. Endocrinol. (Oxf.) 63, 381–394 (2005).

    Article  CAS  Google Scholar 

  80. Buvat, J. & Bou Jaoudé, G. Significance of hypogonadism in erectile dysfunction. World J. Urol. 24, 657–667 (2006).

    Article  PubMed  Google Scholar 

  81. Boloña, E. R. et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin. Proc. 82, 20–28 (2007).

    Article  PubMed  Google Scholar 

  82. McVary, K. T. Clinical practice: erectile dysfunction. N. Engl. J. Med. 357, 2472–2481 (2007).

    Article  CAS  PubMed  Google Scholar 

  83. Bhasin, S., Enzlin, P., Coviello, A. & Basson, R. Sexual dysfunction in men and women with endocrine disorders. Lancet 369, 597–611 (2007).

    Article  CAS  PubMed  Google Scholar 

  84. Skakkebaek, N. E., Bancroft, J., Davidson, D. W. & Warner, P. Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clin. Endocrinol. (Oxf.) 14, 49–61 (1981).

    Article  CAS  Google Scholar 

  85. Carani, C. et al. Effects of androgen treatment in impotent men with normal and low levels of free testosterone. Arch. Sex. Behav. 19, 223–234 (1990).

    Article  CAS  PubMed  Google Scholar 

  86. Steidle, C. et al. AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J. Clin. Endocrinol. Metab. 88, 2673–2681 (2003).

    Article  CAS  PubMed  Google Scholar 

  87. Cavallini, G., Caracciolo, S., Vitali, G., Modenini, F. & Biagiotti, G. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology 63, 641–646 (2004).

    Article  CAS  PubMed  Google Scholar 

  88. Corona, G. et al. The age-related decline of testosterone is associated with different specific symptoms and signs in patients with sexual dysfunction. Int. J. Androl. 32, 720–728 (2009).

    Article  CAS  PubMed  Google Scholar 

  89. Kalinchenko, S. Y., Kozlov, G. I., Gontcharov, N. P. & Katsiya, G. V. Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone. Aging Male 6, 94–99 (2003).

    Article  CAS  PubMed  Google Scholar 

  90. Chatterjee, R. et al. A novel therapy with testosterone and sildenafil for erectile dysfunction in patients on renal dialysis or after renal transplantation. J. Fam. Plann. Reprod. Health Care 30, 88–90 (2004).

    Article  PubMed  Google Scholar 

  91. Foresta, C., Caretta, N., Rossato, M., Garolla, A. & Ferlin, A. Role of androgens in erectile function. J. Urol. 171, 2358–2362 (2004).

    Article  CAS  PubMed  Google Scholar 

  92. Shamloul, R. et al. Testosterone therapy can enhance erectile function response to sildenafil in patients with PADAM: a pilot study. J. Sex. Med. 2, 559–564 (2005).

    Article  CAS  PubMed  Google Scholar 

  93. Greenstein, A. et al. Does sildenafil combined with testosterone gel improve erectile dysfunction in hypogonadal men in whom testosterone supplement therapy alone failed? J. Urol. 173, 530–532 (2005).

    Article  CAS  PubMed  Google Scholar 

  94. Tas, A., Ersoy, A., Ersoy, C., Gullulu, M. & Yurtkuran, M. Efficacy of sildenafil in male dialysis patients with erectile dysfunction unresponsive to erythropoietin and/or testosterone treatments. Int. J. Impot. Res. 18, 61–68 (2006).

    Article  CAS  PubMed  Google Scholar 

  95. Hwang, T. I., Chen, H. E., Tsai, T. F. & Lin, Y. C. Combined use of androgen and sildenafil for hypogonadal patients unresponsive to sildenafil alone. Int. J. Impot. Res. 18, 400–404 (2006).

    Article  CAS  PubMed  Google Scholar 

  96. Rosenthal, B. D., May, N. R., Metro, M. J., Harkaway, R. C. & Ginsberg, P. C. Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone. Urology 67, 571–574 (2006).

    Article  PubMed  Google Scholar 

  97. Yassin, A. A., Saad, F. & Diede, H. E. Testosterone and erectile function in hypogonadal men unresponsive to tadalafil: results from an open-label uncontrolled study. Andrologia 38, 61–68 (2006).

    Article  CAS  PubMed  Google Scholar 

  98. Aversa, A., Isidori, A. M., Spera, G., Lenzi, A. & Fabbri, A. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin. Endocrinol. (Oxf.) 58, 632–638 (2003).

    Article  CAS  Google Scholar 

  99. Shabsigh, R., Kaufman, J. M., Steidle, C. & Padma-Nathan, H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J. Urol. 172, 658–663 (2004).

    Article  CAS  PubMed  Google Scholar 

  100. Rochira, V., Balestrieri, A., Madeo, B., Granata, A. R. & Carani, C. Sildenafil improves sleep-related erections in hypogonadal men: evidence from a randomized, placebo-controlled, crossover study of a synergic role for both testosterone and sildenafil on penile erections. J. Androl. 27, 165–175 (2006).

    Article  CAS  PubMed  Google Scholar 

  101. Buvat, J. et al. What is the threshold level of the PDE5 inhibitors' testosterone-dependence in men? A double blind placebo-controlled trial of testosterone gel addition in men with ED non responding to tadalafil 10 mg once a day alone [abstract #376]. Eur. Urol. Suppl. 8, 214 (2009).

    Article  Google Scholar 

  102. Greco, E. A., Spera, G. & Aversa, A. Combining testosterone and PDE5 inhibitors in erectile dysfunction: basic rationale and clinical evidences. Eur. Urol. 50, 940–947 (2006).

    Article  CAS  PubMed  Google Scholar 

  103. Berridge, M. J. Smooth muscle cell calcium activation mechanisms. J. Physiol. 586, 5047–5061 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Jacques Buvat (Director, Center d'Etude et de Traitement de la Pathologie de l'Appareil reproducteur et de la Psychosomatique [CETPARP], Lille, France) for his helpful collaboration during the preparation of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mario Maggi.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Corona, G., Maggi, M. The role of testosterone in erectile dysfunction. Nat Rev Urol 7, 46–56 (2010). https://doi.org/10.1038/nrurol.2009.235

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2009.235

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing