testosterone replacement therapy: should it be performed in erectile dysfunction?

the classical etiology of erectile dysfunction (ed) comprises aging and vascular, neurogenic, psychological and hormonal components. recent studies have shown that ed can be the forerunner of serious cardiovascular disturbances. it has also been reported that peripheral neuropathy and microvascular injuries caused by pathophysiological changes in patients with diabetes and obesity lead to ed in a significant number of such cases. these patients develop clinically significant ed and comprise a significant portion of the patient group which do not respond to pde-5 inhibitors. testosterone has been shown to increase the expression of pde-5. this function of testosterone supports its effect on the regulation of erection and increasing the sexual libido. in view of the complexity of ed, as well as the effect of testosterone on erection, it is concluded that pde-5 inhibitors in combination with testosterone replacement would be a better therapy alternative in the management of erectile dysfunction in hypogonadal patients.