If a man has violation of sexual function due to androgen deficiency, as well as erectile dysfunction (ED), treatment should begin with normalization of testosterone levels. Normalization of level of androgens by administration of hormonal drugs (for example, testosterone undecanoate) significantly increases effectiveness of use of phosphodiesterase type 5 inhibitors (PDE-5) and results of erectile dysfunction therapy.
Effect of Testosterone on Erectile Function
Some Canadian Neighbor Pharmacy scientific papers also demonstrate effect of testosterone on erectile function: after recovery of testosterone levels, a significantly better response to sildenafil therapy (100 mg) was observed compared with men taking sildenafil and placebo.
If monotherapy, aimed at eliminating adrenal deficiency, is ineffective, in relation to normalization of sexual function, it is advisable to combine hormonal therapy with use of vasoactive drugs. Use of vasoactive drugs should be started no earlier than 1 – 1,5 months after restoring normal level of testosterone. This sequence of treatment is due to the role of testosterone, as the main catalyst of sexual excitement – the first and main stage in occurrence of erection. In addition, according to the latest Canadian Neighbor Pharmacy data, androgens are involved in the process of maintaining production of nitric oxide (NO2), which is necessary for erection.
!Thus, mandatory condition for effectiveness of PDE-5 inhibitors is normal hormonal background of a man, i. e. absence of androgen deficiency!
Modern ideas of medicine indicate that testosterone can have a direct effect on structure of cavernous bodies and nerves. This is confirmed by experiments on animals, when castration led to change in structure of cavernous nerves.
A number of studies have confirmed that decrease in the level of androgens provokes increased deposition of fat cells in cavernous bodies. This prevents mechanism of erection initiation due to venous insufficiency, decrease in blood flow and elasticity of cavernous tissues.
Despite a few observations, it can now be argued that treatment of erectile dysfunction in patients with hypogonadism with testosterone preparations leads to normalization of structure of cavernous bodies, improvement in blood flow and elimination of venous insufficiency, and, as a result, restoration of erection or increase in effectiveness of PDE-5 inhibitors. Monotherapy with PDE-5 inhibitors in such cases is ineffective.
!Replacement therapy with testosterone restores structure of cavernous bodies, improves blood flow and eliminates venous insufficiency!
Low level of testosterone plays an important role in onset of erectile dysfunction:
- reduction of relaxation of smooth muscle cells of cavernous tissue;
- reduction of NO2 production;
- increased apoptosis of smooth muscle cells;
- increased number of adipocytes;
- decreased sexual desire.
Since therapy with vasoactive drugs is symptomatic, that is, it is aimed at eliminating symptoms of the disease and does not eliminate factors that cause erectile dysfunction, they are classed as second-line drugs in treatment of erectile dysfunction in men with androgen deficiency. Although recently there are new data on therapeutic effect of Viagra, the most popular representative of the class of PDE-5 inhibitors, when administered daily before sleep in the course mode for at least 1 month.
Of vasoactive drugs that affect onset of erection, preference is given to phosphodiesterase type 5 inhibitors (Viagra, Cialis, Levitra) as drugs having high enough efficiency (70 – 80% depending on underlying and concomitant diseases), which does not decrease with prolonged use. Preservation of efficacy and safety of vasoactive drugs with long-term use is extremely important, since symptomatic nature of therapy with organic forms of erectile dysfunction implies their permanent (lifelong) reception.
Viagra and Cialis are today drugs that have shown their effectiveness in combination therapy with androgens. To understand mechanism of action of PDE-5 inhibitors, as well as the role of testosterone in development of their effect and possible inefficiency with decreasing testosterone content, knowledge of mechanism of erection is necessary.
Recently, there has been an improvement in prognosis for treatment of erectile dysfunction in most patients. This is primarily due to introduction of modern drugs, not aimed at eliminating symptoms (symptomatic treatment), but on therapy of causes that triggered the ailment (pathogenetic treatment). In case of erectile dysfunction, pathogenetic treatment is aimed at eliminating endothelial dysfunction, which forms the basis of any form of organic disorders of erectile function.
These drugs, in particular, include PDE-5 inhibitors and preparations containing analogues of male hormone testosterone, which allow to normalize level of androgens and provide good therapeutic base for treatment with PDE-5 inhibitors.
Long-term course of taking PDE-5 inhibitors is a new practice in treatment of erectile dysfunction, as previously these drugs were recommended for use during close proximity of sexual contact. Therapeutic effect in this scheme of treatment is carried out by improving function of endothelium, and allows in some cases complete normalization of sexual function, and subsequent abandonment of use of drugs.
Tags: impotence , Men’s Health , sexual frustration