Sexual Function

It is well known that androgen replacement restores sexual function in hypogonadal men. These include sexual desire (libido), sexual fantasies, sexual enjoyment and frequency of sexual thoughts, sexual activities, and erectile function. In younger hypogo-nadal men, sexual performance, including erectile dysfunction, is improved by androgen replacement therapy (13-17). In older men, erectile dysfunction is usually multifactorial; other causes, such as vascular, neurogenic, psychogenic, medication-induced, and cavernosal problems may predominate. Improvement in erectile function by testosterone treatment of androgen-deficient older men may be minimal or not as significant as in younger subjects (18-20). Although objective data are limited, it is possible that in androgen-deficient older men whose erectile dysfunction has been improved by phosphodiesterase V inhibitors (e.g., Sildenafil, Vardenafil, and Tadalfil) sexual performance may benefit by cotreatment with testosterone through improvement in libido. It should be noted that androgen replacement to restore serum testosterone to the low normal range induces maximum sexual function improvement in men who are hypogonadal (13,14,17,21). Once a threshold level of serum testosterone is achieved with androgen replacement therapy, further increases in serum testosterone levels do not increase sexual motivation or performance (21).

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