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The role of testosterone in erectile dysfunction

Nature Reviews Urology volume 7, pages 46–56 (2010)Cite this article

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

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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

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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.

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  1. Department of Clinical Physiopathology, Sexual Medicine & Andrology Unit, University of Florence, Viale Pieraccini 6, Florence, 50139, Italy

    Giovanni Corona & Mario Maggi

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Correspondence to Mario Maggi.

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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

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