The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction

Abstract

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD.The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT.The mean age was 58.81 ± 4.56 (52–69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively (p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases.This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

Aqueous extract of Lespedeza cuneata improves male menopause by increase of nitric oxide and dihydrotestosterone

“…Patients with impaired gonadal function cause fatigue, depression, weakness, and loss of confidence. Generally, if the free testosterone level is less than 70 ng/ dL or the total testosterone level is less than 300 ng/dL, the patient is classified as hypogonadal (Efesoy et al, 2018;Ho et al, 2016). In this study, the total testosterone level in ALC group did not change, but DHT and HSD17B13 were increased which has been involved in androgenic activity (Celik and Yucel, 2013;Kataoka et al, 2013).…”

“…4D). Sexual function is generally known to be independent of testosterone levels (Efesoy et al, 2018;Groneberg et al, 2013), but TDS due to this decrease results in psychological sexual dysfunction (Ho et al, 2016). Patients with impaired gonadal function cause fatigue, depression, weakness, and loss of confidence.…”

Role of Glucose-Lowering Medications in Erectile Dysfunction

“…The vasoprotective effectiveness of androgens was also confirmed after testosterone replacement therapy (TRT), where endothelial function was completely restored and the progression of ED was significantly counteracted both for a short time [ 43 ] and in the long-term in men with hypogonadism [ 44 ]. Accordingly, men affected by hypogonadism with veno-occlusive dysfunction demonstrated improved penile haemodynamics after TRT with decreased end-diastolic velocity of the cavernous artery, thus preventing impotency [ 45 ]. Notably, the molecular processes driving ED amelioration after testosterone replacement were further investigated in vivo.…”

Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial

“…From January 2015eMarch 2016, we recruited 2 groups of patients who visited our hospital. Patients were included in group 1 (circumcision and no PE) if they (i) were men aged 18e45 years; (ii) had a score of >21 in the 5-item version of the International Index of Erectile Function (IIEF-5) 24 ; (iii) were sexually active with stable partners in the last 6 months; (iv) had a global severity index of <2 in the Chinese version of the Symptom Checklist-90-R 25,26 ; (v) asked for circumcision because of redundant foreskin; (vi) agreed to participate in our study; and (vii) had a score of 8 in the Premature Ejaculation Diagnostic Tool (PEDT). 27 Patients were included in group 2 (circumcision and PE) if they (i) were men aged 18e45 years; (ii) had an IIEF-5 score >21; (iii) were sexually active with stable partners in the last 6 months; (iv) had a global severity index of <2 in the Chinese version of the Symptom Checklist-90-R; (v) asked for circumcision because of redundant foreskin; (vi) agreed to participate in our study; (vii) had a PEDT score of !11; (viii) were diagnosed with lifelong PE with an intravaginal ejaculation latency time (IELT) of <1 minute in >70% of coital attempts from their first sexual experience; (ix) had minimal response to recommended treatments, which include psychobehavioral strategies and pharmacotherapy (dapoxetine, off-label use of SSRIs and clomipramine, topical anesthetics, and phosphodiesterase type 5 inhibitors), or expected complete healing without the use of medications; and (x) had a penile sensitivity threshold of <4, which is the minimum volt value of shock stimulation when it can be clearly perceived by the patient.…”