Erectile dysfunction and testosterone replacement therapy: When, why and how

Testosterone deficiency (TD) is of growing concern to clinicians, as the prevalence has increased over time with increasing aging of the population in the western world. In this chapter we will show that both the biochemical and clinical diagnosis is difficult because in men with previously normal virilisation, symptoms of hypogonadism are relatively mild even if serum T concentrations are low. And, what makes it more difficult, hypogonadism mimics symptoms that go along with physiological aging, such as reduced libido, sexual dysfunction, asthenia, low energy, depressed mood, and more specific symptoms such as reduced volume of the ejaculate and slower grow of facial hair. The fact however that TD often occurs in combination with certain clinical conditions such as chronic disease in general, the metabolic syndrome in particular and certain medication makes it possible to a sketch a profile of a man with TD and to identify those who may benefit from testosterone replacement therapy (TRT). TRT is safe in the short term (long-term data are lacking), but conclusive evidence of effectiveness is lacking. Furthermore, there are more and more indications that a change to a healthy lifestyle, especially more physical activity, diet, stress reduction and social support, is a valid alternative.