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Testosterone And Erectile Dysfunction

Are you suffering from the inability to get an erection during a sexual encounter?  Have you been diagnosed with erectile dysfunction (ED) and are not responding to Viagra® or Cialis® (PDE-5 Inhibitors) after you have been told that they are supposed to help with your erections? You are not alone.  Today, the solution for ED is more advanced than just prescribing Viagra® for certain individuals.  Studies have hypothesized that erectile dysfunction has been interlinked with low blood testosterone levels which include and are not limited to male hypogonadism and aging.  Although specific in criterion, testosterone replacement therapy (TRT) may be the next beneficial treatment for your ED.

A rather complex sequence of events must occur in order to achieve an erection.  Within the past few years, animal studies have shown that testosterone plays a vital role for an erection to take place by regulating nitric oxide (Shabsigh, et. al) (Mikhail), which increases blood streaming into the penis.  In a Massachusetts Male Aging Study, 52% of males between the ages of 40 to 70 reported some degree of ED (Jacob).  Aging has been associated with ED and declines in testosterone levels.   However, the exact mechanism for age associated testosterone deficiency remains unknown, (Jacob).  For some men, male hypogonadism may be the reason for testosterone deficiency.  Hypogonadism is “referred to as the presence of persistently low circulating testosterone compared with the normal range derived from healthy young and middle-aged men” (Mikhail, 2006) due to “inadequate functions of the (gonads) testicles” (Jacob).  Worthy of note is a study that showed that although there is an increase in testosterone during an erection, “the percent increase in testosterone levels from flaccidity to the erected stages of erection was less pronounced in men with ED compared with those without ED, 15% and 48% respectively” (Mikhail).  This and various studies set the underlying core hypothesis that males with ED may have testosterone deficiency. 

The focus of testosterone deficiency has sparked numerous studies that have evaluated the outcomes that TRT has for ED patients.  Research has shown that TRT has improved ED for those with low testosterone levels.  Testosterone supplementation after 1 month has been shown to increase blood flow to the penis by 27% in a study performed on 10 men with ED and low testosterone (Mikhail).

Also interesting to this topic is the following finding that states, although “PDE5 inhibitors are first line treatment for ED, 23-50% of patients do not respond to PDE5 inhibitors alone”(Shabsigh, et. al).  23-50% is a significant amount of men who failed PDE5 inhibitor therapy.  Imperative to such findings is that men with hypogonadism are likely to fail PDE5 inhibitors (Shabsigh, et. al).  Preliminary evidence also appoints towards the direction that hypogonadism may be linked to the decreased response to PDE5 inhibitors and that TRT may “convert non-responders to responders of PDE5 inhibitors” (Mikhail). 

Combination therapies of TRT with PDE5 inhibitors have been looked into in various studies for men with ED and hypogonadism.  It has been revealed that combination therapy of 1% testosterone gel with a PDE5 inhibitor has lead to significant improvement in erectile function and the response to PDE5 inhibitors for men with ED and hypogonadism (Shabsigh, et. al).  One study revealed that a minimum testosterone level is needed for PDE 5 inhibitors to perform successfully (Guay).  40-50% of men with below normal testosterone levels had no response to PDE 5 inhibitors (Guay).  It was then suggested that TRT would restore testosterone levels and hence erectile function upon combination with PDE5 inhibitors (Guay).  Monotherapy use of TRT has been found to be beneficial for those whose ED is solely due to hypogonadism and rather non-beneficial for those whose ED is due to various issues other than hypogonadism, (Shabsigh, et. al).  One study showed that in males with hypogonadism, 35-40% reported improvements in ED with TRT, in which the remaining 60-65% of males had a lack of response possibly due to other contributing factors such as other underlying disease states or medications, (Guay).  In accordance to the American Urological Association, “TRT is not an appropriate option for the treatment of ED in men who have normal serum testosterone levels” (Jacob).  In essence, “TRT is clearly indicated in hypogonadal patients and is beneficial in patients with ED and hypogonadism.  Combination therapy is expected to be appropriate for those who failed initial PDE5 inhibitors” (Shabsigh, et. al).      

The National Institutes of Health Consensus Panel on ED recommends that morning blood testosterone be taken for men who experience ED (Mikhail).  It is especially highly recommended for men who have failed PDE5 inhibitors.  Upon the results of the tests, hypogonadism can be ruled in or ruled out.  If the cause of the ED is thought to be hypogonadism, medication therapy with TRT may be considered.  Likewise, for men on PDE5 inhibitors with failed outcomes, considering combination therapy with TRT may be beneficial.  Today, so many men with ED possibly due to low testosterone without underlying subtle clinical symptoms such as decreased libido may be overlooked and not screened with a testosterone blood test (Mikhail) (Shabsigh, et. al).  Blood tests for testosterone levels are also recommended to those at risk for hypogonadism which includes men with type 2 diabetes, metabolic syndrome (stroke, coronary artery disease), chronic renal failure as well as other chronic diseases (Shabsigh, et. al).  A simple, convenient and reliable saliva test can be done at home that measures testosterone in the saliva that is reflective of testosterone levels in your blood.  Visit to find out more.  Your testosterone levels can be matched to a testosterone dose that can lead to results you want to see.

Are traditional oral therapies for erectile dysfunction not working for you?  Are you a type 2 diabetic or have experienced a stroke in the past and recently experiencing erection problems?  You may have low testosterone blood levels.  You may be the perfect candidate to receive a saliva test to measure your blood testosterone levels.  Your life can be turned around.  Take charge of your sexual life.  You may have hypogonadism and TRT may be the perfect solution for your ED. 

Guay, André. "Testosterone and Erectile Physiology." The Aging Male 9.4 (2006): 201-06.
Jacob, Bobby C. "Testosterone Replacement Therapy in Males With Erectile Dysfunction." J Pharm Pract 24.3 (2011): 298-306.
Mikhail, N. "Does Testosterone Have a Role in Erectile Function?" The American Journal of Medicine 119.5 (2006): 373-82.
Shabsigh, R., J. Rajfer, A. Aversa, A. M. Traish, A. Yassin, S. Y. Kalinchenko, and J. Buvat. "The Evolving Role of Testosterone in the Treatment of Erectile Dysfunction." International Journal of Clinical Practice 60.9 (2006): 1087-092.




The information on this website if purely informational and should not be used to diagnose, cure or treat any patient without the direction and supervision of a physician. If you are intersted in using Tri-Mix or any other treatment for erectile dysfunction make sure to check with your physician first. This and any therapy should be individualized for you by a prescribing physician that knows you, your medical history, and any current and prior medication history. Tri-Mix is not approved by the FDA for the treatment of Erectile Dysfunction and does require a prescription that can only be filled at a compounding pharmacy.

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