Viagra +/- Testosterone = Viagra

Unless you've been hiding under a rock, you're well aware that testosterone is all the rage these days.  In my neck of the woods, there are billboard ads in addition to innumerable television commercials.  A frequent question posed on www.avvo.com and www.healthtap.com is how to treat erectile dysfunction.  Too many times, men want to jump on the testosterone bandwagon without addressing all the other issues, eg stress (job, money, family, friends), relationship, lifestyle choices (tobacco & excess alcohol use), obesity/overweight, overall health (depression, diabetes, high blood pressure, high cholesterol) and medications used to treat chronic conditions eg finasteride.

So it's always fascinating to find a study which throws a wrench at conventional wisdom.  In this situation, a randomized, double-blind, parallel, placebo-controlled trial was published yesterday in Annals of Internal Medicine in which the authors concluded that the addition of testosterone to sildenafil (Viagra) did not improve erectile function.  They used the International Index of Erectile Function (IIEF-5) to objectively measure erectile dysfunction as scores less than 25 (maximum score = 30) in 140 men 40-70yo who were deemed hypogonadal w/Total Testosterone <330ng/dL or Free Testosterone <50pg/mL.

During the initial sildenfail dose optimization phase, erectile function improved by almost 8 points.  The participants were then randomized to 10g/d of testosterone cream vs placebo for the next 14 weeks (with dose adjustment (anywhere from down to 5g/d up to 15g/d) made at week 2 according to level achieved).  Unfortunately, the authors only found a non-statistically significant increase of barely 2 points in those randomized to testosterone vs placebo.

The good news is that side effects did not vary dramatically between those randomized to testosterone vs placebo, although hematocrit did increase more (as expected) in those randomized to testosterone, suggesting adequate dosing level.  However, the authors also noted that sildenafil alone boosted testosterone by 100ng/dL prior to the addition of testosterone such that perhaps some of the participants no longer needed any additional testosterone.

Regardless, erectile dysfunction is but one reason for testosterone supplementation in hypogonadism: improvement in body composition, muscle strength, physical performance, cognition, and metabolism.  So don't stop your testosterone therapy just yet.

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