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It has been thought for years that testosterone effect on sexual function is mainly through libido. Although libido is certainly increased by the administration of testosterone in hypogonadal men, there is also some recent experimental evidence in rats to suggest that there may be peripheral effects in penile tissue from testosterone also. Nitric oxide is the primary mediator of penile erection and investigators have shown that nitric oxide synthase in penile tissue is androgen-dependent (Fertil Steril, 63:1101, 1995). Therefore, in the hypogonadal state, it is possible that nitric oxide production in penile tissue may be deficient, with substandard penile smooth muscle relaxation and a poor quality erection. Thus, we may have both central and peripheral effects from testosterone on sexual function.
In men who are identified as having a low testosterone (total and or bioavailable) and have difficulties with sex drive, erectile function, testosterone therapy may be tried prior to moving on to more invasive tests or therapies. In the event that normal sexual function returns with replacement, then further evaluation is unnecessary. However, as mentioned above, many elderly men with impotence will have multiple factors leading to their impotence problem and simple hormonal replacement will not result in return of normal sexual activity in most When a trial of testosterone is unable to return a man to normal sexual function, but there are beneficial effects on libido, the wisdom of proceeding on with ongoing androgen therapy is less well established. The physician in this circumstance will have to balance the subjective improvement with potential for adverse effects.
Side effects of testosterone therapy: Itching or irritation or discomfort at site of application may occur the first few days as your body adjusts to the patch. Other side effects reported include acne, headache, anxiety or a change in sex drive, painful or frequent urination, frequent or persistent erections, nausea, vomiting, swelling of the feet or ankles, mental confusion, depression, breathing trouble.