© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
energy, and reduced ED should occur within 3months.
Increased strength, enhanced bone mineral density
(
BMD), improved cognition, enhanced cardiovascular
health, decreased body fat, and improvement in some
components of metabolic syndrome are more likely to
be noticed between 6 and 12 months.
Non-response to treatment can occur secondary
to compliance issues, malabsorption, insufficient
dose, unsatisfactory formulation (seen with some
compounded testosterone made in pharmacies), or
because the patient’s symptoms are not related to TDS.
Remember that for ED patients who are not
responding to testosterone alone or PDE-5 inhibitors
alone, physicians should strongly consider giving
both therapies. Similarly, physicians should check
the testosterone levels of “clinically depressed” male
patients who are not responding to their antidepressant
medications. If their testosterone levels are low, a
significant number of these men will respond better
to combined TRT and an antidepressant.
42
Conclusion
ED and TDS are closely related. In addition to affecting
sexual health, both conditions also affect other male
health issues. Screening for ED, especially in younger
men, should become standard clinical practice for the
primary care physician. Possible systemic effects and
associated effects of TDS are now well documented.
TRT is very safe and effective in the right man.
Disclosure
Dr. Michael Greenspan serves/has served as advisor/
consultant/speaker for: Pfizer, Eli Lilly, Bayer,
Abbott, Solvay, Paladin, American Medical Systems,
GlaxoSmithKline and Watson Pharma.
Dr. Jack Barkin has been a clinical investigator, speaker
and medical advisory board member and consultant
forAbbott, Lilly, Bayer, Paladin, Watson Pharma, Bayer,
AstraZeneca , Astellas, Solvay, Pfizer and Triton.
References
1.
Feldman HA, Goldstein I, Hatzichristou DG et al. Impotence
and its medical and psychological correlates: results of the
Massachusetts Male Aging Study.
J Urol
1994;151(1):54-61.
2.
McKinlay JB. The worldwide prevalence and epidemiology of
erectile dysfunction.
Int J Impot Res
2000;12(
Suppl 4):S6-S11.
3.
Morley JE, Charlton E, Patrick P et al. Validation of a screening
questionnaire for androgendeficiency in agingmales.
Metabolism
2000;49(9):1239-1242.
4.
Mulligan T, Frick MF, Zuraw C, Stemhagen A, McWhirter C.
Prevalence of hypogonadism in males aged at least 45 years.
The HIM Study.
Int J Clin Pract
2006;60(7):762-769.
5.
Inman BA, Sauver JL, Jacobson DJ et al. A population- based,
longitudinal study of erectile dysfunction and future coronary
artery disease.
Mayo Clin Proc
2009;84(2):108-113
6.
Montorsi F, Briganti A, Salonia A et al. Erectile dysfunction
prevalence, time of onset and association with risk factors in 300
consecutive patients with acute chest pain and angiographically
documented coronary artery disease.
Eur Urol
2003;44(3):360-364.
7.
Jackson G. 10
th
World Congress of the International Society for
Sexual and Impotence Research; Sept 2002.
8.
JacksonG. The secondPrinceton consensus on sexual dysfunction
andcardiacrisk:newguidelinesforsexualmedicine.
JSexMed
2006;
3(1):28-26.
9.
Website:
10.
Rosen R, Altwein J, Boyle P et al. Lower urinary tract symptoms
and male sexual dysfunction: the multinational survey of the
aging male (MSAM-7).
Eur Urol
2003;44(6):637-649.
11.
Barkin J. Erectile dysfunction and hypogonadism (low
testosterone)
Can J Urol
2011;18(
Suppl 1):2-7.
12.
Barkin J. Emerging Therapies.
Can J Urol
2012;19(
Suppl 1):49-53.
13.
Vardi Y. Microvascular complications in diabetic erectile
dysfunction: do we need other alternatives.
Diabetes Care
2009;
32(
Suppl 2):S420-S422.
14.
Park K, Ku JH, Kim SW, Paick J. Risk factors in predicting a
poor response to sildenafil citrate in elderly men with erectile
dysfunction.
BJU Int
2005:95(3):366-370.
15.
Viagra Product Monograph.
16.
Cialis Product Monograph.
17.
Levitra Product Monograph.
18.
Health Canada website:
/
advisories-avis/_2012/2012_101-eng.php.
19.
World Health Organization website.
20.
Heartland Institute website.
21.
Dorsey WJG. The illicit sale of medications for the treatment
of erectile dysfunction: PDE5 inhibitors: a prime target for
counterfeiters. Science Daily 2010.
22.
Liu XS, Folia C, Gomella LG. Pharmacology for common
urologic diseases: 2011 review for the primary care physician.
Can J Urol
2011;18(
Suppl 1):24-38.
23.
Serfoglu EC, Mandava SH, Gokce A, Chouhan JD, Wilson SK,
Hellstrom WJ. Long-term revision rate due to infection in
hydrophilic-coatedinflatablepenileprostheses:11-yearfollowup.
J Sex Med
2012;
Jul3. Doi 10.1111/j. 1743-6109.2012.02830. Epub
ahead of print.
24.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J,
Mishra A. The international index of erectile function (IIEF):
a multidimensional scale for assessment of erectile function.
Urology
1997;49(6):822-830.
25.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM.
Development and evaluation of an abridged 5-item version
of the international index of erectile function (IIEF-5) as a
diagnostic tool for erectile dysfunction.
Int J Impot Res
1999;11(6):
319-326.
26.
Data on File, Pfizer Inc., New York, New York.
27.
Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC,
HvidstenK. Validation of the erection hardness score.
J Sex Med
2007;4(6):1626-1634.
28.
King R. Abstract MP-05-133; 9
th
ESSMCongress Vienna, Austria
December 2009.
29.
Rommerts FFG. Testosterone: an overview of biosynthesis,
transport, metabolism and non-genomic actions. In: Nieschlag
E, Behre HM, eds. Testosterone: Action-Deficiency-Substitution.
Cambridge, UK: Cambridge University Press; 2004:1-38.
30.
Cherrier MM, Matsumoto AM, Amory JK et al. The role of
aromatization in testosterone supplementation: effects on
cognition in older men.
Neurology
2005;64(2):290-296.
GREENSPAN AND BARKIN
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