No need to add testosterone to sildenafilBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8016 (Published 27 November 2012) Cite this as: BMJ 2012;345:e8016
Erectile dysfunction and low serum concentrations of testosterone often coexist, so researchers designed a double blind placebo controlled trial to test whether men with both should add testosterone gel to their regular treatment with sildenafil. The extra testosterone made no difference to erectile function scores or any other measure of sexual wellbeing in middle aged men, despite serum concentrations of testosterone increasing to within normal limits⇑.
The 140 men spent three to seven weeks optimising their sildenafil before randomisation, then 14 weeks using the same dose of sildenafil plus three tubes a day of testosterone or placebo gel. Their sex lives improved significantly during the run in period. Men in both groups reported similar sexual activity, satisfaction, and quality of life for the rest of the trial. The extra testosterone failed to work for any subgroup identified by age, body mass index, or baseline concentration of testosterone. Adherence was good, although six men dropped out because of side effects. Five were using the active gel.
These participants were fairly typical of middle aged men presenting to surgeries and clinics with erectile problems and low concentrations of testosterone, say the researchers. Sildenafil alone worked well for them, and doctors may want to rethink the common practice of routinely adding exogenous testosterone in the hope of even better outcomes.
Cite this as: BMJ 2012;345:e8016