Hormone Therapy for Erectile Dysfunction

Hormone Therapy in Erectile Dysfunction: Diagnosis and Treatment

Erectile dysfunction (ED), one of the most common diseases in men, is defined as the chronic inability to achieve or maintain a penile erection sufficient for sexual intercourse. The frequency of ED increases with age, from ~35% in men aged 60 years to ~50% in men older than 70 years.

 The Role of Testosterone in Erectile Function

Testosterone plays an important role in male sexual health, contributing to sexual desire (libido), the maintenance of erectile-function mechanisms, and overall reproductive health. However, testosterone is only one of several factors involved in achieving and maintaining an erection. Normal erectile function also depends on adequate blood flow, healthy nerve function, psychological well-being, and the absence of certain underlying medical conditions.

Low testosterone levels may contribute to reduced sexual desire and, in some men, erectile difficulties. Nevertheless, erectile dysfunction (ED) does not automatically indicate testosterone deficiency. Many cases of ED are primarily associated with vascular disease, diabetes, medication effects, psychological factors, or a combination of causes.

For this reason, testosterone levels should be assessed in the context of a patient's symptoms and overall health rather than treated as the sole explanation for erectile difficulties.

 How Hormonal Imbalances May Be Associated with Symptoms

Hormonal disorders can affect sexual function in different ways. Testosterone deficiency, also known as hypogonadism, may be associated with reduced libido, fewer spontaneous or morning erections, fatigue, and changes in mood or body composition. Erectile difficulties may also occur, although they are not specific to low testosterone.

Other endocrine conditions, including thyroid disorders, elevated prolactin levels, and certain disorders affecting the pituitary gland, may contribute to sexual symptoms in selected patients. In addition, obesity, chronic illness, sleep disturbances, and some medications can influence hormone levels or sexual function.

These symptoms are not sufficient to establish a hormonal diagnosis. They may overlap with symptoms of cardiovascular disease, diabetes, depression, sleep disorders, and other conditions. A clinical assessment is therefore necessary to determine whether a hormonal abnormality is present and whether it is likely to be contributing to the patient's symptoms.

 Diagnostic Assessment Before Hormone Therapy

The evaluation of erectile dysfunction should begin with a medical and sexual history, a review of current medications, and an assessment of relevant risk factors. Depending on the clinical presentation, a healthcare professional may also perform a physical examination and assess cardiovascular and metabolic health.

When testosterone deficiency is suspected, total testosterone is generally measured in the morning, when levels are typically highest. A low result should usually be confirmed with a second morning measurement on a separate day before a diagnosis is established. Testosterone results must be interpreted alongside symptoms and the patient's clinical circumstances.

Additional tests may be appropriate depending on the findings. These can include luteinizing hormone (LH) to help distinguish testicular from pituitary or hypothalamic causes, prolactin when indicated, and thyroid testing when symptoms or history suggest a thyroid disorder. Sex hormone-binding globulin (SHBG) and calculated or accurately measured free testosterone may be considered when total testosterone is difficult to interpret.

The specific tests should be selected by a qualified healthcare professional. A single laboratory result, an online symptom questionnaire, or erectile difficulties alone cannot establish testosterone deficiency or determine whether hormone therapy is appropriate.

Indications and Limitations of Hormone Treatment

Testosterone therapy may be considered for men who have compatible symptoms and consistently low testosterone levels confirmed through appropriate testing, after the underlying cause has been evaluated. The aim is to treat clinically established testosterone deficiency, not to raise testosterone levels simply because erectile dysfunction is present.

In appropriately selected patients, testosterone treatment may improve sexual desire and some other symptoms of hypogonadism. Its effect on erectile function, however, varies. Testosterone therapy may not adequately improve erections when the main causes are vascular, neurological, medication-related, or psychological. Other evidence-based ED treatments may still be needed.

Testosterone therapy is not a universal treatment for ED and is not recommended solely for age-related changes without a confirmed diagnosis of hypogonadism. It may also be unsuitable for some patients, including those with certain prostate or breast conditions, elevated hematocrit, specific untreated medical conditions, or plans for near-term fertility. Testosterone treatment can suppress sperm production, so fertility goals should be discussed before treatment begins.

Treatment decisions should be individualized, with the expected benefits, possible risks, alternative options, and underlying cause of hormonal deficiency considered together.

 Risks, Monitoring, and Medical Supervision

Testosterone therapy requires medical supervision because it can cause adverse effects and may not be appropriate for every patient. Potential concerns include an increase in hematocrit, acne or oily skin, fluid retention, worsening of some urinary symptoms, and suppression of sperm production. The effects on individual cardiovascular outcomes depend on the patient's circumstances and the available evidence; risks should be discussed rather than assumed to be identical for everyone.

Before treatment, a healthcare professional should review the diagnosis, medical history, fertility plans, relevant contraindications, and baseline laboratory findings. Depending on the patient's age, history, and risk factors, assessment may include a complete blood count or hematocrit and an individualized discussion of prostate health.

Follow-up is important to evaluate symptom response, treatment adherence, testosterone levels where indicated, and possible adverse effects. Hematocrit and other safety measures should be monitored according to the treatment plan and applicable clinical guidelines. If symptoms do not improve, or if significant adverse effects occur, the diagnosis and treatment strategy should be reassessed.

Hormone therapy should not be started, adjusted, or discontinued without appropriate clinical guidance. The goal is to treat a confirmed hormonal disorder safely—not to use testosterone as a substitute for a comprehensive evaluation of erectile dysfunction.

Sexual health and the quality of an erection ensure not only the quality of a man's life, but also the mental, emotional and physical well-being of his partner. Since erectile function is a complex interaction between psychological and physiological factors, ED disorders require consultation at a psychotherapist or psychologist. At the same time, the search for effective and safe treatment with the help of medicinal methods continues. Both new methods of treatment or medicines, as well as new modern forms of drugs or methods of delivery of active substances, appear. The systems of prolonged, continuous release of the active component into the blood deserve attention.

Hormone Therapy for Erectile Dysfunction: Evidence and Risks

Long-lasting testosterone (T) implants were approved by the FDA as early as 1972. Until then, the only available treatment options were intramuscular injections of T. Implants (granules of substances) were surgically placed in the subcutaneous space and gradually dissolved. It is believed that their long-term effect is explained by the gradual dissolution of the granules in the relatively hypovascular subcutaneous space. Later, the method of drug administration using bioidentical pellets (BP) appeared.

HIGH SUCCESS RATE THERAPY  OF ERECTILE DYSFUNCTION: Stem Cell Therapy in Erectile Dysfunction: Mechanisms, Cellular Protocol

Hormone therapy  is a modified form of slow release of the active substance. BHRT  is a miniature granule (the size of a grain of rice), it is created from soy and yam - natural hypoallergenic materials that are not rejected by the human body. First, the pellet is "saturated" with hormones or other necessary substances, and then "implanted" into the patient's subcutaneous fat.

One of the substances that BHRT can "supply" to a man's body is testosterone. In addition, pellets with tadalafil appeared, a substance that proved itself well in the treatment of erectile dysfunction. The combination of two factors – a drug effective in the specified direction and the optimal form of its administration – can provide better results, relieve many men of erectile dysfunction (or improve the state of erection) and have an unambiguously positive effect on the quality of life.

Tadalafil is prescribed not only as a symptomatic treatment, similar to Viagra, but also as a course drug for pathogenetic action on erectile dysfunction. According to six randomized controlled studies, an oral dose of tadalafil 5 mg per day showed a positive effect after treatment at least 6 months compared to the control group with fewer side effects. Long-term use of ta-dalafil in low doses is one of the first-line drugs for restoring damaged vascular endothelium and ensuring long-term improvement of erectile function.
Research design From 2021 to 2022 a prospective randomized study without placebo control was conducted. All patients filled out and signed an informed consent to participate in the study. The study included men younger than 65 years old, who had a permanent partner and suffered from ED for 1 year or more.

After a thorough history collection, all patients were asked to fill out the International Index of Erectile Function (MIEF-5), the MIEF-Questionnaire 5 included 5 questions about erectile function: "How do you rate your confidence that you will be able to achieve and maintain an erection?", "How often is the erection hard enough to penetrate during sexual stimulation?", "How often are you able to maintain an erection after penetration of a partner?", "How difficult is it to maintain an erection until the end of penetration?", "How often are you satisfied with sexual intercourse?". The questions were evaluated on a scale from 1 (pronounced manifestations of erectile dysfunction) to 5 (absence of symptoms).

The patients underwent ultrasound Doppler examination of the vessels of the penis. During the procedure, the speed of systolic (Vs) and diastolic (Vd) blood flow, as well as the resistance index (IR) were measured. Also, all patients underwent a digital rectal examination, general and biochemical blood analysis with determination of prostatic specific antigen (PSA), general urinalysis and hormonal research, which included determination of the levels of total testosterone, free testosterone, prolactin, estradiol and dehydroepiandrosterone sulfate.

Patients with abnormal PSA values, uncontrolled diabetes were excluded from the study , oncological diseases, acute infectious diseases, kidney and liver failure, family disharmony, as well as severe mental disorders. All selected patients were asked to stop taking any concomitant medications to improve

Clinical and preventive medicine, sexual function 2 weeks before the start of the study. A total of 60 patients who met the specified criteria and had no contraindications were selected for inclusion in the study. All patients were prescribed pellets with bioidentical tadalafil 75 mg. After 4 months of follow-up, patients were asked to re-fill the MIEF-5.

They also had a Doppler examination of the vessels of the penis, a general urinalysis and a general blood test to determine the hormonal background. The pellet was inserted in the conditions of a sterile operating room through a 3 mm skin incision in the outer quadrant of the buttock. and the introduction of the substance as deeply as possible into the subcutaneous adipose tissue with the help of a trocar.

 Clinical results of hormone therapy for erectile dysfunction

Characteristics of the patients. The average age of the patients was 54 ± 7.3 years. Comorbidities were observed in all patients. The levels of PSA and sex hormones were within the normal range. All patients showed an improvement in MIEF-5 system.
None of the patients had an allergic reaction, inflammatory changes, or pain at the site of pellet implantation. There were also no side effects and negative impact on the general condition of the subjects. The results of repeated blood analysis, which included hemogram, kidney tests, liver tests, lipid profile and coagulation did not contain significant pathological changes.
All patients noted not only an improvement in erectile function, but also a complete elimination of ED. A positive and stable effect of se-ed participants was recorded in 84.5%. There were also improvements in glycemic control and erectile function (the latter being a common complication of diabetes) in overweight patients.
In particular, tadalafil proved to be effective in the treatment of benign prostatic hyperplasia – both as a monopreparation and as an adjunctive therapy. The drug is safer than other treatment options, as it not only does not worsen (a side effect of treatment with 5-alpha-reductase inhibitors), but even improves sexual function. Tadalafil can be used to treat symptoms of the lower urinary tract, which are usually a sign of benign prostatic hyperplasia, and chronic prostatitis.
In addition, tadalafil has an anti-inflammatory effect on the patient's body and the ability to prolong sexual intercourse. In all cases, as with ED, the effect occurs due to the inhibitory effect of tadalafil on phosphodiesterases of various types.
This study showed the effectiveness of using tadalafil by the introduction of a pellet in the treatment of erectile dysfunction in men younger than 65 years. The appointment of tadalafil in the form of subcutaneous implantation of a pellet is safe and does not cause significant side effects during systemic treatment.

We looked at the hormonal cause of decreased potency, which can be solved quite easily within a few days and have a prolonged effect. But there are other situations where the cause may be chronic inflammation, post-traumatic syndrome, or a psycho-emotional state. We are ready to help you cope with any problems in the health of your sex life.

Patient testimonials and treatment outcomes are individual and may vary significantly from person to person. The results described reflect individual experiences and should not be interpreted as a guarantee of similar outcomes for other patients. The effectiveness of treatment depends on multiple factors, including the underlying cause and severity of the condition, the patient’s overall health, and their individual response to therapy. Testimonials are provided for informational purposes only and do not constitute medical advice or a guarantee of treatment success.  Read more testimonials :Patient Stories About Stem Cell Therapy