Hormonal erectile dysfunction - Evaluation and management

Hypogonadism is an uncommon cause of erectile dysfunction, but one that can be treated readily and effectively. Unfortunately, hypogonadal states in adult males are difficult to diagnose on purely clinical grounds; it is necessary to seek biochemical support, The simplest way to establish the diagnosis of hypogonadism is by determination of serum testosterone levels. Several methods exist but either total testosterone determination along with assessment of sex hormone-building globulin or bioavailable testosterone appears to be the most reliable and accessible. Once a diagnosis of hypogonadism has been established in a man with erectile difficulties, a trial of androgen supplementation is warranted, if no contraindications exist. Knowledgeable monitoring is essential. In the absence of an adequate response, comorbidities should be diligently sought out. No credible guidelines exist for androgen administration to patients with erectile dysfunction. Based on the current state of knowledge, a set of practical recommendations is provided.