Late Onset Hypogonadism (LOH) and sexual Health

Several causes may account for this lower success rate: the threshold level of the testosterone activity on sexual desire and erections may be as low as 7 nmol/l in some men. In addition, in men with ED and LOH vascular comorbidities are prevalent and may prevent the effect of testosterone therapy on erections. Lastly the hypogonadism associated with ED may be in some cases a consequence rather than the cause of ED. Even if  testosterone therapy may fail to improve erectile function of  some hypogonadal ED patients, routine testosterone determination remains mandatory in aging men consulting for ED. Achieving physiologic levels of testosterone is indeed one of the rare opportunities to restore spontaneous erections and save the patient from having to plan sexual activity. In addition restoring testosterone, which is generally low in such patients, is the only way of restoring sexual desire. Replacing testosterone may also improve other symptoms associated with LOH. Lastly a threshold testosterone level appears to be required to achieve full efficacy with PDE5 inhibitors in certain men, although this hypothesis has still to be confirmed.