Special Situations Requiring Interventions for Men with ED

Depression and Serotonin Reuptake Inhibitors

Sexual dysfunction associated with the use of serotonin reuptake inhibitors has been reported in 30-70% of treated patients and is a significant contributor to discontinuation of these medications. A review of selective phosphodiesterase type-5 inhibitors for antidepressant-associated sexual dysfunction suggests treatmet of this side effect of antidepressant medication could improve depression disease management outcomes (105).

Testosterone Deficiency

Androgen replacement can improve libido, erection rigidity, and sexual satisfaction in men with demonstrable low serum levels of testosterone (106). In a large cohort of 1461 men presenting with ED, just over one-sixth (17.7%) at initial screening had biochemical evidence to suggest the possibility of hypogonadism. More rigorous estimation of serum testosterone, associated parameters, and the presence of clinical symptoms resulted in 3% of the population having a diagnosis of hypergonadotropic hypogonadism. Of these, one-fifth agreed to a trial of testosterone therapy but two-thirds of this eligible group also required another erectogenic agent to resolve the ED (107).

Treatment can be with daily 5 mg transdermal patches or gel or 250 mg intramuscular injection three times weekly. The dose may need adjustment depending on clinical and biochemical response. Monitoring of hematocrit, liver, prostate, and lipid parameters is mandatory.

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