Q: I use Cialis for treatment of ED (erectile dysfunction). It works OK, but I wish sometimes it would work better than it does. I have been seeing a lot of advertisements that recommend testing for low testosterone. Do you think taking testosterone would help me?
A: Probably not. Although the erectile dysfunction and low testosterone not uncommonly occur at the same time, they really are two separate conditions. Many folks who have difficulty having an erection still have a healthy desire for sex. Folks who have a low testosterone typically have a markedly decreased desire for sex, as well as decreased strength, stamina and normal male aggressiveness. Men with low testosterone don't necessarily have erectile dysfunction, but they frequently do.
A study published in the Nov. 20 issue of the Annals of Internal Medicine found that testosterone supplementation added to men ages 40-70 with low testosterone already using Viagra for erectile dysfunction did not improve their erectile dysfunction better than a placebo. It did not improve any aspect of sexual function, frequency of sexual encounters, vitality, ED- related quality of life or marital intimacy.
I'd suggest discussing additional treatment options with a urologist, as well as evaluating whether or not any of your medications could be to blame.
Q: I have low testosterone treated with Androgel applied once a day to my shoulder and upper chest area. It does seem to help, but I find the gel pretty messy. I know this is the most popular way low testosterone is treated, but why couldn't I just take testosterone pills instead?
A: If it were only that easy! The problem is that testosterone in a pill form just doesn't work well to correct a low testosterone level. When swallowed, it's absorbed in the digestive tract and sent to the liver where it's not only heavily broken down, but exerts a direct toxic effect on the tissues of the liver before it has a chance to exert its desired effect on the rest of the body. Also, because of the rapid metabolism of testosterone pills, they would need to be taken several times a day.
While testosterone pills are used in other countries, the FDA doesn't consider them to be a particularly safe or effective treatment of low testosterone in adult males — especially when compared with testosterone gels (Androgel, Testim), testosterone patches (Androderm) or even twice-daily testosterone (Striant) placed in the mouth between the cheek and gum.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: Ask Dr. H, P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. — C.W., Winter Park, Fla. — S.D., Detroit