The Therapy of Nebido as Mono or in Combination With PDE-5 Inhibitors in Hypogonadal Patients With Erectile Dysfunction

Hypogonadism is a pathophysiologic and clinical factor in a substantial number of patients with ED,and data indicate that a threshold level of testosterone is necessary for normal erectile function.Testosterone therapy is clearly indicated in hypogonadal patients and is beneficial in other patients with ED and hypogonadism.However,testosterone efficacy as monotherapy for ED could be limited,and combination therapy with testosterone and other ED treatments,such as PDE-5 inhibitors may be valuable in certain subpopulations of patients.

Inclusion criteria

• Patients with ED over 3 months (specify using IIEF score)
• Age >= 18 years.
• Stable sexual relationship
• With low or low normal serum testosterone level (either total or bioavailable testosterone) TT <= 4 ng/ml and/or BT <= 1 ng/ml
• Aging Male Symptom scale with total score starting at 37 points (must not replace TT < 4 ng/ml)
• Eligible subjects who previously took the oral androgen or PDE5 inhibitor must have discontinued their use for 1 month

Exclusion criteria

• Contraindication to treatment with Testosterone according to the SPC
• Hypersensitivity to the active substances or any of the excipients of Nebido
• Diagnosed or suspected carcinoma of the prostate or the male breast cancer
• Past or present liver tumors
• Acute or chronic hepatic diseases
• Severe cardiac, hepatic or renal insufficiency
• History of penile implant or significant penile deformity
• Diagnosed sleep apnea
• Polycythemia (Hematocrit >50%)
• Prolactin >25 ng/ml
• Organic hypothalamic-pituitary pathology
• Any unstable medical, psychiatric or drug/alcohol abuse disorder
• Prostate specific antigen (PSA)>= 4 ng/ml
• Severe symptomatic benign prostatic hyperplasia (IPSS) sum score >=20)
• Diabetes mellitus which is uncontrolled (HbAlc level >10%)
• Epilepsy not adequately controlled by treatment
• Patients requiring fertility treatment
• Hypertension which is not adequately controlled on therapy
• Clinically significant chronic hematological disease which may lead to priapism such as sickle cell anemia, multiple myeloma or leukemia
• Hypersensitivity to PDE-5 inhibitors
• Concomitant Medication:

• Nitrites or Nitric oxide donors
• Anti-androgens
• anti-coagulants, with the exception of anti-platelet agents
• Any of potent inhibitors of cytochrome P-450 3A4:such as HIV protease inhibitors (Ritonavir or Indinavir); Anti-mycotic agent (Itraconazole and Ketoconazole)-topical application allowed; or Erythromycin.