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Rosenthal BD, May NR, Metro MJ, Harkaway RC, Ginsberg PC. Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone. Urology 2006;67:571-574.

This study evaluates whether combination therapy with testosterone gel (T-gel) and sildenafil citrate is effective in achieving adequate potency in 90 subjects (aged 32-74) with low-normal serum testosterone levels in whom at least 3 attempts at sexual intercourse with maximal dosage of sildenafil alone has failed.

24 men had testosterone levels less than 400 ng/dL (range 92 to 365, mean 231.4) and were subsequently started on 1% T-gel mono-therapy, 5 g daily). After 4 weeks of T-gel alone (week 4), sildenafil citrate (Viagra, 100 mg) was added to the treatment regimen for an additional 12 weeks (through week 16). Potency was defined as the ability to have at least one episode of satisfactory intercourse during the treatment period.

All the men had normalized serum testosterone levels after 4 weeks of T-gel mono-therapy (range 424 to 596 ng/dL, mean 525).  However, none of the men regained potency. At week 16, almost all (22 of 24, 92%) of the men reported improved potency with combination therapy. Improvement in erection quality was also observed.

The results of this study support the use of T-gel with sildenafil citrate in men with low-normal serum testosterone levels in whom sildenafil alone fails. It also underscores the numbers of men with low to low-normal testosterone levels who would benefit from testosterone screening when evaluated for erectile dysfunction.