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Testosterone replacement and supplementation

Testosterone can be given orally, by injection or implant, and now by a transdermal route (patch). Oral administration of testosterone is an unreliable route for increasing testosterone levels and injections or implants, both invasive techniques, are needed to sustain increased levels. The testosterone patch is a convenient and noninvasive method of obtaining controlled and sustained increases in testosterone levels. However, the use of the testosterone patch has been limited to date, probably because of problems with skin irritation.

Testosterone replacement in men who are truly hypogonadal is generally accepted as beneficial. However, the relationship between erectile dysfunction and testosterone is controversial, although there is evidence that nocturnal erections are androgen dependent. However, hypogonadal men have been shown to have a normal erectile response to erotic stimuli, as have a group of sex offenders on the anti-androgen cyproterone acetate. Moreover, it has been shown that testosterone levels are similar in impotent and potent elderly men. Many middle-aged men complain of a group of symptoms including mental and physical tiredness, lethargy and erectile dysfunction, which is increasingly attributed to a ‘male menopause’. These men are usually eugonadal but their testosterone level may be at the lower end of the normal range. There is some evidence that their well-being and sexual interest can be increased by boosting their testosterone levels by supplementation, although rarely to a level satisfactory to the patient. However, none of the studies have shown any beneficial effect on erectile dysfunction. Testosterone supplements carry the credible risk of stimulating a latent hormone-sensitive prostatic carcinoma and as no benefits have been demonstrated for sufferers of erectile dysfunction, its use for this indication should be resisted. Generic Testosterone