EFFECT OF RAISING ENDOGENOUS TESTOSTERONE LEVELS IN IMPOTENT MEN WITHSECONDARY HYPOGONADISM - DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL WITH CLOMIPHENE CITRATE

Secondary hypogonadism is not an infrequent abnormality in older patie nts presenting with the primary complaint of erectile dysfunction. Bec ause of the role of testosterone in mediating sexual desire and erecti le function in men, these patients are usually treated with exogenous testosterone, which, while elevating the circulating androgens, suppre ss es gonadotropins from the hypothalamic-pituitary axis. The response of this form of therapy, although extolled in the lay literature, has usually not been effective in restoring or even improving sexual func tion. This failure of response could be the result of suppression of g onadotropins or the lack of a cause and effect relationship between se xual function and circulating androgens in this group of patients. Fur ther, because exogenous testosterone can potentially increase the risk of prostate disease, it is important to be sure of the benefit sought , i.e, an increase in sexual function. In an attempt to answer this qu estion, we measured the hormone levels and studied the sexual function in 17 patients with erectile dysfunction who were found to have secon dary hypogonadism. This double blind, placebo-controlled, cross-over s tudy consisted of treatment with clomiphene citrate and a placebo for 2 months each. Similar to our previous observations, LH, FSH, and tota l and free testosterone levels showed a significant elevation in respo nse to clomiphene citrate over the response to placebo. However, sexua l func tion, as monitored by questionnaires and nocturnal penile tumes cence and rigidity testing, did not improve except for some limited pa rameters in younger and healthier men. The results confirmed that ther e can be a functional secondary hypogonadism in men on an out-patient basis, but correction of the hormonal status does not universally reve rse the associated erectile dysfunction to normal, thus requiring clos er scrutiny of claims of cause and effect relationships between hypogo nadism and erectile dysfunction.