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Androgen deficiency can lead to decreases in nocturnal erections and libido. Hypogonadism is associated with impotence, yet erection in response to visual stimulation is preserved in men with hypogonadism, suggesting that androgens are not essential for erection. Although androgens can enhance male sexual function, testosterone therapy for the treatment of ED should be discouraged unless the cause is clearly related to hypogo-nadism. Androgen therapy in normal men may enhance sexual behavior but is without significant effect upon erectile function.

Usefulness of oral methyltestosterone is limited in men with hypogonadal impotence. Improvement following transdermal testosterone may require several months of therapy. Androgen replacement regimens for treating male hypogonadism include long-acting intramuscular injections (e.g., testosterone enanate, testosterone cypi-onate) and oral preparations (e.g. methyltestosterone, fluoxymesterone). Transdermal patches (Testoderm, Androderm) and topical testosterone gel (Androgel) are also available. Transdermal testosterone also may improve sexual function and psychological well-being in women who have undergone oophorectomy and hysterectomy. Transdermal delivery systems can provide a more constant serum testosterone level than do intramuscular injections, but they are more expensive.

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