Testosterone and erectile function: an unresolved enigma.

Erectile function depends on a complex interrelationship between psychological, neurologic, vascular, and endocrine factors. It is well known that androgens play a critical role in the physiology of erectile function. This statement was based on several clinical observations: (1) castration is associated with a decline in sexual interest and erectile function, although some potency may be maintained; (2) antiandrogens result in erectile dysfunction (ED), although sexual interest may persist; and (3) androgen supplementation improves sexual function in hypogonadal men. However, the underlying mechanisms by which androgens regulate erectile function are poorly defined [1]. In their in depth and thoughtful review article, Traish et al provide an extensive analysis of the cellular, molecular, and physiologic mechanisms of androgens in erectile physiology and try to incorporate current evidence into clinical practice [2]. Several questions are raised from this article that stimulate discussion and provide guidance for future research.