Erectile dysfunction has multiple causes in older men. Combination therapy may therefore be an attractive option.

We conducted a randomized double blind trial over 2 months. We allocated 89 men who had different causes of erectile dysfunction and low testosterone concentrations randomly to two groups. One group received topical therapy with placebo cream and the other received active cream containing testosterone 0.8%, isosorbide dinitrate 0.5% and co-dergocrine mesylate 0.06%. Serum concentrations of total testosterone were measured every 15 days. Response to each therapy was assessed by measurement of tumescence using RigiScan and a sexual questionnaire.

Serum concentrations of total testosterone increased significantly in all patients (p<0.05) after 15 days of treatment with active cream (240±27ng/dl vs. 360±29ng/dl). Application of active cream to the penile shaft in the laboratory induced full tumescence in 18% of patients and partial tumescence in 53%. No patient had full tumescence after application of placebo cream. Sexual desire was improved in 70% of patients during treatment with active cream. Analysis of data from the questionnaires showed that 40% of patients reported full erections with successful intercourse, sexual enjoyment and satisfaction and 37% reported partial erections that were insufficient for successful intercourse. No patient experienced a full erection and successful intercourse after placebo cream. No major side effects were reported.

Topical treatment with cream containing testosterone and vasoactive agents is a new effective treatment for erectile dysfunction associated with low testosterone concentrations, particularly for patients with psychogenic causes.