ED + testosterone

PDE5 inhibitors: Sildenafil, Vardenafil, Tadalafil, Avanafil

inhibit cGMP metabolism to its inactive form → prolonging cGMP actions

Alprostadil

PDE1 activation of prostaglandins → activates adenylate cycle incr cAMP = vasodilation

Drugs that cause ED

Anticholinergics:

First gen antihistamines

TCA, SSRI paroxetine, sertraline, fluvoxamine, fluoxetine

Sildenafil (Viagra)

More visual effects bc also inhibits PDE 6

Vardenafil (Staxyn ODT)

DNU if QT prolongation or taking antiarrhythmics

More visual bc PDE

Tadalafil (Cialis)

More back pain

approved of ED + BPH long half life

Avanafil (Stendra)

Quickest

Sertoli cells

synthesize androgen binding protein

Leydig cells

Synthesize Testosterone

17a methyl derivative

oral → aloha methyl group less hepatic

can cause Hepatotoxicity

Ester derivative

Parenteral intramuscular admin → lipophilic

Primary Hypogonadism

Low T + elevated gonadotropin

secondary Hypogonadism

Low T + low-normal gonadotropin

mixed Hypogonadism

Low T + variable gonadotropin levels

Oral testosterone products - Undecanoate

1. Kyzatrex

2. Jatenzo

3. Tlando

4. Undecartex

take with food

IM testosterone

1. cypionate (Azmiro)

2. Enanthate

3. Undecanoate (Avid) → BBW for pulmonary oil micro embolism

Causes mood swings

Subq testosterone

Enathate → 1qw

Testopel → implantation dont recc

Nasal testosterone

Neatest 3x daily

ADR: nasal irritation

Topical testosterone GEL:

1. androgen

2. testim

3. volgelxo pump

4. volgelxo → inner thigh

BBW testosterone

Gel/Solu —> 2nd exposure to children virilization use clothes

Undecanoate injection → pulmonary oil microembolism

Incr BP: Oral undecanoate (Kyzatrex, Tlando, Undecatrx)