Low testosterone levels can occur in men at any age, and testosterone replacement therapy (TRT) addresses this issue. In addition, recent studies have shown that combination therapy with Tadalafil (Cialis), a medication commonly used to treat erectile dysfunction (ED), improves sexual function, overall sexual satisfaction, prostate health, cardiovascular health, estradiol reduction, and ratio, as well as exercise performance in men.
Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, enhances TRT’s effectiveness, and this combination therapy can benefit men with type 2 diabetes (T2D).
Boston University of the School of Medicine estimates that low testosterone affects 4 to 5 million men in the United States. Though it can happen at any age, it’s prevalent in older males. In younger patients, hypogonadism may be the primary event, while in older men, age-related decline in testosterone production may be a part of their ED profile.
Therefore, any patient presenting with ED should have a basic hormone profile to determine if they have low testosterone. Treatments to optimize testosterone not only improves libido, energy level, and the potential to have normal erections but also enhance the response to Tadalafil (Cialis) if deemed the appropriate treatment.
Research is increasingly suggesting that combination therapy is safe and beneficial. Tadalafil can help improve a patient’s performance while undergoing replacement therapy. However, a study from 2022 found that if a patient’s testosterone levels are too low (below 307 ng/dL), these medicines may be less effective. In addition, a study suggests that testosterone and tadalafil work in synergy and may rely on one another to achieve optimal results. Thus, it is vital to have the right testosterone levels when taking tadalafil.
In another systematic review conducted by Canadian Urological Association Journal, combining Tadalafil with testosterone therapy demonstrates promising results as a safe and effective treatment option. Standards widely accepted diagnose hypogonadism when a man’s serum testosterone level falls below 300 ng/dL. Furthermore, for men with low testosterone levels (between 300 and 400 ng/dL) who did not respond to initial Tadalafil treatment alone, adding testosterone therapy may improve sexual function. The lower the baseline testosterone level, the more superior the improvement in sexual function with combination therapy compared to monotherapy.
In a 2012 randomized controlled trial, Tadalafil combined with testosterone undecanoate finds to be more effective than testosterone undecanoate alone in improving testosterone levels, sexual function, and satisfaction in older and middle-aged men with late-onset hypogonadism (LOH), which is an age-related decline in testosterone. The study also reports an improved erectile function (IIEF) score, which measures the ability to achieve and maintain an erection, and the Sexual Encounter Profile (SEP) score, which measures the ability to achieve successful intercourse. In addition, this combination therapy not only improved the physical aspects of sexual function but also increased men’s self-confidence and satisfaction.
Case study, spanning over 5 years
A recent study by The Third Hospital of Peking University found that testosterone replacement therapy (TRT) may be an effective treatment for men with erectile dysfunction (ED) caused by low testosterone levels. The study followed a 46-year-old man who had been unable to find relief from ED by using tadalafil, a common medication for the condition.
After just two months of TRT treatment, the patient’s testosterone levels returned to normal, and he experienced improvements in physical fitness and anxiety symptoms. Additionally, the combination of TRT and tadalafil on-demand significantly improved the patient’s sexual function.
The patient continued the combined treatment for 45 months and then TRT alone for 18 months. By the end of the treatment, the patient had fully restored normal penile erection and sexual satisfaction.
This study suggests that TRT may be a safe and effective treatment of ED caused by testosterone deficiency. It enhances the effectiveness of tadalafil and can be used long-term without significant issues. If you’re struggling with ED and have been diagnosed with low testosterone levels, talk to your doctor about whether TRT may be the proper treatment.
Unlock enhanced sexual satisfaction with tadalafil. Studies have revealed that this medication can dramatically improve sexual function, desire, and overall pleasure. Taking Tadalafil 5 mg once daily has been shown to significantly enhance ejaculation and orgasm, intercourse satisfaction, and erectile function, resulting in an overall improvement in sexual pleasure for men.
Tadalafil, a medication for erectile dysfunction, was found to improve heart function in men with diabetes-related heart problems in a 20-week study. The study also showed that tadalafil positively affected other areas, such as cardiovascular, metabolic, immune, and renal function in both men and women. However, women did not show the same improvement in heart function as men.
Tadalafil was generally well-tolerated, with minor side effects reported in 14.5% of patients. The study suggests that tadalafil may have a conditional cardioprotective impact in men with diabetic cardiomyopathy. Further studies are needed to understand the specific mechanisms and markers of the medication’s effects on diabetes-related complications.
Another one from the International Journal of Impotence Research aimed to investigate whether scheduled tadalafil administration is more effective than on-demand tadalafil in improving endothelial function in men with ED.
The pilot study also found that scheduled tadalafil administration improved the lining of blood vessel function markers, including decreased vascular cell adhesion molecule, endothelin-1, and C-reactive protein, and increased insulin levels.
Additionally, the research found that patients receiving scheduled tadalafil experienced a significant improvement in morning erections. The results suggest that scheduled tadalafil administration may be more effective than on-demand tadalafil in improving endothelial function in men with ED.
Footnotes: The endothelium is a thin layer that lines the interior of the heart and blood vessels.
Type 2 Diabetes
A study found that low testosterone levels in male adolescents may be a risk factor for insulin resistance. Testosterone replacement therapy (TRT) can significantly improve patients’ insulin sensitivity and suppress levels of a protein called hsCRP, which can help prevent the development of diabetes mellitus and cardiovascular diseases in the future.
In another study conducted where a 6-month trial, eligible patients were randomly assigned to either take tadalafil 5mg or a placebo once a day. A pilot study found that taking a low dose of tadalafil once a day can effectively improve blood sugar control and erectile function in patients with type 2 diabetes and erectile dysfunction.
A 2020 paper found that testosterone replacement therapy (TRT) can have positive effects on cardiovascular health in men with type 2 diabetes (T2DM) and metabolic syndrome (MetS). The study, which conducted a meta-analysis of multiple randomized controlled trials, found that TRT can lower blood sugar levels, improve insulin sensitivity, and lower cholesterol.
Lean Muscle Mass
In a small clinical trial, daily tadalafil helped nonobese men increase their lean muscle mass, likely due to insulin production, lowered the amount of estradiol (a type of estrogen) in the body, and improved how well the blood vessels functioned. Studies in the lab also showed that tadalafil increased muscle cells’ amount of two proteins, myogenin and androgen receptors suggesting that tadalafil directly affects these proteins and helps muscles grow stronger.
A Journal of Sexual Medicine study finds tadalafil’s ability to lower levels of estradiol (E2) in the body in a 12-month investigation. The study also found that the ratio of testosterone to estradiol (T:E ratio) increased in the patients who took tadalafil. The results showed that the treatment was safe and well tolerated, with sustained improvements in sexual function and erectile function. The study suggests that tadalafil might have a role in regulating erectile function through a possible inhibition of aromatase activity and cross-talk between androgen and estrogen.
The American Heart Association’s Circulation Journal did a study over 16 weeks with 405 patients with a condition called pulmonary arterial hypertension (PAH). The patients either did not take any treatment or took a medication called bosentan. Random choices with a fake treatment (placebo) or Tadalafil in doses (2.5, 10, 20, or 40 mg) once daily. The study’s main goal was to see how far the patients could walk in 6 minutes. The study also checked how the patient’s condition changed, their risk of worsening, and their overall well-being.
The results showed that Tadalafil increased the distance walked in 6 minutes in a dose-dependent manner, with the 40 mg dose showing the most significant improvement. In addition, patients who took Tadalafil also had a reduced risk of clinical worsening and improved health-related quality of life.
Some evidence suggests that tadalafil may improve exercise performance in healthy men. For example, a study published in the Journal of Clinical Pharmacology found that tadalafil improved exercise capacity and delayed the onset of exercise-induced angina in healthy men with a history of myocardial ischemia.
Studies can help us understand the potential benefits of TRT and tadalafil, but it’s important to remember that everyone is different. So while research can provide insight, it’s always best to talk with a medical professional to see if these treatments are right for you.
Our clinic offers clinical evaluations to determine if a combination or solo therapy is the best option for you. Call us at 224-304-4004 to schedule your appointment and get personalized advice.
The content on this website is for informational purposes only. The information provided is not intended to be a substitute for professional medical advice, diagnosis, or treatment. We cannot guarantee that the information on this website is complete, accurate, or up-to-date, and it should not be relied upon as such.
Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: A systematic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433544/
Effects of taking tadalafil 5 mg once daily on erectile function and total testosterone levels in patients with metabolic syndrome https://onlinelibrary.wiley.com/doi/10.1111/and.12751
Impact of low testosterone on response to treatment with tadalafil 5 mg once daily for erectile dysfunction https://pubmed.ncbi.nlm.nih.gov/24726311/
Efficacy of testosterone replacement therapy plus alternate-day tadalafil for patients with late-onset hypogonadism: An open-label, randomized, crossover study https://pubmed.ncbi.nlm.nih.gov/33342003/
Combination therapy of testosterone enanthate and tadalafil on PDE5 inhibitor non-reponders with severe and intermediate testosterone deficiency https://www.nature.com/articles/ijir201232
Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215032/
Tadalafil improves total testosterone, IIEF score and SEP in old and middle-aged males with late-onset hypogonadism https://pubmed.ncbi.nlm.nih.gov/22741450/
65-month testosterone replacement therapy for androgen deficiency-induced ED: a case report and review of the literature https://pubmed.ncbi.nlm.nih.gov/24520668/
Tadalafil once daily improves ejaculatory function, erectile function, and sexual satisfaction in men
The role of testosterone in male sexual function https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9789013/
The efficacy of combination treatment with injectable testosterone undecanoate and daily tadalafil for erectile dysfunction with testosterone deficiency syndrome https://pubmed.ncbi.nlm.nih.gov/25648342/
Combining Testosterone and PDE5 Inhibitors in Erectile Dysfunction: Basic Rationale and Clinical Evidences https://www.europeanurology.com/article/S0302-2838(06)00811-6/fulltext
Treatment Strategy for Non-Responders to PDE5 Inhibitors https://pdfs.semanticscholar.org/b9c8/f2f8127345aa68809070316d4c9d743fc37e.pdf
Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699638/
Erectile Dysfunction Drugs Are Safe, Possibly Beneficial After Heart Attack
The American College of Cardiology
The role of testosterone in male sexual function https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9789013/
Sex-specific effects of daily tadalafil on diabetic heart kinetics in RECOGITO, a randomized, double-blind, placebo-controlled trial https://www.science.org/doi/10.1126/scitranslmed.abl8503
Effect of low-dose tadalafil once daily on glycemic control in patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, placebo-controlled pilot study https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-022-00825-w
Metabolic Effects of Testosterone Replacement Therapy in Patients with Type 2 Diabetes Mellitus or Metabolic Syndrome: A Meta-Analysis https://www.hindawi.com/journals/ije/2020/4732021/
Tadalafil improves lean mass and endothelial function in nonobese men with mild ED/LUTS
Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence
Testosterone: Estradiol Ratio Changes Associated with Long-Term Tadalafil Administration: A Pilot Study
Tadalafil Therapy for Pulmonary Arterial Hypertension https://www.ahajournals.org/doi/full/10.1161/circulationaha.108.839274
The effect of tadalafil on the time to exercise-induced myocardial ischaemia in subjects with coronary artery disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884941/
Relationship between chronic tadalafil administration and improvement of endothelial function in men with erectile dysfunction: a pilot study https://www.nature.com/articles/3901513
Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: results of a European multicenter, open-label study of patient preference https://pubmed.ncbi.nlm.nih.gov/14693300/
Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction https://pubmed.ncbi.nlm.nih.gov/11012578/