A practical guide to diagnosis, management and treatment of testosterone deficiency for Canadian physicians.

The percentage of men receiving appropriate management for testosterone deficiency syndrome (TDS) is small in comparison to prevalence estimates. This is despite linkages to cardiovascular disease, osteoporosis, diabetes, sexual function, sarcopenia, emotional well-being and the metabolic syndrome. Furthermore, the availability of guidelines has not significantly enhanced the care of TDS patients. A multidisciplinary group of medical experts sought to improve the management of testosterone-deficient patients by Canadian physicians. This report describes their conclusions and defines an algorithm for appropriate TDS management.

The effect of physician and patient education when combined with vardenafil treatment in Canadian males with erectile dysfunction: an open-label, factorial-designed, cluster-randomized clinical trial.

INTRODUCTION: Studies evaluating the effect of education on treatment success with phosphodiesterase type 5 (PDE5) inhibitor therapy in men with erectile dysfunction (ED) are limited. Additional education of the primary care physician (PCP) and the patient are thought to optimize the treatment of ED. AIM: To assess the impact of education of the PCP or of the patient in the treatment of ED with vardenafil relative to usual care. METHODS: In this 12-week, open-label, multicenter, factorial-designed, cluster-randomized Canadian study, 1,029 patients with ED were enrolled into four different education groups: usual care, patient education, PCP education, and both PCP and patient education. All groups started on vardenafil 10 mg, with the option to titrate at weeks 4 and 8. MAIN OUTCOME MEASURES: The primary efficacy measure was the difference at week 4 last observation carried forward (LOCF) in the overall improvement in erectile function (EF) as measured by the Global Assessment Question (GAQ), while on background vardenafil, between those receiving education vs. those who did not. Other secondary assessments included responses to diary questions regarding penetration (sexual encounter profile, SEP2) and erection maintenance (SEP3), and to questionnaires regarding treatment satisfaction (Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS]). RESULTS: A total of 956 patients were included in the intent-to-treat population. Mean baseline International Index of Erectile Function-EF domain score was 13. GAQ response rates at week 4 LOCF were high (>80%) for all groups, regardless of the education given. Mean per patient SEP2 and SEP3 rates at week 12 LOCF were 86-89% and 79-83%, respectively. In an exploratory analysis, a positive relationship between GAQ responses and EDITS scores was observed (P < or = 0.0007). Vardenafil was generally well tolerated. CONCLUSIONS: In men with moderate ED, vardenafil led to high success rates and satisfaction regardless of the education given. The benefits of education for PCP and patients in Canada were possibly masked by a ceiling effect in this study population.