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Is Total Testosterone a Convincing Indicator for the Need for Testosterone Supplementation? A Study of other Parameters: Nocturnal Penile Tumescence, Rigidity Monitoring and Questionnaires

Michael J Mathers, Stephan Roth and Frank Sommer

Introduction and objective: Every Andrologist knows numerous cases in which men with normal testosterone values present with clinical signs of testosterone deficiency. We present cases in which eugonadal men show a measureable objective improvement in functioning and symptoms after testosterone supplementation. Case report: After testosterone supplementation two eugonadal men (total testosterone>8.00 ng/ml) improved on nocturnal penile tumescence and rigidity monitoring (RigiScan®) with a 48.5 minutes increase (greater than 60% rigidity) at the base and 43.2 minutes at the tip compared to before supplementation. The second case an increase (greater than 60% rigidity) of 39.2 minutes at the base and 44.4 minutes at the tip. Furthermore International Index of Erectile Function (IIEF) and Aging Male’s Symptom (AMS) scale improved after initiation of testosterone treatment. Discussion: There seems to be a discrepancy between laboratory findings in eugonadal men and symptoms of hypogonadism such as objective nocturnal penile tumescence and rigidity, free testosterone and scores of questionnaires which address these symptoms. This inconsistency is discussed according to the literature. Conclusion: Controlled studies are desirable to verify that eugonadal men with testosterone deficiency symptoms can objectively and subjectively benefit from testosterone supplementation.