There is much evidence documenting that testosterone (T) plays a crucial role in regulating male sexual function acting at either the central or peripheral levels. Sexual symptoms, and in particular erectile dysfunction and reduced frequency of sexual thoughts and sleep-related erections represent the most specific symptoms associated with hypogonadism in adulthood. There is evidence to suggest that sex is actually an excellent way to boost T levels in milder forms of hypogonadism. It has been reported that sexual inertia resets the reproductive axis to a lower activity, somehow inducing a secondary hypogonadism, characterized by a reduced Luteinizing Homrone (LH) bioactivity. T replacement therapy is capable of improving all aspects of male sexual function and should be considered the first line treatment in patients with erectile dysfunction with overt hypogonadism. However, TTh as mono-therapy might not be sufficient in complicated subjects. In such cases, combination therapy with phosphodiesterase type V inhibitors may improve the outcome. In young uncomplicated individuals with milder forms of hypogonadism, the restoration of normal sexual function, however obtained, might improve T levels
