Q: I am a 44 years old scientist and taking treatment for erectile dysfunction (ED) for the last 3 years. At the beginning when I consulted the Doctor he advised for serum testosterone check, which was 177.0 ng/dl and Free 8.8 pg/ml. I was advised Andriol Testocap twice daily, Cavetra 50 SOS and Forage TDS. Despite taking these medicines for a long time my latest testerone level last year was 26.81 pg/ml (free), which was in the normal range and total was 2.16 ng/ml, which was below the normal range. The doctor checked my LFT, PSA, testerone level periodically. Though there was slight elevation of SGPT 51.0 u/l, he asked me to continue the medicines. Despite taking Andriol testocap there is no considerable improvement until I take Penegra. I also feel very weak throughout the day. What are the side effects of Andriol testocap? Please also tell me the role of Forage 330 mg, which I am taking thrice daily. What if I don't continue with Andriol Testocap and use Penegra SOS?

A:Once the serum testosterone levels are found to be in the subnormal range, it is necessary to know if the problem is at the level of testes or elsewhere up in the chain. Therefore luteinizing hormone (LH) is measured and depending on its value that helps arrive at definitive diagnosis, appropriate medication is administered. If the impairment is at the testicular level, then one can give testosterone therapy. The choice of testosterone therapy is between conventional injectable depot and new oral formulations. When oral preparation such as Andriol Tetocap is used, it bypasses the liver and has minimal effect at that level; thus LFTs need not be tested that regularly. However prostate must be kept under close watch. In your enquiry, there is no information on the duration of Andriol Testocap use. Generally a maximum of 160 mg (i.e. 2 caps twice daily) are given for no longer than 3 weeks and depending on response, the dose is reduced to about half (80 mg daily). Levocarnitine (sold under different brand names including Forage) is indicated in proven cases of carnitine deficiency which mainly occurs in kidney dialysis patients, but can be present in other cases also. There is no known, proven use in cases like yours. There is absolutely no problem in using Penegra on SOS basis since its mode of action is quite different.