Q: I have been prescribed 40 mg Andriol Testocap or Cerenos twice daily for 2 months for a low testosterone reading of 4.4 ng nl. Are these medicines safe and free from side effects? Will it affect the liver or the kidneys in any way? I am on 70 mg Silybon twice daily for fatty liver. Also is it safe to take Tadalafil 10 mg twice a week?

A:Based on the information supplied by you, I am not very sure if the reasons for erectile dysfunction is low testosterone level. Testotsterone is of two types: total and free. The normal range of total testosterone is 300 to 1,000 ng/dL. It fluctuates from day to day and within 24 hours of the day. A person with 300ng as as normal as the one with 1,000 ng. However, the bioavailable level - that is actually useful and required - is 0.5 to 3% of the total testosterone. Thus it can range from 1.5 to 30ng. I think you have given the free testosterone level. Low testosterone levels are exceedingly uncommon. In any case there should be other signs and symptoms. Any preparation of testosterone should be avoided in liver dysfunction. It also increases weight; hence over-weight people are in danger of becoming even more obese. You have not stated that you are also suffering from hypertension even though you are taking enalapril 2.5mg for the past three years. Hypertension itself is one of the major causes of erectile dysfunction. Added to the problem is your weight - 80kg for a person of your age and height (168cm) is obese. It should be less than 70kg at the most. Obesity is another known cause of erectile dysfunction. There is no problem in your taking tadalafil (Zydalis) up to 20mg 2 times or even more frequently every week. For your liver problem you can also try Hepa Merz one tablet thrice daily for several weeks. I wish you had got Liver Function Tests done.