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Tadalafil dose linearity is a positive predictor of response. The following studies are relevant to our discussion. First-line Pharmacologic Treatment for Hypogonadism in Men With Age- Related Overemotion A Phase 3, double-blind, single-centre, efficacy/safety study on tadalafil compared to placebo was a multicenter cohort study designed to evaluate the efficacy and safety of a long-acting, reversible formulation tadalafil compared to sildenafil in men aged 50 through 70 with secondary hypogonadism associated advanced age (Bergheim et al, 2009; Grigsby 2010; Kjellstrom et al, 2012). Participants were recruited from the local pharmacy with a diagnosis of hypogonadism (including oligo-amenorrhea, oligo-amenorrhea with hypergonadotropic hypogonadism type 2, and oligo-amenorrhea with secondary hyperprolactinemia type). All men entered the study on a fixed dose treatment schedule based on an objective pre-specified target testosterone goal. The study was conducted in United Cialis dosage mayo clinic States, and data are presented as the mean tadalafil dosage 60 mg ± SE with two-tailed t-tests. The primary efficacy endpoint was an increase in total testosterone (T) level of at least 1.5 standard Sildenafil citrate uk deviations (1.5 SD) from baseline (+15% testosterone) by 12 weeks of treatment. For this efficacy outcome, there was a significant increase in T levels from baseline all men. The increase in T after tadalafil was significantly greater than placebo. The study also concluded that tadalafil did not influence estradiol (E2) or thyroid status and that it did not worsen hemoglobin A1c levels (Ascher et al, 2013). In men with low androgen levels (Oligo-amenorrhea, Hyperprolactinemia with Hypergonadotoxinemia type 2, and Hyperhomo-testicular Disorder 4), a Phase 3 study of tadalafil compared to placebo was conducted (Kjellstrom et al, 2012). It is important to note that this study measured FSH and LH, serum gonadotropins, rather than testosterone. Men with secondary hypogonadism (defined as two or more of the following three clinical end-points: oligoovulation (>10% increase), oligo-amenorrhea with hypergonadotropic hypogonadism type 2, and secondary hyperprolactinemia type) a mean testosterone of 6.5 mg/dL were randomized to placebo, tadalafil 400 mg, 800 or 1200 mg. Tadalafil mg resulted in a mean 1.5, 3.5, and 5.5 mg/dL increase, respectively, from baseline and was statistically superior tadalafil 30mg liquid dosage to placebo. In three men out of 28 with this hypogonadism subset within the placebo arm, a mean tadalafil best dosage increase of 16.4, 15.8, and 12.5 mg/dL were observed with tadalafil 1200 mg alone. In these men, tadalafil was safe and well tolerated In two studies, men with primary hypogonadism were studied (Bergheim et al, 2009; Grigsby 2010; Kjellstrom et al, 2012). In an open-label extension study, which increased testosterone levels in men with secondary hypogonadism, efficacy and safety were achieved in men with decreased testosterone levels (in both primary and)

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