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Common side effects of testosterone replacement therapy include local irritations, prostate enlargement, breast tissue enlargement, aggravation of breast and prostate cancers, depression, elevation of red blood cell count (polycythemia), or worsening of congestive heart failure. Low testosterone levels: Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished function of the testes resulting in low testosterone production) can have low sex drive and erectile dysfunction. Call Your Doctor immediately or Go to an Emergency Room If: You have an extended or painful erection, unrelated to sexual desire, lasting more than a few hours. buy cialis online buy cialis online cialis online ordering cialis online buy cialis cialis canada viagra medication online buy viagra online When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing. cialis canada cialis canada Nocturnal penile tumescence (NPT) - It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. Erectile dysfunction, heart disease and other vascular diseases: Although ED can be caused by various conditions, about 7 in 10 cases are due to narrowing of the small arteries in the penis. This causes reduced blood flow to the penis. This is the same problem that can occur in other blood vessels. For example, narrowing of the blood vessels in the heart (the coronary arteries) is a cause of angina and other heart problems. Narrowing of blood vessels to the brain is a risk factor for having a stroke. Narrowing of blood vessels in the legs can cause peripheral vascular disease. purchase viagra online canada buy viagra cheapest prices for viagra online buy viagra online Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 a.m.) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.