Objectives: To evaluate PDE-5 inhibitors response in combination to hormonal replacement therapy in patients complaining of erectile dysfunction with low-normal serum testosterone and poor response to sildenafil citrate, vardenafil and tadalafil. Methods: We have been following 77 men with age between 28 to 88 (mean ± 59 years) years old with androgen deficiency and using hormonal replacement therapy since 2004. They were seen every month to check the Testosterone levels and see responses with PDE5 inhibitors answering the SHIM score. We decided to use Testosterone 1%, 2% and 3% gel and testosterone cypionate injections. All men had a clinical examination and blood drawn for hormonal profiles every month, the Prostate specific antigen level was included in males >40 years old with digital rectal examination. Results: The prevalence of men complaining with the symptoms of androgen deficiency was associated with erectile dysfunction and loss of libido. Most of these patients did not achieve a good erection before HRT with PDE5 inhibitors (sildenafil citrate, tadalafil or vardenafil). The libido changes dramatically after HRT and increases proportionally to testosterone level and response to PDE-5 inhibitors. Conclusions: We concluded that hormonal replacement therapy is necessary for achieving better erections, to improve the PDE-5 inhibitors response, sexual performance improvement, quality of life and even retarding the signals of elderly.