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The response to PDE5 inhibitors is reduced as the low testosterone levels reduce expression of both the nitric oxide synthase gene and the PDE5 gene and downregulate PDE5 enzyme

This production is induced by cytokines, which stimulate cells such as fibroblasts and osteoblasts, and can cause indirect tissue damage [132]

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The expression levels of SREBP-2 and 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) in the liver of hyperlipidemic mice were also significantly reduced by SCL (Hirose et al., 1991)