Erectile dysfunction is one of the symptoms that arise from several causative factors. Treatment of sexual dysfunction requires a comprehensive multi-disciplinary science of all the risk factors that cause it. In the case of post pituitary adenomectomy, intervention in the pituitary dramatically affects all the hormones produced by the pituitary. Hormone replacement therapy is required to maintain hormone levels within physiological limits. Sexual function is sometimes not a priority of therapy after surgery. Here, we present a A 58-year-old man with complaints of decreased erection after surgical removal of a pituitary macroadenoma.( History post-operation pan-hypopituitary and treated with thyroid, glucocorticoid replacement therapy. Internist consulting for testosterone replacement therapy and erectile dysfunction, and premature ejaculation. (IIEF-5) score 5 with severe ED, EHS score 1, PEDT score was 14 (Premature ejaculation), absence of NPT. Receiving some testosterone replacement therapy but not regularly and sometimes get PDE5 inhibitor. This case report concludes that erectile dysfunction caused by secondary hypogonadism, testosterone therapy, and PDE5 inhibitors had a better effect than a single therapy alone. Testosterone helps the formation of nitric oxide and PDE 5, which functions for the erection process.