Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians

Abstract

Published literature on this topic was identified by using MEDLINE (1966 to May 2007), EMBASE (1980 to week 22 of 2007), Cochrane Central Register of Controlled Trials (second quarter of 2007), PsycINFO (1985 to June 2007), AMED (1985 to June 2007), and SCOPUS (2006). The literature search was updated by searching for articles in MEDLINE and EMBASE published between May 2007 and April 2009. Searches were limited to English-language publications. This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system. RECOMMENDATION 1: The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use (Grade: strong recommendation; high-quality evidence). RECOMMENDATION 2: The American College of Physicians recommends that clinicians base the choice of a specific PDE-5 inhibitor on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile (Grade: weak recommendation; low-quality evidence). RECOMMENDATION 3: The American College of Physicians does not recommend for or against routine use of hormonal blood tests or hormonal treatment in the management of patients with erectile dysfunction (Grade: insufficient evidence to determine net benefits and harms).

Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial

“…In clinical trials, T replacement has consistently shown improvement in libido (22,30), whereas its efficacy in improving erectile dysfunction remains unclear (31). To our knowledge, no previous randomized controlled trial has assessed the efficacy of T replacement in men with low T and ejaculatory disorders.…”

Sildenafil increases serum testosterone levels by a direct action on the testes

“…Accordingly, the American College of Physician guidelines recommend PDE5Is as the first-line therapy for erectile dysfunction (Goldstein et al , 1998; Rosen et al , 2002; Qaseem et al , 2009). Nevertheless, the effects of PDE5Is on androgen levels in men with low testosterone remain poorly understood.…”

A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management

“…Although head-to-head studies are lacking, the efficacy reported for PDE5 inhibitors is greater than that reported for lifestyle intervention and testosterone treatment (15, 25). The American College of Physicians guidelines emphasize lifestyle and risk factor modification, given that erectile dysfunction is an early marker of cardiovascular risk, recommend PDE5 inhibitors as first-line pharmacotherapy, and judge the evidence for testosterone treatment insufficient to guide definitive recommendations (43). …”