Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis

Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores

“…The present and previous [11,13] positive results are in apparent contrast to those reported by Tserstvadze et al [38], who did not document any significant effect of TTh on erection, either alone or when added to PDE5i. It should be recognized that Tserstvadze et al [38] used the DerSimonian and Laird [39] method for the calculation of the effect size, which may underestimate the true between-study variance, potentially producing overly narrow confidence intervals for the mean effect [40], especially when the between-study variance is large [41]. In addition, Tserstvadze et al [38] analyzed only nine RCTs enrolling mixed eugonadal/ hypogonadal patients, which may have resulted in a possible inclusion bias.…”

“…Interestingly, by applying this method we recently documented a positive effect of TTh on sexual function in hypogonadal patients (total T < 12 nmol/l), in line with some previous meta-analyses [11,13]. The present and previous [11,13] positive results are in apparent contrast to those reported by Tserstvadze et al [38], who did not document any significant effect of TTh on erection, either alone or when added to PDE5i. It should be recognized that Tserstvadze et al [38] used the DerSimonian and Laird [39] method for the calculation of the effect size, which may underestimate the true between-study variance, potentially producing overly narrow confidence intervals for the mean effect [40], especially when the between-study variance is large [41].…”

“…In addition, a meta-analysis is particularly useful when there are a variety of reports with low statistical power; pooling data from multiple studies can improve power and provide a convincing result. However, results from previous meta-analyses on this topic have been conflicting [8,[11][12][13]38]. The different methods used to compare PROs can explain, at least partially, the conflicting results.…”

Herbal Viagra and nitric oxide: how hard is the evidence?

“…However, these approaches have been overtaken by the phosphodiesterase-5 inhibitors (PDE-5 inhibitors), which are very effective as oral therapy in the treatment of impotence [1]. These drugs include sildenafil, tadalafil (Cialis®), and vardenafil (Levitra®).…”

“…However, there is little evidence for the efficacy of DHEA [87]. For that matter, the literature supporting the use of pharmaceutical testosterone for erectile dysfunction is mixed [1].…”