Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels

Abstract

OBJECTIVE Lack of sexual activity due to erectile dysfunction (ED) decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis.In this paper we studied the effect of different type V phosphodiesterase (PDE5) inhibitor treatments for ED on the reversibility of this endocrine pattern. DESIGN Open-label, retrospective study. PATIENTS Seventy-four consecutive patients were treated on demand with sildenafil (Sild) (50 mg) and tadalafil (Tad) 20 mg. MEASUREMENTS The success in sexual intercourse was recorded and total (tT) and free testosterone (f T) levels were studied before and after 3 months of treatment.RESULTS Basal level of tT and f T were at the bottom of the normal range and LH levels were at the top of the high normal range. After treatments, this endocrine pattern was reversed in both groups. However, the T increase in Sild-treated patients was significantly lower than in those treated with Tad (4·7 ± ± ± ± 2·7 vs. 5·1 ± ± ± ± 0·9, P < 0·001). f T levels followed a directly proportional pattern, while the inverse was found when LH production was studied. The intercourse rate reflected this effect: in fact, the Sild group showed a 4·9 ± ± ± ± 2·9/month full sexual intercourse rate while in the Tad group a significantly higher rate of sexual intercourse was found (6·9 ± ± ± ± 4·6/month, P = 0·04). However, drug consumption was comparable between the groups (Sild 4·9 ± ± ± ± 2·9 vs. Tad 4·4 ± ± ± ± 2·8 pills /month, P = 0·72).CONCLUSIONS As it is unlikely that the two drugs have a different direct effect on the pituitary-testis axis, this effect is probably due to the higher frequency of full sexual intercourse in the Tad-treated group, because of the drug's longer half-life.

Erectile dysfunction in spinal cord-injured men: different treatment options

“…This finding was also reported by Carosa and coworkers 21,22 in 74 patients with ED receiving sildenafil and tadalafil. They explained this finding by the fact that lack of sexual activity due to ED decreases testosterone levels through a central effect on the hypothalamic-pituitary axis.…”

Six months of daily treatment with vardenafil improves parameters of endothelial inflammation and of hypogonadism in male patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, prospective trial

“…Several observational trials suggested an improvement of total testosterone serum levels in men with erectile dysfunction after 3 months of various therapies (29,30). These authors suggested that the improvement of testosterone levels was a consequence of improved sexual activity in men using impotence drugs (29,30). In this way, testosterone deficiency was interpreted both as the cause and the effect of impotence (30).…”

“…We show that PDE5i can improve testosterone production in hypogonadal men, although the mechanism remains unclear. Several observational trials suggested an improvement of total testosterone serum levels in men with erectile dysfunction after 3 months of various therapies (29,30). These authors suggested that the improvement of testosterone levels was a consequence of improved sexual activity in men using impotence drugs (29,30).…”

Increased cyclic guanosine monophosphate production and endothelial nitric oxide synthase level in mononuclear cells from sildenafil citrate-treated patients with erectile dysfunction

“…It has been reported that testosterone influences both the level of eNOS protein and erectile functionality. 29 Moreover, Carosa et al 30 have reported increased testosterone plasma levels after sildenafil citrate treatment. In this study, no changes in free testosterone plasma levels were observed after sildenafil treatment, which diminished the involvement of testosterone in the findings reported here.…”