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Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction FREE

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The summary below is from the full reports titled “Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians” and “Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis.” They are in the 3 November 2009 issue of Annals of Internal Medicine (volume 151, pages 639-649 and pages 650-661). The authors of the first report are A. Qaseem, V. Snow, T.D. Denberg, D.E. Casey Jr., M.A. Forciea, D.K. Owens, and P. Shekelle, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians; the authors of the second report are A. Tsertsvadze, H.A. Fink, F. Yazdi, R. MacDonald, A.J. Bella, M.T. Ansari, C. Garritty, K. Soares-Weiser, R. Daniel, M. Sampson, S. Fox, D. Moher, and T.J. Wilt.

Ann Intern Med. 2009;151(9):I-44. doi:10.7326/0000605-200911030-00159
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Who developed these guidelines?

The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, specialists in the care of adults.

What is the problem and what is known about it so far?

Erectile dysfunction (ED), or impotence, is an inability to get or keep an erection firm enough for sexual intercourse. Causes can be psychological or physical. Physical causes include advanced age, heavy drinking, chronic diseases (such as diabetes), hormonal abnormalities (such as low testosterone levels), and use of some drugs (such as some treatments for high blood pressure or depression). Because hormonal abnormalities can cause ED, some doctors will routinely measure hormone levels in men with this condition. However, the value of this testing in men who have no other signs of hormone problems is unclear. Phosphodiesterase-5 (PDE-5) inhibitors are drugs available to treat ED. Commonly prescribed PDE-5 inhibitors include sildenafil (known by the brand name Viagra [manufactured by Pfizer, New York, New York]), vardenafil (known by the brand name Levitra [manufactured by GlaxoSmithKline, Brentford, United Kingdom]), and tadalafil (known by the brand name Cialis [manufactured by Lilly, Indianapolis, Indiana]).

How did the ACP develop these recommendations?

The authors reviewed published studies about the value of hormonal testing for men with ED and about the benefits and harms of the different PDE-5 inhibitors. They also looked for studies that compared one PDE-5 inhibitor with another.

What did the authors find?

High-quality research was lacking to define the value of hormonal testing for men with ED. Studies show improvements in patients' ability to get and keep an erection with a PDE-5 inhibitor compared with no active treatment regardless of the cause of ED. Some evidence showed that higher doses of sildenafil and vardenafil resulted in better responses than lower doses. This was not true for tadalafil. Also, higher doses increased the risk for adverse effects. Side effects were mainly mild or moderate (such as headache or nausea) in most people. However, people who took PDE-5 inhibitors and nitrate medications at the same time or had unstable heart disease had a risk for heart attack. Blindness in patients taking a PDE-5 inhibitor has been reported, but these cases do not prove that the condition is related to the drug. There is not enough evidence to conclude that one PDE-5 inhibitor is better than another with respect to benefit or side effects.

What does the ACP suggest that patients and doctors do?

For men who seek ED treatment, a PDE-5 inhibitor is appropriate unless the patient is taking a nitrate medication or has unstable heart disease. Patients taking nitrate medications should not take a PDE-5 inhibitor. The choice among PDE-5 inhibitors should be based on patient's preferences, including ease of use, cost, and adverse effects. There is no strong evidence that one PDE-5 inhibitor is clearly better than another. Whether to measure hormone levels before treating ED is a decision that the doctor and patient must make knowing that no good studies are available to determine the benefits and harms of testing.

What are the cautions related to these recommendations?

These recommendations may change as new studies become available.





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