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Guidelines Offered for Erectile Dysfunction Therapy

Two articles recommend phosphodiesterase-5 inhibitors, reserve judgment on hormones

TUESDAY, Oct. 20 (HealthDay News) -- The American College of Physicians (ACP) recommends the use of phosphodiesterase-5 (PDE-5) inhibitors in the treatment of erectile dysfunction (ED), but the jury is still out on hormonal treatments for the condition, according to a pair of articles published online Oct. 20 in the Annals of Internal Medicine.

Alexander Tsertsvadze, M.D., of the University of Ottawa, and colleagues reviewed 191 trials and observational studies on ED management with PDE-5 inhibitors (sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil) or hormone therapy. Their meta-analysis found that PDE-5 inhibitors were more effective than placebo at improving erection and sexual intercourse success. However, the evidence on hormonal treatment was inconsistent and insufficient to determine whether hypogonadism was prevalent in men with ED.

Amir Qaseem, M.D., of the University of Pennsylvania, and colleagues reviewed the medical literature on ED for the ACP and assessed the evidence using ACP clinical practice guidelines. Based on the review, the ACP issued formal clinical guidelines for ED treatment, including prescribing (PDE-5) inhibitor as initial ED therapy (absent contraindications) and that the specific PDE-5 inhibitor be chosen by patient preferences. The ACP also concluded there was insufficient evidence on hormonal treatment and did not recommend for or against that management option.

"Oral PDE-5 inhibitors improved erectile functioning and had similar efficacy and safety profiles. Results on the efficacy of hormonal treatments and the value of hormonal testing in men with ED were inconclusive," Tsertsvadze and colleagues write.

Two of the ACP authors reported receiving grants or royalties from pharmaceutical companies.

Abstract - Tsertsvadze
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Abstract - Qassem
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