Hormonal testing and pharmacologic treatment of erectile dysfunction: A clinical practice guideline from the American College of Physicians

Description: The American College of Physicians developed this guideline to present the available evidence on hormonal testing in and pharmacologic management of erectile dysfunction. Current pharmacologic therapies include phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil, and hormonal treatment. Methods: 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).
Source: Qaseem A, Snow V, Denberg TD, Casey DE, Forciea MA, Owens DK, Shekelle P. Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2009 Oct 19. [Epub ahead of print] [PubMed]

Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses

The prevalence of hypogonadism has been found to be increased in certain chronic illnesses, especially diabetes, hypertension and obesity. Recently, the prevalence of hypogonadism in primary care practices mirrored that in our population of men with erectile dysfunction (ED). In this study, the prevalence of hypogonadism in nearly 1000 men with ED was tabulated, using a retrospective chart review, and analyzed for association with the various contributing medical and psychological factors. The prevalence of hypogonadism was determined in men with a variety of chronic illnesses, and was further characterized by decade. We observed an association between hypertension (P=0.025), tobacco abuse (P=0.0059), sleep apnea (P=0.0001), work stress (P=0.041) and hypogonadism. These data were further analyzed for the odds ratio and confidence interval (Forest plot), which showed strong association for sleep apnea and work stress. We did not observe any significant association between diabetes, atherosclerosis, alcohol abuse, multiple medications, asthma, seizure disorder, anxiety/depression and hypogonadism (P values for Cochran-Mantel-Haenszel general association were 0.48, 0.97, 0.25, 0.69, 0.22, 0.76 and 0.98, respectively). We suggest that a host of chronic illnesses have a high prevalence of secondary hypogonadism. Men who have chronic medical or psychological illnesses should have their testosterone level checked, especially when sexual dysfunction symptoms or signs are present.
Source: Guay A, Seftel AD, Traish A. Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses. Int. J. Impot. Res 2009 Oct 1. [Epub ahead of print] [PubMed]

Racial disparities in erectile dysfunction among participants in the California Men's Health Study

Introduction. The burden of erectile dysfunction (ED) among different racial and ethnic groups is unclear, in part, because prior studies have not included all four major racial and ethnic groups in the same population-based sample. Aim. To determine the prevalence and odds of ED among all four major racial and ethnic groups after adjustment for demographic, medical, socioeconomic, and lifestyle characteristics. Methods. This cross-sectional study was conducted using data from men, aged 45-69 years, without a diagnosis of prostate cancer (N = 78,445), who completed questionnaires as part of the California Men's Health Study, a large multiethnic cohort study with detailed demographic, medical and, socioeconomic data. Main Outcome Measure. Erectile dysfunction measured by a previously validated four-level response question. Results. The overall prevalence of ED by age category was 13%, 24%, and 44% for men aged 45-49 years, 50 and 59 years, and 60-69 years, respectively. In a multivariable model, relative to white men, Hispanic (OR 1.05, 95% CI 0.99, 1.12), Asian (OR 1.1, 95% CI 1.02, 1.19), and other men (OR 1.13, 95% CI 1.06, 1.1.21) had increased odds of moderate-severe ED, while black men were less likely to report moderate to severe ED (OR 0.86, 95% CI 0.81, 0.92). Black (OR 0.54, 95% CI 0.48, 0.61) and Asian men (OR 0.91, 95% CI 0.80, 1.04) were less likely to have severe ED after adjustment for age, socioeconomic status, medical co-morbidities, and lifestyle characteristics. Conclusion. These data demonstrate that the prevalence of ED among different racial and ethnic groups is likely the result of complex phenomena and depends upon the interplay of socioeconomic, demographic, medical, cultural, and lifestyle characteristics. After accounting for these factors, these data suggest that Asian and black men are less likely to have severe ED relative to white men.
Source: Smith JF, Caan BJ, Sternfeld B, Haque R, Quesenberry CP, Quinn VP, Shan J, Walsh TJ, Lue TF, Jacobsen SJ, Van Den Eeden SK. Racial Disparities in Erectile Dysfunction among Participants in the California Men's Health Study. J Sex Med 2009 Sep 30. [Epub ahead of print] [PubMed]