title: Is sildenafil citrate associated with an amelioration of the symptomatology of androgen decline in the aging male?
abstract: OBJECTIVE
  We examined whether treatment of erectile dysfunction with sildenafil citrate is associated with amelioration of the symptomatology of androgen decline in the aging male, and whether this alters the endocrine pattern.
  
  
  METHODS
  A double-blind, randomized, placebo controlled, crossover study with sildenafil citrate was conducted in 60 men (age range 47 to 75 years old) who presented with erectile dysfunction and screened positively for androgen decline in the aging male by the questionnaire of the same name. The patients were randomized to receive sildenafil citrate or placebo in a 1:1 ratio and were crossed over after 3 months of treatment for an additional 3 months. The evaluation included International Index Erectile Function and Aging Male Symptoms questionnaires, hormonal profiles, total testosterone, and bioavailable testosterone.
  
  
  RESULTS
  A total of 40 patients completed the study. Compared to placebo, sildenafil citrate improved erectile function (52.7 +/- 2 vs 39 +/- 1.9, p <0.001) and Aging Male Symptoms score (33.5 +/- 1.3 vs 28.6 +/- 1.3, p <0.001) in the total group. Breakdown into hypogonadal and normal men showed that the International Index of Erectile Function score improved more in normal (Delta 18.5 +/- 3.6) than in hypogonadal men (Delta 6.7 +/- 2.7). There were no differences in improvement on the Aging Male Symptoms questionnaire between hypogonadal and normal men. No treatment changes were observed in total testosterone and bioavailable testosterone.
  
  
  CONCLUSIONS
  In the total group of patients sildenafil citrate was associated with expected improvement in erectile function and in the Aging Male Symptoms questionnaire without any alteration in hormonal pattern. The available questionnaires for androgen decline in the aging male are not specific for the diagnosis of biochemical androgen decline in the aging male, although the suboptimal response to sildenafil citrate suggests the presence of hypogonadism.
authors.affiliation: Department of Urology, Shaare Zedek Medical Center, Jerusalem 91031, Israel. dimkanev@mail.ru
authors.forename: Dmitry
authors.initials: D
authors.lastname: Koulikov
authors.forename: Alon
authors.initials: A
authors.lastname: Fridmans
authors.forename: Boris
authors.initials: B
authors.lastname: Chertin
authors.forename: Ofer
authors.initials: O
authors.lastname: Shenfeld
authors.forename: Amicur
authors.initials: A
authors.lastname: Farkas
authors.forename: Irving M
authors.initials: IM
authors.lastname: Spitz
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D047649:Andropause / Q000502:physiology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D007172:Erectile Dysfunction / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D013739:Testosterone; D000068677:Sildenafil Citrate