title: Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Erectile dysfunction (ED) is a common male sexual disorder. The relative benefits and harms of pharmacologic therapies for ED, as well as the value of hormonal testing in men with ED, are uncertain.
  
  
  OBJECTIVE
  To evaluate the efficacy and harms of oral phosphodiesterase-5 (PDE-5) inhibitors and hormonal treatments for ED and assess the effect of measuring serum hormone levels on treatment outcomes for ED.
  
  
  METHODS
  English-language studies from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, AMED, and SCOPUS through April 2009. Trial reference lists also were scanned.
  
  
  METHODS
  Randomized, controlled trials (RCTs) of oral PDE-5 inhibitors and hormonal treatment for ED, and observational studies reporting measurement of serum hormone levels, prevalence of hormonal abnormalities, or both in men with ED.
  
  
  METHODS
  Two independent reviewers abstracted data on study, participant, and treatment characteristics; efficacy and harms outcomes; and prevalence of hormonal abnormalities.
  
  
  RESULTS
  Data, primarily from short-term trials (<or=12 weeks), indicate that PDE-5 inhibitors were more effective than placebo in improving sexual intercourse success (69.0% vs. 35.0%). The proportion of men with improved erections was significantly greater among those treated with PDE-5 inhibitors (range, 67.0% to 89.0%) than with placebo (range, 27.0% to 35.0%). The PDE-5 inhibitors were associated with increased risk for any adverse events compared with placebo (for example, relative risk with sildenafil, 1.72 [95% CI, 1.53 to 1.93]). In 4 head-to-head RCTs comparing sildenafil, vardenafil, and tadalafil, improvement of ED and adverse events did not differ among treatments. Results from 15 RCTs evaluating hormonal treatment of ED were inconsistent on whether treatment improved outcomes. Evidence was insufficient regarding whether men with ED had a higher prevalence of hypogonadism than men without ED.
  
  
  CONCLUSIONS
  Many RCTs were of low methodological and reporting quality, particularly those involving hormonal treatments or directly comparing different PDE-5 inhibitors. Most RCTs provided only short-term efficacy and harms data.
  
  
  CONCLUSIONS
  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 hormone testing in men with ED were inconclusive.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsertsvadze
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Yazdi
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bella
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ansari
authors.forename: Chantelle
authors.initials: C
authors.lastname: Garritty
authors.forename: Karla
authors.initials: K
authors.lastname: Soares-Weiser
authors.forename: Raymond
authors.initials: R
authors.lastname: Daniel
authors.forename: Margaret
authors.initials: M
authors.lastname: Sampson
authors.forename: Steven
authors.initials: S
authors.lastname: Fox
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
mesh_terms: D000075202:Contraindications; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5 / Q000009:adverse effects / Q000627:therapeutic use*; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000175:diagnosis; D007006:Hypogonadism / Q000150:complications / Q000175:diagnosis; D008297:Male; D010410:Penile Erection / Q000187:drug effects; D011388:Prolactin / Q000097:blood; D013739:Testosterone / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use*
chemical_list: D013739:Testosterone; D011388:Prolactin; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5