• Correction of any hormonal abnormality (testosterone replacement for hypogonadism after carefully determining etiology, correction of thyroid dysfunction, maximal glycemic control in diabetes, treatment of hyperprolactinemia with dopamine agonist)
• Treatment of any underlying systemic disorders, including depression (SSRIs can cause ED but may help to prevent premature ejaculation)
• Mechanical devices (rings, vacuum pump device): cumbersome to some patients, but side effects are minimal
• Surgical interventions: typically used as a last resort; options include revascularization, removal of venous shunts, and penile implants
• Supportive counseling

Reference: Larson PR, et al: Williams Textbook of Endocrinology, 10th ed. Philadelphia, W.B. Saunders, 2003.

The most important step is to reverse the underlying organic etiologies and discontinue any offending medications, if possible.

Reference: Basa ALP, Afsharkharaghan H (Zollo A, ed): Endocrinology in Medical Secrets, 3rd ed. 2001.

A typical initial evaluation includes history (with particular attention to medications), physical exam, and laboratory testing to rule out endocrine abnormalities. Start by checking TSH, prolactin, and testosterone and ruling out systemic disease with urinalysis, complete chemistry panel and blood count, and HbA1c level in patients with diabetes. Carefully review the patient’s medication list and ascertain alcohol consumption to assess possible etiologies for ED. Nocturnal penile tumescence testing is available to assess erectile function.

Reference: Basa ALP, Afsharkharaghan H (Zollo A, ed): Endocrinology in Medical Secrets, 3rd ed. 2001.

Answer:

• Hormonal: hypogonadism (primary or secondary), hyperprolactinemia (with resultant hypogonadism), hyperthyroidism or hypothyroidism, and diabetes. Less common: adrenal insufficiency and Cushing’s syndrome.
• Pharmacologic: long list of implicated medications: antihypertensives (clonidine, beta blockers, vasodilators, thiazide diuretics, spironolactone); antidepressants (selective serotonin reuptake inhibitors [SSRIs], tetracyclic antidepressants), antipsychotics, anxiolytics, cimetidine, phenytoin, carbamazepine, ketoconazole, metoclopramide, digoxin. Alcohol is a major culprit. Illicit drugs include marijuana, cocaine, and heroin.
• Systemic disease: any severe illness can cause ED and hypogonadotrophic hypogonadism.
• Vascular: diabetes, peripheral vascular disease.
• Neurologic: diabetes, spinal cord injury, neuropathy.
• Psychogenic: uncommon in isolation, but contributes to most cases due to other etiologies. It is a diagnosis of exclusion.

Reference: Larson PR, et al: Williams Textbook of Endocrinology, 10th ed. Philadelphia, W.B. Saunders, 2003.

ED is the inability to obtain and maintain an erection sufficient for sexual intercourse. ED is usually multifactorial in etiology, and most men have at least some psychogenic factors that contribute to the disorder (i.e., performance anxiety can exacerbate underlying organic etiology).

Reference: Larson PR, et al: Williams Textbook of Endocrinology, 10th ed. Philadelphia, W.B. Saunders, 2003.

Yes. Impase acts pathogenetically in endothelial insufficiency. Prevention of endothelial dysfunction by impase allows both to stop progression of cardiovascular disease and to prevent erectile dysfunction.

A total of 58 patients with ischemic heart disease and angina of effort (FC II) (mean age 55.6 years) participating in the study were diagnosed to have erective dysfunction (ED) of a mild (35%), moderate (57%) and severe degree (8%). All the patients were randomized into two groups. Group 1 (n=21, mean age 56.4 years) received standard cardiotropic therapy (nitrates, beta-blockers, ACE inhibitors on demand, diuretics, antioxidants) and placebo. Group 2 (n=37, mean age 54.3 years) received the same standard cardiotropic therapy plus impase (1 tablet each other day for 3 months). The results of the trial show that impase addition to cardiotropic therapy raised exercise tolerance, diminished the number of anginal attacks in mild and moderate exercise, enhanced coronary microcirculatory blood flow, increased reserve circulation index by 34%, improved metabolism of vascular endothelium in the whole body.

Reference: Urologiia. 2007 Jul-Aug;(4):69-71.