Just in case anyone out there was unconvinced that erectile dysfunction is best treated by popping one of those well-advertised pills, the American College of Physicians has officially proclaimed the superiority of drugs such as Viagra, Levitra and Cialis over hormone treatment.
Published in the Annals of Internal Medicine, the new clinical practice guideline finds that for most men who complain of erectile dysfunction, one of the phosphodiesterase type 5 inhibitors -- sildenafil, tadalafil and vardenafil -- is a more effective treatment than pills, creams, gels or patches containing testosterone.
Oral or gel testosterone were little more effective than a placebo in the studies reviewed by the guideline's authors, but the so-called PDE5 inhibitors improved erections in 73% to 88% of cases (compared with 26% to 32% in cases in which a placebo was given). The practice guideline found little research evidence to recommend one of the five existing erectile-dysfunction drugs over another, leading the authors to recommend that doctors base their prescribing decisions on a drug's cost, ease of use, side-effect profile and the patient's preference.
The practice guideline unveiled Tuesday is aimed largely at primary care physicians, who increasingly are the first to diagnose and treat erectile dysfunction in their male patients. It notes that erectile dysfunction is often the result of diabetes, cardiovascular disease or depression. But it makes no recommendation for preliminary testing or counseling of patients whose dysfunction may stem from -- or presage -- more serious illness.
That, says UCLA urologist Christopher Saigal, is a missed opportunity for a "teachable moment," especially for primary care physicians.
"When I have a patient who's obese, has high blood pressure and high cholesterol, I do mention that lifestyle modification will prevent his ED from getting worse and that without it, the Viagra that works now may not work in five years," Saigal said.
Given the challenges primary care doctors face, he added, writing a prescription for a pill may be faster and more effective than dispensing unwelcome advice. But it doesn't address underlying medical problems, and it won't fix most men's ED problem permanently, he cautioned.Copyright © 2015, Los Angeles Times