Dehydroepiandrosterone and Erectile Function: A Review

Effects of Anti-Diabetic Drugs on Erectile Dysfunction: A Systematic Review and Meta-Analysis

Background

Erectile dysfunction (ED) is considered one of the complications of diabetes mellitus (DM), affecting about 35-75% of diabetic patients. Studies suggest that anti-diabetic drugs could potentially alleviate ED in diabetics, yet the effects of different drug classes remain unknown.

Objective

Our study aims to investigate the influence of various anti-diabetic drugs on ED.

Materials and Methods

Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis were carried out, focusing on clinical research linking anti-diabetic drugs and ED. Relevant studies were sought from PubMed, Embase, and Cochrane Library databases. Review Manager 5.4.1 facilitated meta-analysis and subgroup analysis, while Stata 15.1 was employed for sensitivity analysis to ensure result robustness.

Results

An initial search yielded 3,906 articles across databases. After screening the titles and abstracts of 3,906 articles and performing a full-text review of 30 selected articles, we selected three studies for analysis ultimately. Our most significant finding is that glucagon-like peptide-1 receptor agonists (GLP-1RAs) show an advantage over metformin in improving erectile dysfunction in diabetic patients (Z = 2.41, P = 0.02), with a particularly notable effect observed in patients with higher BMI or obesity (Z = 2.26, P = 0.02). This suggests that GLP-1RAs may offer a promising therapeutic option for this patient population. Additionally, thiazolidinediones may enhance sexual function, although their safety and efficacy require further confirmation. Acarbose, insulin, and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) also show potential for positively impacting ED, but more research is needed to establish their efficacy. Finally, the impact of metformin and sulfonylureas on ED remains uncertain, with mixed evidence from existing studies.

Conclusion

In conclusion, GLP-1RAs demonstrate an advantage over metformin in improving erectile dysfunction in diabetic patients. Other antidiabetic drugs also show potential for enhancing erectile function in this population, but further extensive clinical trials are needed to address knowledge gaps and safety concerns.

The pathophysiology of Post SSRI Sexual Dysfunction - Lessons from a case study

BACKGROUND

Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated.

OBJECTIVE

Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options.

METHOD

We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient's symptoms.

RESULTS

The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, 'brain zaps', overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT_1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems.

CONCLUSIONS

The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic - and possibly noradrenergic - mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes.

Relationship of steroid sex hormones with female sexual dysfunction in female patients having urinary incontinence

To investigate serum estradiol, progesterone and dehydroepiandrosterone levels on FSD in females having urinary incontinence (UI), we studied 150 females [100 having UI (50 with FSD and 50 without FSD) and 50 controls]. There were significant lower estradiol and progesterone and higher DHEA serum levels in patients than controls (P = 0.001for all). In UI patients, females having sexual disruption had significantly low levels of estradiol (p = 0.001). Low estradiol serum level represented an isolated predictive factor for sexual dysfunction in incontinent female patients (p = 0.001). A low estradiol serum level might be a possible risk factor for FSD in women having UI.

Endocrinological and symptomatic characteristics of patients with late-onset hypogonadism classified by functional categories based on testosterone and luteinizing hormone levels

OBJECTIVES

To define the characteristics of patients with late-onset hypogonadism based on endocrinological findings.

METHODS

We assessed age, body mass index, laboratory/endocrinological profiles and symptom-specific questionnaire scores of 967 men with late-onset hypogonadism symptoms. The patients comprised four groups by testosterone and luteinizing hormone concentrations: normal group, compensated hypogonadism group, primary hypogonadism group and secondary hypogonadism group. We compared characteristics between the normal group and compensated hypogonadism group in men with normal testosterone concentration, and the primary hypogonadism group and secondary hypogonadism group in hypogonadal men after age adjustment.

RESULTS

The normal group, compensated hypogonadism group, primary hypogonadism group and secondary hypogonadism group accounted for 83.6%, 3.4%, 0.8% and 12.2% of patients, respectively. Despite age adjustment, serum dehydroepiandrosterone sulfate and insulin-like growth factor 1 concentrations were significantly lower in the compensated hypogonadism group than the normal group. Only the Aging Males' Symptoms scale mental subscore was significantly different. Serum testosterone and dehydroepiandrosterone sulfate concentrations were significantly lower in the primary hypogonadism group than the secondary hypogonadism group. Only the Aging Males' Symptoms scale sexual subscore was significantly different.

CONCLUSIONS

Most patients with late-onset hypogonadism symptoms are in the normal group, with secondary hypogonadism being much more frequent than primary hypogonadism. Current symptomatic differences among these groups are minor. Classifying patients by testosterone and luteinizing hormone levels might provide useful information for follow up.

Non-testosterone management of male hypogonadism: an examination of the existing literature

Testosterone deficiency is defined as a total testosterone level <300 ng/dL confirmed on two early morning lab draws. Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. However, these treatments are invasive or have undesirable effects including the risk of drug transference. Additionally, testosterone therapy has been associated with increases in hematocrit and controversy remains regarding the risk of cardiovascular and thromboembolic events while on testosterone therapy. As such, much interest has recently been focused on alternative treatment options for testosterone deficiency in the form of orally-administered medications with more favorable side effect profiles. Lifestyle modifications and varicocelectomy have been shown to raise endogenous testosterone production. Similarly, SERMs and aromatase inhibitors (AIs) have been shown to raise testosterone levels safely and effectively. Human chorionic gonadotropin (hCG) remains the only FDA-approved non-testosterone treatment option for testosterone deficiency in men. However, this medication is expensive and requires patient-administered injections. Over the counter herbal supplements and designer steroids remain available though they are poorly studied and are associated with the potential for abuse as well as increased hepatic and cardiovascular risks. This review aims to discuss the existing treatment alternatives to traditional testosterone therapy, including efficacy, safety, and side effects of these options. The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency.

Risk Factors of Sexual Dysfunction in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

BACKGROUND

Hidradenitis suppurativa (HS) has a high impact on quality of life. However, sexual health has scarcely been investigated.

OBJECTIVE

To describe the frequency of sexual dysfunction (SD) in women and erectile dysfunction (ED) in men with HS and to explore potential risk factors.

PATIENTS AND METHODS

We conducted a cross-sectional study using a crowd-sourced online questionnaire spread by the Spanish hidradenitis suppurativa patients' association (ASENDHI).

RESULTS

In total, 393 participants answered the questionnaire. SD was found in 51% (95% CI 45-57%) of women and ED in 60% (95% CI 49-70%) of men. Factors related to SD were education status, patient's global assessment for disease activity, numeric rating scale for pain and unpleasant odour and the absence of a stable relationship. Factors related to ED were increasing age, the presence of active lesions in the genital area and the number of areas affected by active lesions.

CONCLUSIONS

There is a high prevalence of SD and ED in HS patients. Being in a stable relationship has been a protective factor of SD in women. The results suggest that sexual impairment in HS patients is due, at least in part, to disease activity, symptoms and active lesions.