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Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians
- Amir Qaseem, MD, PhD, MHA;
- Vincenza Snow, MD;
- Thomas D. Denberg, MD, PhD;
- Donald E. Casey, Jr., MD, MPH, MBA;
- Mary Ann Forciea, MD;
- Douglas K. Owens, MD, MS;
- Paul Shekelle, MD, PhD; and
- for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians*
- From the American College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania; University of Colorado, Aurora, Colorado; Atlantic Health, Morristown, New Jersey; Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, California; and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
Abstract
Description: The American College of Physicians developed this guideline to present the available evidence on hormonal testing in and pharmacologic management of erectile dysfunction. Current pharmacologic therapies include phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil, and hormonal treatment.
Methods: Published literature on this topic was identified by using MEDLINE (1966 to May 2007), EMBASE (1980 to week 22 of 2007), Cochrane Central Register of Controlled Trials (second quarter of 2007), PsycINFO (1985 to June 2007), AMED (1985 to June 2007), and SCOPUS (2006). The literature search was updated by searching for articles in MEDLINE and EMBASE published between May 2007 and April 2009. Searches were limited to English-language publications. This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system.
Recommendation 1: The American College of Physicians recommends that clinicians initiate therapy with a PDE-5 inhibitor in men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use (Grade: strong recommendation; high-quality evidence).
Recommendation 2: The American College of Physicians recommends that clinicians base the choice of a specific PDE-5 inhibitor on the individual preferences of men with erectile dysfunction, including ease of use, cost of medication, and adverse effects profile (Grade: weak recommendation; low-quality evidence).
Recommendation 3: The American College of Physicians does not recommend for or against routine use of hormonal blood tests or hormonal treatment in the management of patients with erectile dysfunction (Grade: insufficient evidence to determine net benefits and harms).
Article and Author Information
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Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.
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Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Grant Support: Financial support for the development of this guideline comes exclusively from the American College of Physicians' operating budget.
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Potential Conflicts of Interest: Grants received: V. Snow (Bristol-Myers Squibb, Centers for Disease Control and Prevention, Novo Nordisk, Merck Vaccines, Boehringer Ingelheim, Wyeth, Sanofi Pasteur), P. Shekelle (Pfizer). Royalties: P. Shekelle (Up-to-Date). Any financial and nonfinancial conflict of interest of the group members were declared, discussed, and resolved.
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Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem{at}acponline.org.
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Current Author Addresses: Drs. Qaseem and Snow: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
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Dr. Denberg: 12631 East 17th Avenue, B180, Academic Office 1, Aurora, CO 80045.
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Dr. Casey: 475 South Street, PO Box 1905, Morristown, NJ 07962.
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Dr. Forciea: 3615 Chestnut Street, Philadelphia, PA 19104.
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Dr. Owens: 117 Encina Commons, Stanford, CA 94305.
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Dr. Shekelle: 1776 Main Street, Santa Monica, CA 90401.
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Author Contributions: Conception and design: A. Qaseem, V. Snow, D.E. Casey Jr., D.K. Owens.
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Analysis and interpretation of the data: A. Qaseem, D.E. Casey Jr., M.A. Forciea, D.K. Owens.
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Drafting of the article: A. Qaseem, V. Snow, T.D. Denberg, D.E. Casey Jr., M.A. Forciea, D.K. Owens.
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Critical revision of the article for important intellectual content: A. Qaseem, V. Snow, T.D. Denberg, D.E. Casey Jr., M.A. Forciea, D.K. Owens, P. Shekelle.
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Final approval of the article: A. Qaseem, V. Snow, T.D. Denberg, D.E. Casey Jr., M.A. Forciea, D.K. Owens, P. Shekelle.
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Statistical expertise: A. Qaseem.
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Administrative, technical, or logistic support: A. Qaseem.
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Collection and assembly of data: A. Qaseem.
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↵* This paper, written by Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Thomas D. Denberg, MD, PhD; Donald E. Casey Jr., MD, MPH, MBA; Mary Ann Forciea, MD; Douglas K. Owens, MD, MS; and Paul Shekelle, MD, PhD, was developed for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Paul Shekelle, MD, PhD (Chair); Roger Chou, MD; Paul Dallas, MD; Thomas D. Denberg, MD, PhD; Mary Ann Forciea, MD; Robert H. Hopkins Jr., MD; Linda Humprey, MD, MPH; David B. Nash, MD, MBA; Douglas K. Owens, MD, MS; and Donna Sweet, MD. Approved by the ACP Board of Regents on 11 July 2009.
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