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Clinical Question:
Does Sildenafil improve sleep-related erections in hypogonadal men?
Bottom Line:
Sildenafil administered at bedtime improves sleep-related erections in
hypogonadal men, suggesting that the nitric oxide pathway may be
pharmacologically enrolled and enhanced despite low serum testosterone.
Furthermore, these data strongly support the idea of a synergic effect on
sleep-related erections of sildenafil and testosterone.
Reference:
Sildenafil improves sleep-related erections in hypogonadal men: evidences
from a randomized, placebo-controlled, crossover study of a synergic role
for both testosterone and sildenafil on penile erections.Rochira V,
Balestrieri A, Madeo B, Granata AR, Carani C.J Androl. 2005 Nov 8; [Epub
ahead of print]
Study Design:
Randomized Controlled Trial
Synopsis:
In order to study the effects of sildenafil on human sleep-related erections
according to the state of androgenization, we evaluated the effects of
sildenafil on sleep-related erections in hypogonadal men before and during
testosterone replacement treatment and in control subjects. Twenty-four
hypogonadal men and twenty-four healthy men as a control group were
enrolled. All hypogonadal subjects had very low testosterone levels: <200 ng/dl
(8.93 nmol/L). All subjects underwent nocturnal penile tumescence and
rigidity monitoring (NPTRM) for 3 consecutive nights and randomly assumed
sildenafil 50 mg or placebo 1 hour before bedtime in the second or in the
third night of nocturnal penile monitoring. The hypogonadal subjects were
tested twice, without replacement treatment (H-T) and after at least 6
months of testosterone replacement therapy (H+T). The subjects of the
control group (C) were tested once. The following parameters of
sleep-related erections were analyzed: total number of valid erections,
total duration of both rigidity > 70% and increase in penile circumference >
30 mm, maximum rigidity, and maximum increase in penile circumference. NPTRM
parameters were reduced in hypogonadal men before testosterone treatment (H-T+P)
when compared with control subjects taking placebo (C+P). NPTRM parameters
after testosterone (H+T+P) and sildenafil (H-T+S) administration were
similar to that of control subjects taking placebo (C+P). When the
statistical analysis was restricted to the hypogonadal men before
testosterone treatment, sildenafil alone significantly increased NPTRM
parameters when compared with placebo (H-T+S vs H-T+P). Testosterone
restored normal erections when administered to hypogonadal subjects (H+T+P
vs H-T+P), in hypogonadal men, however, the combined treatment (sildenafil
plus testosterone) resulted in the maximum positive effect on NPTRM
parameters. When the increase from baseline was analyzed, the effects of
testosterone plus sildenafil resulted higher than the sum of the effects of
both drugs used alone. |