Hormonal and topical treatments are not so popular and have taken a backseat ever since oral medications hit the scene, however for some they are excellent options. Please note that the information in this article is purely for educational purposes. A physicians advice is of utmost importance.
Hormonal Treatment For Erectile Dysfunction
Hormonal therapy should normally be restricted to the patients who are suffering from erectile dysfunction of endocrine origin. Even when various psychogenic or organic factors are absent, severe deficiency of androgen can be present if the amount of testosterone in the body is below 12 nmol/l. It is important to first check the values that are present in either lower part of the normal range or minutely lower than the normal range. Only one on the borderline measurement cannot justify the initiation of testosterone substitution.
Early morning is the best time to determine the level of testosterone because the level of serum in younger men reflects a significant circadin rhythm and there are possibilities of observing variations up to 30%. As the substitution of androgen is not better than placebo in cases where there is normal serum testosterone, it does not make much sense to go for hormone therapy without any proven deficit because of its known expected side effects. However, when the values of testosterone are subnormal time and again, then it should be remembered that for both central and peripheral intracavernosal signal transduction(which is reponsible for NO synthetase), testosterone is a very important deciding as well as conditioning aspect. In a case like this, an increase in the low testosterone levels back within the physiological range is expected to improve the actualization of PD5 inhibitors or in certain cases, the erectile dysfunction getting normalized automatically.
In case of hyperprolactinemia, measurements must be done repeatedly to rule out minor increase in the serum levels induced due to stress. Exclusion of causes that are pharmacological and may be responsible for increase in prolactin levels is important. For patients with prolactinoma, treatment using dopamine antagonist may be started.
Topical Treatment For Erectile Dysfunction
Topical treatments can help in erection, although in more recent times oral medications have taken precedence. Topical solutions include Nitroglycerine paste that can aid in increasing arterial perfusion as well as improve erection with the help of proper stimulation. It is a must to use condoms in these therapies. One can expect to see a positive result in the patients with either psychogenic issues but the patients suffering from intense impairment of penile circulation do not benefit so much with it.
Prostaglandin gels have not proven very effective as the local resorption through tunica albuginea into the corpora cavernosa is not adequate. Their intraurethral application however may reduce this problem. MUSE is one such product that does not required application through needle. Even with its doses of 500-1000µg, it cannot be compared with inracavernosal usage of vasoactive components in terms of efficiency. It’s notable side effect is the sensation of burning in the urethra. If the partner is pregnant, and patient’s dose of PGE1 is high, then the use of condoms is highly important.