Cardiometabolic Risks And Sexual Health

Main Category: Cardiovascular / Cardiology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Heart Disease;  Men’s Health
Article Date: 03 Sep 2012 – 0:00 PDT

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Assessment of sexual function should be incorporated into cardiovascular risk evaluation for all men, regardless of the presence or absence of known cardiovascular disease, according to Dr. Ajay Nehra, lead author of a report by the Princeton Consensus (Expert Panel) Conference, a collaboration of 22 international, multispecialty researchers. Nehra is vice chairperson, professor and director of Men’s Health in the Department of Urology at Rush University Medical Center in Chicago.

Erectile dysfunction (ED) is a red flag in younger men, less than 55 years of age for future cardiac morbidity or mortality – death or disease – for cardiovascular disease (CVD). In some patients, the time window between onset of ED and a cardiovascular event may be two to five years.

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done,” said Nehra. “Erectile dysfunction often occurs in the presence of silent, non-symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The panel recommends that younger men, more than 30 years old who experience ED receive a thorough, non invasive cardiovascular disease evaluation. As the consensus panel considers all men with ED who are older than 30 to be at increased CVD risk, a thorough noninvasive and, when indicated, invasive evaluation of CVD status is recommended.

They found that younger men who experienced ED were twice as likely to develop cardiovascular disease than men without ED. The highest risk for cardiovascular disease was in younger men.

While controversial, the consensus panel also recommended that testosterone levels be measured in all men diagnosed with organic ED due to an accumulation of recent studies that link low testosterone to ED, CVD and cardiovascular mortality.

“Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality,” said Nehra. In population based studies of 500 or more patients, low testosterone levels have increased mortality level.

These and other recommendations for controlling ED and CVD emerged from the Princeton III Meeting on Cardiometabolic Risks and Sexual Health, held in 2010, that were reported in the August 2012 issue of the Mayo Clinic Proceedings.

The purpose of the Princeton III meeting was to find an approach for optimizing sexual function and preserving cardiovascular health in men with known CVD. The conference updated findings from the Princeton I and Princeton II meetings, held in 2000 and 2005, respectively.

“The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease,” Nehra said.

The panel’s approach broadens the use of the 2010 American College of Cardiology/American Heart Association guideline for assessment of cardiovascular risk in asymptomatic adults to address an at-risk population that the guideline does not mention – men with ED. Even long-term observational studies, such as the well-known Framingham Heart Study, include few data from patients younger than 40 years.

“Experts have been considering the connection between erectile dysfunction and cardiovascular disease for a while,” said Nehra. “Recent data and publications about the connection have become more consistent in linking the two.”

There is a growing body of scientific evidence that ED is a particular precursor of CVD in men younger than 40. One study found that men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED.

In light of this evidence, the panel recommended that the cardiovascular evaluation include an assessment of important indicators of risk that can be seen in certain blood and urine tests, patient and family history and a review of lifestyle factors. Such an evaluation will help stratify the patient’s CV risk and guide the next steps in evaluation and treatment.

“That means that doctors treating men for erectile dysfunction can play a critical role in helping monitor and start reducing a patient’s cardiovascular risk, even when the patient has no symptoms,” said Nehra.

The new recommendations also emphasize using exercise ability before prescribing treatment for ED to ensure that each man’s cardiovascular health is consistent with the physical demands of sexual activity, especially for those who have been identified as having a high risk for CVD.

The panel encouraged a collaborative approach to management of men’s sexual function and cardiovascular risk, incorporating general, urologic, endocrine and cardiologic expertise. Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function, the report said.

The Princeton III panel also strongly urges physicians to inquire about ED symptoms in all men older than 30 years of age with CVD risk factors. “Identification of ED, particularly in men younger than 60, represents an important first step toward CVD detection and reduction,” the panel concluded.

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Erectile Dysfunction Linked to Increased Cardiovascular Risk

Editor’s Choice
Main Category: Cardiovascular / Cardiology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Heart Disease
Article Date: 30 Aug 2012 – 16:00 PDT

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According to a recent report by the Princeton Consensus (Expert Panel) Conference, men’s sexual function should be evaluated and taken into account when they are being tested for risk factors of cardiovascular problems.

Lead author of the study Dr. Ajay Nehra, vice chairperson, professor and director of Men’t Health in the Department of Urology at Rush University Medical Center in Chicago, worked with over 20 other experts to determine their findings.

The study explains that erectile dysfunction (ED) is a risk factor in men younger than 55 for eventual cardiovascular disease. In some men diagnosed with ED, a cardiovascular event may occur within 2 to 5 years.

Nehra explains:

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done. Erectile dysfunction often occurs in the presence of silent, symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The researchers recommend that men over 30 who suffer from ED should be evaluated closely for cardiovascular disease, because they believe that any man over 30 who has ED has a large risk for CVD (cardiovascular disease).

The experts determined that men who experience ED are at twice the risk of having cardiovascular disease than men who do not have ED. The younger then men are, the higher the risk of CVD.

Recent trials have shown that low testosterone levels may be associated with ED, CVD and cardiovascular death. Therefore, the team says men should also be tested to determine their testosterone levels.

Trials of over 500 patients have shown that low levels of testosterone result in a higher risk of mortality. Nehra continues: “Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality.” These findings, along with advice for patients with ED and CVD were been published in Mayo Clinic Proceedings in the August 2012 issue.

The goal of the Princeton III meeting, which updated data presented at Princeton I and Princeton II meetings in 2000 and 2005, was to discover a method for optimizing sexual function in men and improving cardiovascular health in patients who have CVD.

Nehra commented:

“The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease.”

The team’s approach adds to the 2010 American College of Cardiology/American Heart Association recommendation to screen asymptomatic adults at risk of cardiovascular disease. However, this did not involve men with ED. Other studies, including the Framingham Heart Study, only include minimum information about patients under the age of 40.

“Experts have been considering the connection between erectile dysfunction and cardiovascular disease for a while. Recent data and publications about the connection have become more consistent in linking the two”, said Nehra.

Evidence of ED being linked with CVD in men under the age of 40 is rapidly growing. One trial explained that men between the ages of 40 and 49 who had ED had a 50% higher likelihood of coronary artery disease than the men who did not have the disorder.

The team notes that it would be beneficial for the cardiovascular evaluations to involve looking at blood and urine tests and lifestyle habits, as well as history of family health to determine if risk factors are present in the patient. This will assist in deciding appropriate treatment.

Nehra said: “That means that doctors treating men for erectile dysfunction can play a critical role in helping monitor and start reducing a patient’s cardiovascular risk, even when the patient has no symptoms.”

The panel recommends evaluating whether men who have ED have cardiovascular health persistent with the physical action needed for sexual activity. This is more important for men who have a very high risk of developing CVD.

The report said: “Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function.”

The Princeton III team recommends that doctors ask patients, especially men older than 30, if they have any symptoms of ED.

They conclude: “Identification of ED, particularly in men younger than 60, represents an important first step toward CVD detection and reduction.”

Written by Christine Kearney

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease.

Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC.
Mayo Clinic Proceedings, August 2012

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Kidney Removal Increases Risk Of Erectile Dysfunction

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Main Category: Urology / Nephrology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Transplants / Organ Donations
Article Date: 01 Aug 2012 – 12:00 PDT

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According to a multi-center study featured online in the British Journal of Urology International, California University’s San Diego School of Medicine researchers have found that patients undergoing a total nephrectomy, i.e. a complete removal of a kidney, have a higher chance of developing erectile dysfunction.

Senior author of the study, Ithaar Derweesh, MD, an associate professor of surgery at the UC San Diego School of Medicine and urologic surgeon at UC San Diego Health System, said: “This is the first study in medical literature to suggest that surgery for kidney removal can negatively impact erectile function while partial kidney removal can protect sexual function.”

The researchers evaluated two cohorts of men who underwent surgery for renal cell carcinoma in a retrospective study. The total number of patients involved in the study was 432. The patients were divided into those who had a complete nephrectomy and those who had kidney-preserving surgery. They assessed the patients’ sexual function before and after their surgery by using a sexual health questionnaire, known as the International Index of Erectile Function.

Derweesh said: “What we are seeing is a dramatic yet delayed effect. Approximately six years after surgery, patients who had a total nephrectomy were 3.5 times more likely to develop erectile dysfunction compared to those who had kidney reconstruction.”

Leading researcher Ryan Kopp, MD, who is a chief resident at UC San Diego School of Medicine’s Urology Division, explained:

“The primary argument for kidney-sparing surgery over total kidney removal has been to preserve the kidney filtration function. However, we are also beginning to understand that total kidney removal may also increase the risk of metabolic diseases and significantly decrease quality of life.”

Derweesh concluded that this is the latest research in a series of studies, which suggests that it is wiser to save a patient’s kidney whenever possible, rather than removing it. Earlier research led by Derweesh demonstrated that a partial nephrectomy could lower the risk of osteoporosis and chronic kidney insufficiency, which can potentially lead to cardiac events and metabolic disturbances. He continued saying that further research is required to predict the potential occurrence and to prevent erectile dysfunction in these patients.

Written by Petra Rattue

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Link Identified Between Kidney Removal And Erectile Dysfunction

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Urology / Nephrology
Article Date: 01 Aug 2012 – 0:00 PDT

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Researchers at the University of California, San Diego School of Medicine have identified a link between patients who undergo total nephrectomy – complete kidney removal – and erectile dysfunction. Results from the multi-center study were recently published online in the British Journal of Urology International.

“This is the first study in medical literature to suggest that surgery for kidney removal can negatively impact erectile function while partial kidney removal can protect sexual function,” said Ithaar Derweesh, MD, senior author, associate professor of surgery, UC San Diego School of Medicine and urologic surgeon at UC San Diego Health System.

The retrospective study evaluated two cohorts of men, totaling 432 patients, who underwent surgery for renal cell carcinoma. One group underwent complete removal of the kidney while the other had kidney-sparing surgery. Sexual function was accessed pre- and post-operatively with a sexual health questionnaire known as the International Index of Erectile Function.

“What we are seeing is a dramatic yet delayed effect. Approximately six years after surgery, patients who had a total nephrectomy were 3.5 times more likely to develop erectile dysfunction compared to those who had kidney reconstruction,” said Derweesh.

“The primary argument for kidney-sparing surgery over total kidney removal has been to preserve the kidney filtration function. However, we are also beginning to understand that total kidney removal may also increase the risk of metabolic diseases and significantly decrease quality of life,” said lead author Ryan Kopp, MD, chief resident, Division of Urology, UC San Diego School of Medicine.

Derweesh added that this is the latest in a series of studies that point to the wisdom of saving the kidney in appropriate patients. Prior research led by Derweesh also shows that partial nephrectomy can reduce the risk of osteoporosis and chronic kidney insufficiency which can lead to cardiac events and metabolic disturbances. Further investigation is needed to prevent erectile dysfunction in patients and to predict its potential occurrence.

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Erectile Dysfunction Can Be A Warning Sign For Heart Disease In Younger And Middle-Aged Men And Men With Diabetes

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Diabetes;  Heart Disease;  Obesity / Weight Loss / Fitness
Article Date: 27 Jul 2012 – 1:00 PDT

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Although erectile dysfunction (ED) has been shown to be an early warning sign for heart disease, some physicians – and patients – still think of it as just as a natural part of “old age.” But now an international team of researchers, led by physicians at The Miriam Hospital, say it’s time to expand ED symptom screening to include younger and middle-aged men.

In an article appearing in the July issue of the American Heart Journal, they encourage physicians to inquire about ED symptoms in men over the age of 30 who have cardiovascular risk factors, such as smoking, obesity or family history, and in all men with type 2 diabetes.

As many as 30 million American men suffer from ED, or the inability to maintain an erection sufficient for sexual intercourse. ED and cardiovascular disease share a common cause: narrowing of the arteries, resulting in reduced or obstructed blood flow to the organs. They also share similar risk factors, including smoking, diabetes, obesity and high blood pressure. Because the penile arteries are just a fraction smaller than the arteries supplying blood to the heart, symptoms of conditions that can narrow the arteries, such as arteriosclerosis, are likely to present first in the form of erection problems. That’s why it is also believed that the more severe the ED, the greater the risk of heart disease-related events, such as heart attack and stroke.

“Erectile dysfunction represents an important first step toward heart disease detection and reduction, yet many health care providers and patients assume it’s just a sign of old age, so it may not be something that comes up during an annual physical with a younger man who doesn’t fit the ED ‘stereotype,'” says lead author Martin Miner, M.D., chief of family medicine and co-director of the Men’s Health Center at The Miriam Hospital.

“That’s why we urge physicians to discuss sexual function with the majority of their male patients – including diabetic men of all ages and men over the age of thirty with some of the traditional heart disease risk factors, like smoking or a family history,” he adds.

Although not all men with ED are at increased risk for cardiovascular disease, Miner says it is the physician’s responsibility to make that determination based on aggressive workup and testing. If the patient is found to be at risk, the patient can then receive intensive risk factor management.

Miner and colleagues conducted a literature review of 40 studies that suggest ED is a significant predictor for cardiovascular disease in two populations: men under the age of 60 and men with diabetes. Their analysis supports several widely-held theories, including the role of ED as a significant red flag for cardiovascular disease in younger and middle-aged men.

For example, in the Mayo Clinic’s Olmsted County Study, a large, epidemiological study cohort of men from Olmsted County, Minnesota, men 40 to 49 years old with ED were twice as likely to develop coronary artery disease as those who did not have ED. However, ED had less predictive value for men 70 years and older.

Several studies, including a large analysis of more than 6,300 men enrolled in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial, suggest ED is a particularly powerful indicator of cardiovascular disease in diabetic men as well, prompting researchers to call for ED symptom screening in all men with type 2 diabetes.

Miner points out early identification of men at risk for cardiovascular disease has the potential to lower health care costs and improve outcomes.

“There may be a ‘window of curability’ in which we can intervene early and stop the progression of heart disease,” he says. “Also, it may be possible to someday use erectile function as a measurement to tell us if preventive interventions for heart disease are working.”

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Miner’s co-authors on the paper include Mark Sigman, M.D., co-director of the Men’s Health Center and chief of urology at Rhode Island and The Miriam hospitals; Peter Tilkemeier, M.D., interim chair, division of cardiology at Rhode Island and The Miriam hospitals; Allen D. Seftel, M.D., FACS, of the University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School; Ajay Nehra, M.D., of Mayo Clinic; Peter Ganz, M.D., of San Francisco General Hospital and University of California at San Francisco; Robert A. Kloner, M.D., Ph.D., of Good Samaritan Hospital, Los Angeles; Piero Montorsi, M.D., of the University of Milan; Charalambos Vlachopoulos, M.D., of Athens Medical School; Melinda Ramsey, Ph.D., of Melinda Ramsey, LLC; and Graham Jackson, M.D., FRCP, of Guys and St. Thomas Hospitals, London.

Miner is also a clinical associate professor of family medicine and surgery (urology) at The Warren Alpert Medical School of Brown University. In addition, Sigman is a professor of surgery (urology) and Tilkemeier is an associate professor of medicine at Alpert Medical School.
Lifespan

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Sexual Dysfunction May Be A Tip-off To Heart Disease In Diabetic Men

Editor’s Choice
Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Diabetes;  Heart Disease
Article Date: 21 Jul 2012 – 9:00 PDT

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Sexual dysfunction may be a marker of cardiovascular disease in men with longstanding type 1 diabetes, investigators announced at the 72nd Scientific Sessions of the American Diabetes Association (ADA).

Sara Turek, MPH, and colleagues examined the association of sexual dysfunction with clinical markers of vascular disease in 301 men from the ongoing 50-Year Medalist Study who have had type 1 diabetes for more than 50 years. Turek is a coordinator for the study, which is being conducted at the Joslin Diabetes Center in Boston.

In prior analyses, only about half of the Medalist population has been shown to develop diabetic nephropathy, retinopathy, and neuropathy, which are complications that occur in nearly all type 1 diabetic patients in the general population by about 30 years after their initial diagnosis. The rate of cardiovascular disease in Medalists, however, is similar to that reported in age-matched patients with type 2 diabetes.

Research has also demonstrated that participants in the Medalist Study have usually maintained good long-term glycemic control.

One issue that had not been addressed in the Medalist cohort was sexual dysfunction. “We have noticed that while sexual dysfunction is a common complaint among male Medalists that significantly impairs their quality of life, there is a paucity of data on sexual dysfunction in men with long-duration type 1 diabetes,” Turek commented.

Overall, 210 male Medalists, or 69.8%, had sexual dysfunction as determined by an affirmative response to the question: “Have you ever had sexual problems?”

Males reporting a positive response had a hemoglobin (Hb)A1c of 7.1± 0.9% versus 6.8 ±0.8% in the no-dysfunction cohort (P=0.02). Body mass index (BMI) was 26.1 ±3.8 kg/m2 and. 25.8 ±3.6 kg/m2 (P=0.03) in the two groups, respectively, total cholesterol was 159.3 ±32.1 and 150.1 ±30.6 mg/dL(P=0.02), and high-density lipoprotein (HDL) was 55.1 ±16.2 and 62.1 ±17.8 mg/dL (P

In addition, a history of cigarette smoking was associated with prevalence of sexual dysfunction (51.7% versus 39.3% in the sexual dysfunction and non-sexual dysfunction groups, respectively, P=0.05).

The researchers also examined clinical inflammatory markers that are commonly associated with cardiovascular risk and disease including C-reactive protein (CRP), interleukin (IL-6), and plasminogen activator inhibitor type 1 (PAI-1). Only IL-6 was significantly associated with patient reports of sexual dysfunction (P=0.03), and the association was independent of BMI, age, and glycemic control.

The findings suggest that sexual dysfunction follows the pattern of macrovascular complications seen in the Medalist group, Turek said. Also, the association with Il-6 may provide a pathway linking sexual dysfunction and macrovascular complications in this cohort.

Sara Turek said:

“The clinical message is that sexual dysfunction might be a more overt sign of cardiovascular issues or future cardiovascular issues than other clinical markers of cardiovascular disease symptoms such as hypertension, high cholesterol, and atherosclerosis. So if a patient presents with a complaint of sexual dysfunction, the physician may want to screen for cardiovascular problems since erectile dysfunction may be a predictor of increased cardiometabolic risk in aging men.”

Stephanie Hastings, BA, also a coordinator for the Medalist Study, emphasized that while the determination of erectile dysfunction based on a single question is a limitation to the study, she is confident that the measure provided an accurate assessment of the presence of erectile dysfunction in this group. “Sure, it’s subjective and open to interpretation but we spend a lot of time with our patients, and we find that they are very willing to share whatever information we request in order to help us in our research. We plan to follow up with a lengthier questionnaire, which we expect the majority of the participants to complete openly and honestly,” she said.

Written by: By Jill Stein
Jill Stein is a Paris-based freelance medical writer.

Copyright: Medical News Today

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Propecia (finasteride) Permanent Sexual Dysfunction Risk

Editor’s Choice
Academic Journal
Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Men’s Health;  Endocrinology
Article Date: 15 Jul 2012 – 12:00 PDT

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Patient / Public:4 and a half stars

4.5 (2 votes)

Healthcare Prof:5 stars

5 (2 votes)

Hair loss medication, Propecia (finasteride) may be linked to a side effect of sexual dysfunction, a problem which may not go away after treatment has stopped, researchers from George Washington University reported in the Journal of Sexual Medicine. Propecia is a popular medication taken for male pattern hair loss.

Michael S. Irwig MD, who works at the Center for Andrology and Division of Endocrinology, The George Washington University, Washington, DC, prospectively monitored 54 adult males, average age 31, who had had three or more months of finasteride-associated sexual side effects. A side effect that continues for over three months is described as “persistent”.

All the men were healthy at the start of the study, and had never had any problems with sexual functions; they had no medical or psychiatric conditions and had not used oral prescription drugs before taking Propecia for male pattern hair loss.

All the men in this study were checked and rechecked for 14 months.

96% of those who were reassessed still had persistent sexual side effects; some of them also had changes in cognition, genital sensation, and ejaculate quality.

Dr. Irwig found that 89% of the 54 men met the Arizona Sexual Experiences Scale (ASEX) of sexual dysfunction, which rates sex drive (libido), arousal, penile erection, ability to orgasm, and orgasm satisfaction.

In an Abstract in the same journal, Dr. Irwig concluded:

“In most men who developed persistent sexual side effects (≥3 months) despite the discontinuation of finasteride, the sexual dysfunction continued for many months or years.

Although several rat studies have shown detrimental changes to erectile function caused by 5 alpha reductase inhibitors, the persistent nature of these changes is an area of active research.

Prescribers of finasteride and men contemplating its use should be made aware of the potential adverse medication effects.”

What is Propecia (finasteride)?

Finasteride is a synthetic 5α-reductase inhibitor. It is an inhibitor of the enzyme that coverts testosterone to DHT (dihydrotestosterone). It is produced and marketed by Merck Co., Inc. It is known under the brand names Proscar and Propecia and has been approved by the FDA for the treatment of:

  • Male pattern baldness – hair is lost in a well defined pattern, starting above the temples and thinning at the crown of the head.
  • Benign prostatic hyperplasia – an increase in the size of the prostate

Reported side effected related to finasteride include:

  • Erectile dysfunction (impotence)
  • Abnormal ejaculation
  • Lower ejaculatory volume
  • Abnormal sexual function
  • Testicular pain
  • Gynecomastia – development of male breasts
  • Depression – Merck added this side effect in December 2010

Prostate cancer – The FDA added a warning that finasteride may raise the risk of high-grade prostate cancer. No clear link has been established between finasteride use and prostate cancer risk. Some studies have suggested it may reduce the prevalence and growth of benign prostate tumors. However, finasteride can also mask the early detection of prostate cancer.

A 2008 study found that finasteride reduces prostate cancer risk without boosting the chances of developing aggressive tumors. (Link to article)

A 2010 study suggested that finasteride use is linked to male breast cancer risk. (Link to article)

Written by Christian Nordqvist


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Stendra (Avanafil) For Erectile Dysfunction Approved By FDA

It is estimated that there are approximately 30 million males in the USA who suffer from erectile dysfunction.

Stendra is a medication that is taken, when needed, 30 minutes before starting sexual activity. Doctors are advised to prescribe the lowest dose at which benefit is provided for the patients.

Victoria Kusiak, M.D., deputy director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research, said:

“This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs.”

Stendra is a PDE5 (phosphodiesterase type 5) inhibitor, and increases blood flow to the penis. Patients taking nitrates should not be given this medication, the FDA emphasizes. Nitrates are often used to treat angina – combining Stendra with nitrates can bring about a sudden and severe drop in blood pressure.

In very rare cases, patients taking PDE5 inhibitors may experience color vision changes. On rarer occasions, patients may report sudden vision loss in one eye (and sometimes both). Some patients have reported loss of hearing, or decreased hearing. If you experience a sudden loss of hearing or vision you should cease taking any kind of PDE5 inhibitor, and see your doctor immediately.

The following side effects were reported by some patients during human studies: nasal congestion, common-cold symptoms, back pain, face redness, and headache. In rare cases patients may experience priapism – an erection that lasts for hours; in such cases medical help should be sought immediately.

The FDA reviewed three double-blind, placebo-controlled human studies, involving 1,267 patients who were randomly selected to take either Stendra for up to 12 weeks (50, 100 or 200 mg doses), or a placebo, up to 12 weeks, as needed, 30 minutes before sex.

Patients completed questionnaires when the study started, and then every four weeks. The questionnaires asked about erectile function, vaginal penetration, and successful intercourse. In all three studies, a considerably higher number of patients scored well on all three points, compared to those on placebo.

Stendra is marketed by Vivus Inc., Mountain View, California, USA.

Written by Christian Nordqvist

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Cialis (Tadalafil) Approved For Benign Prostatic Hyperplasia Treatment, USA

Editor’s Choice
Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Erectile Dysfunction / Premature Ejaculation
Article Date: 06 Oct 2011 – 20:00 PDT

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Tadalafil (Cialis) has been approved by the FDA (Food and Drug Administration) for the treatment of BPH (benign prostatic hyperplasia) signs and symptoms – a condition in which the prostate gland enlarges. It has also been approved for the treatment of simultaneous BPH and ED (erectile dysfunction). Since 2003, the medication has been on the market legally in the USA for ED treatment.

Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy (really a misnomer), benign enlargement of the prostate (BEP), or adenofibromyomatous hyperplasia, are all terms which refer to an increase in the size of the prostate gland. Signs and symptoms can include difficulty in starting urination, a weakened urine flow which causes stopping and starting, strain when passing urine, urinating too frequently, waking up in the night often to urinate (Nocturia), sudden urges to urinate which can result in incontinence if a toilet is not found immediately, inability to fully empty the bladder during urination, and sometimes blood in urine.


Normal prostate on left, Benign prostatic hyperplasia on right

IPSS (International Prostate Symptom Score) is commonly used to measure BPH severity of symptoms. Two human studies demonstrated that patients with BPH who were prescribed 5 mg of tadalafil once a day had statistically significant improvements in BPH symptoms compared to those on a placebo. The findings were based on lower total IPSS scores.

Another study reviewed by the FDA showed that males with both BPH and ED combined who were given 5 mg of tadalafil had improvements in both conditions, compared to those in the placebo group. ED symptom improvements were measured using the Erectile Function domain score of the International Index of Erectile Function.

Scott Monroe, director of the Division of Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research, said:

“BPH can have a big impact on a patient’s quality of life. A large number of older men have symptoms of BPH. Cialis offers these men another treatment option, particularly those who also have ED, which is also common in older men.”

Patients taking nitrates, such as nitroglycerin, should not take Cialis – those who do, run the risk of a dangerous drop in blood pressure. The FDA does not recommend Cialis use together with alpha blockers for BPH treatment because studies on their use together have not been conclusive, also there is a risk of a drop in blood pressure.

The following medications have already been approved by the FDA for BPH symptoms:

  • Avodart (dutasteride)
  • Jalyn (dutasteride plus tamsulosin)
  • Proscar, (finasteride)
  • and the following alpha blockers:

  • Cardura (doxazosin)
  • Flomax (tamsulosin)
  • Hytrin (terazosin)
  • Rapaflo (silodosin)
  • Uroxatral (alfuzosin)

Cialis is made and marketed by Eli Lilly and Co.

Written by Christian Nordqvist


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“Partner Betweenness” May Contribute To ED In Couples’ Relationships

Editor’s Choice
Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Sexual Health / STDs;  Men’s health
Article Date: 10 Aug 2011 – 10:00 PDT

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It seems that if your girlfriend or wife is better friends with your friends than you are, you may have more problems on your hands than just a rocky relationship. There is now evidence that there is an association between erectile dysfunction (ED) in heterosexual men and strong relationships that may exist between their partners and their male friends.

Benjamin Cornwell, a professor of sociology at Cornell University and Edward Laumann, a professor of sociology at the University of Chicago, describe the situation as “partner betweennes.” This is when a man’s female partner has stronger relationships with his besties than he does.

The research explains:


“Men who experience partner betweenness in their joint relationships are more likely to have trouble getting or maintaining an erection and are also more likely to experience difficulty achieving orgasm during sex.”

Laumann says partner betweenness undermines men’s feelings of autonomy and privacy, which are central to traditional concepts of masculinity. This can lead to overt conflict or problems with partner satisfaction and attraction:


“The results point to the importance of social network factors that are rarely considered in medical research, network structure and the individual’s position within it.”

Cornwell and Laumann continue:


“Men who experience partner betweenness in their joint relationships are more likely to have trouble getting or maintaining an erection and are also more likely to experience difficulty achieving orgasm during sex. In general, while the majority of men have more contact with all of their confidants than their partners do, about 25% of men experience partner betweenness in at least one of their confidant relationships. Partner betweenness is a significant predictor of ED: A man whose female partner has greater contact with some of his confidants than he does is about 92 percent more likely to have trouble getting or maintaining an erection than a man who has greater access than his partner does to all of his confidants.”

The two studied data from the National Social Life, Health and Aging Project (NAHAP), a comprehensive 2005 survey by NORC at Univeristy of Chicago, which included 3,005 people aged 57 to 85.
Erectile dysfunction, is common among men in the age group studied in the NSHAP. About one-third of the men in the survey experience ED, which increases as men age. Health conditions such as diabetes, heart problems and obesity can contribute to the condition, along with psychological and other factors.

The researchers took these sources of ED into account and found that even among men who were healthy and capable of having satisfying sexual relationships, there is increased risk for sexual problems when their partners have greater contact with the couple’s shared friends.

Written by Sy Kraft

Copyright: Medical News Today

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