Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/andr.12366

The impact of drugs on male fertility: a review

Erectile dysfunction is an important cause of decreased quality of life in men (1,2). Strong epidemiological evidence links the subsequent risk of erectile dysfunction to the presence of well-recognized risk factors for coronary heart disease, such as increased body weight, hypertension, and dyslipidemia (3,4). Some have suggested that a diagnosis of erectile dysfunction is a sentinel event that should prompt investigation for coronary heart disease in asymptomatic men (5). We postulated an association between erectile dysfunction and the metabolic syndrome because four of the five components of the metabolic syndrome are risk factors for erectile dysfunction and are also characterized by abnormal endothelial function (6).\n\nMen were recruited among those attending the outpatient department for metabolic diseases of the teaching hospital at the second University of Naples, Naples, Italy. To be enrolled in the study, subjects had to have three or more of the criteria to meet the diagnosis of the metabolic syndrome, as recommended by the Adult Treatment Panel (7). Exclusion criteria were diabetes or impaired glucose tolerance, impaired renal function, pelvic trauma, prostatic disease, peripheral or autonomic neuropathy, hypertension (blood pressure >140/90 mmHg), cardiovascular disease, psychiatric problems, use of drugs or alcohol abuse, and smoking (both present and past smoking). Endocrine causes of erectile dysfunction were also excluded. A total …

High proportions of erectile dysfuntion in men with the metabolic syndrome

Several studies suggest that type 2 diabetes mellitus (T2DM) is often associated with male hypogonadism. Despite the well-known link, the role of testosterone replacement therapy (TRT) in T2DM has not been completely clarified. The aim of the present study was to analyse systematically the relationship between androgen levels and T2DM by reviewing and meta-analysing available prospective and cross-sectional studies. In addition, a specific meta-analysis on the metabolic effects of TRT in available randomized clinical trials (RCTs) was performed. An extensive Medline search was performed including the following words: 'testosterone', 'type 2 diabetes mellitus' and 'males'. Of 742 retrieved articles, 37 were included in the study. In particular 28, 5 and 3 were cross-sectional, longitudinal and interventional studies, respectively. A further unpublished RCT was retrieved from http://www.clinicaltrials.gov. T2DM patients showed significantly lower testosterone plasma levels in comparison with non-diabetic individuals. Similar results were obtained when T2DM subjects with and without erectile dysfunction were analysed separately. Meta-regression analysis demonstrated that ageing reduced, while obesity increased, these differences. However, in a multiple regression model, after adjusting for age and body mass index (BMI), T2DM was still associated with lower total testosterone (TT) levels (adjusted r = -0.568; p < 0.0001). Analysis of longitudinal studies demonstrated that baseline TT was significantly lower among patients with incident diabetes in comparison with controls (HR = -2.08[-3.57;-0.59]; p < 0.001). Combining the results of RCTs, TRT was associated with a significant reduction in fasting plasma glucose, HbA1c, fat mass and triglycerides. Conversely, no significant difference was observed for total and high-density lipoprotein cholesterol, blood pressure and BMI. The meta-analysis of the available cross-sectional data suggests that T2DM can be considered independently associated with male hypogonadism. Although only few RCTs have been reported, TRT seems to improve glycometabolic control as well as fat mass in T2DM subjects.

Type 2 diabetes mellitus and testosterone: a meta-analysis study

Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes. The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients. Erectile dysfunction (ED) is common, affecting 10% of men aged 40-70 years and increases in frequency with age. ED and cardiovascular disease share many of the same risk factors and often coexist. ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life. The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper (Table 4), can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised. There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease.

A systematic approach to erectile dysfunction in the cardiovascular patient: a consensus statement [see comments]

Importance of the field: Erectile dysfunction (ED) is a common sexual problem, affecting up to half of men over 50 years of age. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil and vardenafil) are currently the first-line treatment option presented to patients with ED. There exists a significant number of men who remain dissatisfied with the available therapies and are either unable to achieve their therapeutic goals or unwilling to tolerate adverse side effects. Therefore, development of novel PDE5 inhibitors with enhanced selectivity, faster onset of action, increased potency and improved tolerability is desirable. Areas covered in this review: Preclinical and clinical studies of avanafil, a new oral PDE5 inhibitor being investigated for the treatment of ED. Data were obtained by searching for all English peer-reviewed articles on Medline and any related abstracts presented on avanafil at major international congresses. What the reader will gain: An understanding of the pharmacokinetic...

/pdf/avanafil-a-new-rapid-onset-phosphodiesterase-5-inhibitor-for-2khfzmy8fy.pdf

Avanafil, a new rapid-onset phosphodiesterase 5 inhibitor for the treatment of erectile dysfunction.

Recommendations to general practice doctors for first line management of erectile dysfunction

Recommandations aux médecins généralistes pour la prise en charge de première intention de la dysfonction erectile.

Recommandations aux médecins généralistes pour la prise en charge de première intention de la dysfonction érectile (réactualisation 2010)

Current epidemiology of erectile dysfunction, an update

Resume But L’objectif de cette enquete etait de realiser un etat des lieux de la prise en charge de la dysfonction erectile (DE) par les urologues francais en decrivant les motifs de consultation en urologie des hommes de plus de 18 ans et en estimant la prevalence des troubles sexuels, en particulier de la DE un jour donne. Materiel Cette enquete a ete realisee, en partenariat avec l’Association francaise d’urologie (AFU), aupres de 150 urologues constituant un echantillon representatif de la profession en France en termes de repartition geographique, d’âge et de type d’exercice. L’enquete nationale de type 1 Jour sur la prevalence de la DE chez des patients consultant en urologie (ENJEU) a ete proposee a tous les hommes adultes se presentant en consultation d’urologie un jour donne (le mardi 19 juin 2007 ou un jour proche). Au total, 1848 (92,5 %) patients ont accepte de participer, l’analyse a porte sur 1740 patients. Le recueil des donnees patient etait base sur un auto-questionnaire portant sur les donnees sociodemographiques, les co-morbidites, les affections urologiques et la sante sexuelle. La recherche d’une DE etait realisee par la question unique de John B. McKinlay. Resultats Parmi les patients (âge moyen 63 ± 14 ans), 68 % (IC95 % = [65,2 % ; 70,7 %]) avaient une DE, severe pour 44 % d’entre eux ; 25 % etaient traites medicalement (dont les deux tiers traites par IPDE5 seuls ou en association). Apres les maladies prostatiques (62 %), les troubles sexuels representaient le premier motif de consultation (14 %). Pres de 60 % des patients indiquaient en avoir deja parle a un medecin (medecin qui etait un urologue dans 44,6 % des cas). La perspective de passer le reste de leur vie avec leur trouble etait « inacceptable » pour 21,1 % des patients ayant une DE et « moyennement acceptable » pour 34,4 %. Conclusion Cette premiere enquete de pratique dans la communaute urologique francaise souligne l’importance des troubles sexuels chez les patients consultant en urologie. Bien que la prevalence de la DE soit importante, peu de patients consultent specifiquement pour ce motif. En consequence, le traitement demeure limite, malgre l’interet declare des urologues.

Prévalence de la dysfonction érectile chez les patients consultant en urologie : l’enquête ENJEU (Enquête nationale de type 1 Jour sur la prévalence de la dysfonction Érectile chez des patients consultant en urologie) ☆

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