UK management guidelines for erectile dysfunctionBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.499 (Published 19 August 2000) Cite this as: BMJ 2000;321:499
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It is most notable by its abscence that Testosterone Replacement
therapy is very rarely seen as a treatment for Erectile Dysfunction,
Depression, anxiety in men of middle or advancing years.
Instead, men suffering what would in women be called
hypogonadism/menopause are offered synthetic drugs, Viagra,
Antidepressants, and Beta blockers to cover a range of symptoms when
tackling the single root cause mighy be more effective.
T replacement carries with it fewer risks than Estrogen Replacement, it is
relatively widely known that researchers have been calling out for years
for Estrogen Replacement to be reviewed because of studies indicating
These calls have been largely ignored (until recently).
Natural Testosterone replacement therapy is however remarkably safe, the
only contraindicaton being in late stage prostate cancer, the majority of
studies showing significant positive benefit to the patient
We know little of the long term effects of many of these drugs,
adverse reactions are rarely reported correctly because of fear of
Natural Human Testosterone on the other hand does not carry such
ambiguities having been around and used very effectively for millions of
Doctors should try to ensure that the priority is the continued ( or
improved ) wellbeing of their patients and not be swayed by the sometimes
dubious incentives offered by Pharmaceutical company Representatives.
For example in a case where Hypogonadism is the root cause
Viagra,Antidepressants and Beta Blockers will serve only
make the patient dependant upon a number of different drugs for different
Tackling the root cause with T replacement therapy, might allow the
patient to become more physically active. This increased physical activity
might have positive benefits far outweighing the therapeutic affects of
any synthetic drug(s).
Increased physical activity would allow the patient to increase production
of his own Testosterone and natural Excercise Induced Endorphins which
might well allow the patient to do without further treatment.
Despite the prevalence of this type of condition, it is surprising
and perhaps disturbing that multiple Pharmacological Symptom treatments
seems to be preferred over tackling the root cause of the patients
physical and emotional problems, these treatments in many cases causing
their own side effects causing yet further problems for the patient.
Doctors should look at their aging male / female patients and
recognise that many hormonal changes are occuring that are in many cases
Looking at and treating an individuals symptoms may serve the
Pharamceutical companies but may not be in the interests of the patient.
Competing interests: No competing interests
Ralph and Nicholas (1) report a useful set of guidelines for the
management of erectile dysfunction (ED). However they have failed to
mention that a significant psychological factor is usually present. In a
London specialist clinic this has recently been reported as 63% (2). In
these groups physical treatments meet with resistance in the patient,
partner or both (3). Issues with intimacy; fear of loss of control;
marital difficulties such as anger, infidelity or poor communication can
result in treatment failure. Unfortunately this can lead to symptom
substitution or precipitate the termination of the relationship.
further cause for concern is that contrary to the expectation that a few
erections will cure ED, patients become dependent on the treatment for
further sexual activity (3). It is thus important that doctors treating
ED pay adequate attention to psychogenic causes and treat these rather
than focusing on the symptom.
Dr M E Jan Wise
Specialist Registrar in Adult Psychiatry
Paterson Centre for Mental Health,
South Wharf Rd,
London W2 1NY
1 D. Ralph and T. McNicholas. UK management Guidelines for erectile
dysfunction. BMJ 2000;321: 499-503.
2 M. R. Baggely, J. F. Hirst, J. P. Watson. Outcome of patients
referred to a psychosexual clinic with erectile difficulties. Sexual and
Marital Therapy. Fall 1996; 11:123-130.
3 D. R. Bodner, E. D. Kursh, M. I. Resnick. Self-injection of
papaverine and phentolamine in the treatment of psychogenic impotence.
Journal of Marital Therapy. Fall 1989; 15:163-176.
Competing interests: No competing interests