If you wonder how big a problem erectile dysfunction actually is – consider the annual sales of “virility” drugs including Viagra, Cialis and Levitra. In 2014 Cialis ranked #44 in the top drugs used worldwide with revenues of 2.29 billion dollars. Viagra still pulls in around 2 billion dollars per year for Pfizer. Levitra comes in significant third in sales.
How These Drugs Work
All of these drugs are PDE5 inhibitors. A molecular called cyclic guanosine monophosphate (cGMP) enables the penis to fill with blood and become erect for intercourse. The enzyme PDE5 acts to break down the cGMP. These drugs block the enzyme and prolong cGMP activity.
This treatment is not the “magic bullet” that we always seem to want. They don’t work at all for a fairly large percentage of men. The erections that are enabled are not the quality of those men experience in their teenage years. They also don’t provide sexual desire. Using these drugs do not address any underlying medical conditions that may be at the root of the problem.
The documentation submitted for a US Patent by Steven Ferguson reveals interesting observations and data about erectile dysfunction. The patent application centers on a clinical trial of 20 men with impotence. Their ages ranged from 21 to 88 years old. Ferguson, when measuring their hormone status found that these men were low in testosterone, low in progesterone and normal to high in estradiol. All had some health issue such as hypertension, diabetes, heart disorders, prostatic hypertrophy, renal insufficiency, depression, high cholesterol, chronic obstructive pulmonary disease and cerebral palsy. Many of these health issues or the drug treatment for them are known as risk factors for the development of erectile dysfunction. His treatment was to supply progesterone and testosterone together in topical creams which were applied to non-hairy skin areas daily.
Ferguson included some men who did not use the cream but felt that they illustrated the low levels of hormones as he had observed. The majority were able to achieve full erections in 1 to 3 months. One dropped out in spite of success because he lost a good deal of the girth around his waist and feared he had cancer. He regained his weight after stopping. The results were stunning in that no attempt was made to address any underlying disease states. This group is very reflective of the general health status of men who experience erectile dysfunction.
Hormones and NO
Nitric Oxide (NO) is an extremely important signaling molecule generated in the body and lasting just a few seconds. It is a potent smooth muscle dilator. It is the mediator of the transformation of guanosine triphosphate to cGMP. cGMP and its importance to erections was pointed out earlier. Hormones, it turns out, are important modulators of NO production. Estrogen, progesterone, androgen (for instance, DHEA, testosterone, dihydrotestosterone) insulin and growth hormone stimulate the production of NO and cGMP. Glucocorticoids (for instance, cortisol) and prolactin can reduce the bioavailability of NO.
cGMP is the kingpin in the series of reactions needed for healthy erections. The virility drugs can restore functioning by slowing the enzymatic breakdown of cGMP. However, hormones are key modulators for the production of NO which in turn increases the production of cGMP. Ferguson’s successes described in his patent application illustrate just how important hormone balance can be in reversing erectile dysfunction.
Duckles, Sue and Miller, Virginia “Hormonal Modulation of endothelial NO production” , Pflugers Arch. 2010 May ; 459(6): 841–851
Written by Carol Petersen and published at www.womensinternational.com