Do hormone levels affect first-line treatment for erectile function in men with BPH?

This study examined the effects of hormone levels on treatment with tadalafil (Cialis) for erectile dysfunction in men with benign prostatic hyperplasia (BPH). Authors concluded that tadalafil improved erectile function in men with BPH regardless of hormone levels before treatment.

BPH can lead to bothersome urinary symptoms that impact quality of life. The likelihood of developing BPH increases with age. Older men are also more likely to have erectile dysfunction. Therefore, it is not uncommon for men to develop both BPH and erectile dysfunction. Phosphodiesterase-5 (PDE5) inhibitors, such as tadalafil, are often the first-line treatment for erectile dysfunction. PDE5 inhibitors expand blood vessels, which increases blood flow throughout the body, including the penis, to help achieve an erection. Studies have shown that treatment can be less effective for erectile dysfunction caused by low testosterone (a male sex hormone) levels. Whether men with BPH and erectile dysfunction due to low testosterone levels respond to treatment with PDE5 inhibitors has not been fully studied.

This study aimed to examine the effects of hormone levels on treatment with tadalafil for erectile dysfunction in men with BPH.

1,075 men from three clinical trials with BPH and erectile dysfunction were randomly assigned to receive either tadalafil or placebo (control drug with no active effect) for 12 weeks. Of these, 340 men had low testosterone levels before treatment. 709 men had normal testosterone levels. 94 men had high levels of luteinizing hormone (LH; a sex hormone regulating testicular function). 964 men had normal levels of LH. None of the men included had previously undergone treatment to increase testosterone levels.

Men with low testosterone were more likely to have diabetes (21.8%), heart and blood vessel disease (54.1%), and high blood pressure (49.1%). Men with normal testosterone reported diabetes (10.6%), heart and blood vessel disease (43.2%), and high blood pressure (36.7%) less often.

The rate of severe erectile dysfunction was higher in men with high LH levels (21.3%) compared to normal LH levels (12.6%). There was also an association between testosterone levels and erectile function before treatment.

Overall, tadalafil improved erectile function significantly more than placebo. Treatment response was slightly lower for men with low testosterone or high LH. However, this difference was not statistically significant. 57% of men with low testosterone and 53% of men with normal testosterone levels showed a significant response to tadalafil treatment.

Authors concluded that hormone levels did not significantly influence response to tadalafil treatment for erectile function in men with BPH.