Lupron and Impotence

[njac]

Hey all, I'm visiting from the pharmacy forum.

Today I was in a radiation oncology office and had a patient inquire about lupron induced impotence. He had a radical prostatectomy 11 years ago but apparently things still work fine.

The question was would Sildenafil or any of the PDE-5 inhibitors help here. I can't find a specific answer - my inclination is to say no, because the erection isn't inhibited by a vascular process, but by a hormonal process.

Any opinions/experience? He'll be back next week and I told him I'd research it and stick a note in his chart.

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[Tori's dad]

I am by no means an expert, but, I believe that the PDE-5 inhibitors work on vascular processes (cGMP mediated increase in NO), just as prostaglandins such as aloprostadil do, albeit by a different mechanism. I guess a different question would be, are the opposing actions of the central acting leuprolide in decreasing GnRH output and thereby decreasing testosterone production, against the vascular effects of the PDE-5 inhibitor equal and opposite or will one be overtaken by the other? Dunno...

 

[njac]

I am by no means an expert, but, I believe that the PDE-5 inhibitors work on vascular processes (cGMP mediated increase in NO), just as prostaglandins such as aloprostadil do, albeit by a different mechanism. I guess a different question would be, are the opposing actions of the central acting leuprolide in decreasing GnRH output and thereby decreasing testosterone production, against the vascular effects of the PDE-5 inhibitor equal and opposite or will one be overtaken by the other? Dunno...

I'm thinking that it doesn't matter how much blood you get there if there isn't testosterone to go with it. But I don't know.
Is testosterone required for the erectile process? I know I've seen that libido plummets while on this medication, maybe he'll just have "a headache" for 3 months.