Phosphodiesterase-5 inhibitors and testosterone in erectile dysfunction: Mechanisms, therapeutic approaches, and emerging perspectives

Erectile dysfunction (ED) is a common condition with important consequences for male sexual health and fertility. Phosphodiesterase type 5 inhibitors are still the first-line treatment, although their effectiveness can be impaired in hypogonadal men. Combination therapy with testosterone replacement can improve treatment results by treating both the hormonal and vascular aspects of ED. Emerging regenerative therapies – low-intensity shockwave therapy, platelet-rich plasma, and stem cell therapy – hold potential for reversing the pathophysiology of ED, with potential curative strategies. Personalized medicine will likely become ever more important in individualizing the management of ED. A combination of lifestyle modification, pharmacologic therapy, and regenerative interventions could maximise outcomes, especially in refractory patients. Further research is necessary to confirm novel therapies and establish individualized treatment protocols.