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Morgado A, Tsampoukas G, Sokolakis I, Schoentgen N, Urkmez A, Sarikaya S. Do "testosterone boosters" really increase serum total testosterone? A systematic review. Int J Impot Res 2024; 36:348-364. [PMID: 37697053 DOI: 10.1038/s41443-023-00763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
Testosterone boosters are heavily marketed on social media and marketplaces to men with claims to significantly increase testosterone. Lax industry regulation has allowed sales of supplements to thrive in the absence of verification of their purported benefits. Our primary objective was to systematically review all data published in the last two decades on testosterone boosters and determine their efficacy. Our outcome of interest was total testosterone increase versus placebo in four different populations: male athletes, men with late-onset hypogonadism infertile men and healthy men. Following search and screening, 52 studies were included in our review, relating to 27 proposed testosterone boosters: 10 studies of cholecalciferol; 5 zinc/magnesium; 4 Tribulus terrestris and creatine; 3 Eurycoma longifolia and Withania somnifera; 2 betaine, D-aspartic acid, Lepidium meyenii and isoflavones; while the remainder were single reports. Our findings indicate that most fail to increase total testosterone. The exceptions were β-hydroxy β-methylbutyrate and betaine, which can be considered effective for male athletes. Eurycoma longifolia, a blend of Punica granatum fruit rind and Theobroma cacao seed extracts (Tesnor™) and purified Shilajit extract (PrimaVie™) can be considered possibly effective for men with late-onset hypogonadism; Eurycoma longifolia and Withania somnifera possibly effective for healthy men; and a non-hormonal aromatase inhibitor (Novadex XT™) possibly effective for male athletes.
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Affiliation(s)
- Afonso Morgado
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal.
| | | | - Ioannis Sokolakis
- 2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nadja Schoentgen
- Urology Department, University Hospital Center Bichat Claude Bernard, Paris, France
| | - Ahmet Urkmez
- Department of Urology, St. Elizabeth's Medical Center, Boston, MA, USA
| | - Selcuk Sarikaya
- Department of Urology, Gülhane Research and Training Hospital, Ankara, Turkey
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2
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Zhuang W, Sun N, Gu C, Liu S, Zheng Y, Wang H, Tong X, Song J. A literature review on Epimedium, a medicinal plant with promising slow aging properties. Heliyon 2023; 9:e21226. [PMID: 38027566 PMCID: PMC10665689 DOI: 10.1016/j.heliyon.2023.e21226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/18/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Ethnopharmacological relevance Aging is related to many factors, such as genes, oxidative damage, metabolic abnormalities, immune regulation and sex hormones. This article reviews the pharmacological mechanism of Epimedium on slow aging from six aspects: gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, the regulation of sex hormone, and clinical efficacy.Aim of the studyThrough literature review, to discover the potential pharmacological mechanism of Epimedium for slow aging. Materials and methods We reviewed the literature on the applications of Epimedium in multiple systems and the potential underlying mechanisms with systematic and comprehensive illustrations. The review includes the following aspects: gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, the regulation of sex hormone, clinical efficacy and safety. Results The slow aging active components of Epimedium may be flavonoids, such as Epimedins A, B, C and icariin The slow aging effect of Epimedium may be related to gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, and the regulation of sex hormone. No severe adverse reaction has been reported. Conclusions Epimedium has potential slow aging effect and been widely used in the clinic for aging-related diseases in the real world in China; however, large-scale studies are still needed.
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Affiliation(s)
- Wei Zhuang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing 100053, China
| | - Nan Sun
- Department of Pharmacy, Beijing Mentougou District Hospital,Beijing, China
| | - Chengjuan Gu
- Department of Endocrinology, Shenzhen Hospital of Guangzhou University of Chinese Medicine(Futian),Shenzhen, China
| | - Shimeng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yujiao Zheng
- Graduate School, Beijing University of Chinese Medicine, China, Beijing, China
| | - Han Wang
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Xiaolin Tong
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Juexian Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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3
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Russo GI, Asmundo MG, Durukan E, Fode M. Quality and benefits of the erectile dysfunction information on websites, social-media, and applications. Int J Impot Res 2023:10.1038/s41443-023-00725-1. [PMID: 37369784 DOI: 10.1038/s41443-023-00725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/27/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Erectile Dysfunction (ED) is defined as the persistent inability to obtain and maintain an erection that enables satisfactory sexual intercourse. ED prevalence vary across age groups, affecting approximately 1-9% of men under 40, 2-9% of those aged 40-59, and increasing to 20-40% for those aged 60-69. However, it remains a frequently untreated or insufficiently treated condition. Especially due to the feeling of discomfort and guilt, patients often avoid consulting their physicians; in this context, digital innovation could potentially play a pivotal role in the diagnosis and management of ED. This narrative review depicts the ongoing status of digital innovations in ED focusing on websites, social media platforms and mobile health applications (MHA). We examined Google, social media platforms (Facebook, Twitter, YouTube, and TikTok), and the recently developed MHA apps on Google Play Store and Apple App Store. Websites provide readily available but sometimes difficult to understand information, while social media is easy to understand and act on. MHA apps are the most complete and trustworthy tool for self-care management. In conclusion, digital innovations are a continuously growing source of information and therapeutic tools.
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Affiliation(s)
- Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | | | - Emil Durukan
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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De Luca R, Bonanno M, Manuli A, Calabrò RS. Cutting the First Turf to Heal Post-SSRI Sexual Dysfunction: A Male Retrospective Cohort Study. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9090045. [PMID: 36135826 PMCID: PMC9503765 DOI: 10.3390/medicines9090045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/06/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual problems, which may arise during the administration of selective serotonin reuptake inhibitors (SSRIs) and persist after their discontinuation. PSSD is a rare clinical entity, and it is commonly associated with non-sexual concerns, including emotional and cognitive problems and poor quality of life. To date, however, no effective treatment is available. The aim of this study was to retrospectively evaluate the potential efficacy of the different treatments used in clinical practice in improving male PSSD. Of the 30 patients referred to our neurobehavioral outpatient clinic from January 2020 to December 2021, 13 Caucasian male patients (mean age 29.53 ± 4.57 years), previously treated with SSRIs, were included in the study. Patients with major depressive disorder and/or psychotic symptoms were excluded a priori to avoid overlapping symptomatology, and potentially reduce the misdiagnosis rate. To treat PSSD, we decided to use drugs positively affecting the brain dopamine/serotonin ratio, such as bupropion and vortioxetine, as well as other compounds. This latter drug is known not to cause or reverse iatrogenic SD. Most patients, after treatment with vortioxetine and/or nutraceuticals, reported a significant improvement in all International Index of Erectile Function-(IIEF-5) domains (p < 0.05) from baseline (T0) to 12-month follow-up (T1). Moreover, the only patient treated with pelvic muscle vibration reached very positive results. Although our data come from a retrospective open-label study with a small sample size, drugs positively modulating the central nervous system serotonin/dopamine ratio, such as vortioxetine, could be used to potentially improve PSSD. Large-sample prospective cohort studies and randomized clinical trials are needed to investigate the real prevalence of this clinical entity and confirm such a promising approach to a potentially debilitating illness.
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Affiliation(s)
- Rosaria De Luca
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98166 Messina, Italy
| | - Mirjam Bonanno
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98166 Messina, Italy
| | - Alfredo Manuli
- UOC Physical Medicine and Rehabilitation, AOU Policlinico G Martino, 98166 Messina, Italy
| | - Rocco Salvatore Calabrò
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98166 Messina, Italy
- Correspondence: mailto:
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Leisegang K, Finelli R, Sikka SC, Panner Selvam MK. Eurycoma longifolia (Jack) Improves Serum Total Testosterone in Men: A Systematic Review and Meta-Analysis of Clinical Trials. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1047. [PMID: 36013514 PMCID: PMC9415500 DOI: 10.3390/medicina58081047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Male hypogonadism is a clinical disorder characterized by reduced serum testosterone in men. Although treatment using herbal medicines, including Eurycoma longifolia, has been investigated, the benefits remain unclear. This study aims to investigate the efficacy of E. longifolia as a sole intervention to increase testosterone levels in males. Materials and Methods: We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) according to the PRISMA guidelines. Relevant articles were retrieved from the databases PubMed, Scopus, Web of Science, Cochrane, Ovid/Embase, and Google Scholar. Results: After literature screening, a total of nine studies was included in the systematic review. Five RCTs were included in the meta-analysis. A significant improvement in total testosterone levels after E. longifolia treatment was mostly reported in both healthy volunteers and hypogonadal men. The random model effect revealed a significant increase (SMD = 1.352, 95% CI 0.565 to 2.138, p = 0.001) in the total testosterone levels in men receiving E. longifolia supplementation, which was confirmed in the hypogonadism subgroup. Conclusions: This systematic review and meta-analysis of the literature supports the possible use of E. longifolia supplementation for enhancing testosterone production. Although more research is required before its use in clinical practice, this may represent a safe and promising therapeutic option, particularly in hypogonadal men.
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Affiliation(s)
- Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, Bellville, Cape Town 7535, South Africa
| | | | - Suresh C. Sikka
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Garolla A, Petre GC, Francini-Pesenti F, De Toni L, Vitagliano A, Di Nisio A, Grande G, Foresta C. Systematic Review and Critical Analysis on Dietary Supplements for Male Infertility: From a Blend of Ingredients to a Rationale Strategy. Front Endocrinol (Lausanne) 2022; 12:824078. [PMID: 35185789 PMCID: PMC8854851 DOI: 10.3389/fendo.2021.824078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022] Open
Abstract
Content Dietary supplements (DS) for male infertility marketed in Italy were evaluated for composition, concentration of ingredients, and recommended daily dose. A systematic review of literature identified ingredients potentially effective on sperm parameters and their minimal effective daily dose (mED). Objective This study was conducted in order to critically evaluate the composition and efficacy of DS marketed in Italy. Design Setting and Participants This was a systematic review of randomized controlled trials. Evidence Acquisition A formula allowed us to classify the expected efficacy of each DS, based on composition. Each DS was scored and included into three classes of expected efficacy: high, low, and none. Evidence Synthesis Among 24 supplements, 3 (12.5%) fall in high, 9 (37.5%) in lower, and 12 (50.0%) in no expected efficacy class. DS composition showed 36 substances, 18 with no literature on male fertility and 18 showing positive effect on sperm parameters, thus considered potentially active ingredients (PAI). All DS were mixtures of ingredients, containing from 2 to 17 different substances. Fifteen supplements (65.2%) contained at least 1 ingredient without evidence of efficacy and 21 formulations had PAI dosed below mED. Some PAI were associated to the improvement of specific sperm parameters. Conclusions DS were usually blends of many substances that are frequently employed at negligible dose or without any evidence of efficacy on male reproduction. Some ingredients have been demonstrated to be effective on specific sperm parameters by RCTs. We report a list of ingredients with potential efficacy on specific sperm parameters, aimed to allow a tailored use of DS. Patient Summary The market of DS for male infertility offers products with potential efficacy in the improvement of sperm parameters but also many with uncertain effects. Based on current scientific literature, our study can help in the choice of DS that are more likely to be effective on specific sperm alterations, so providing the best supplementation for each patient.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Gabriel Cosmin Petre
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | | | - Luca De Toni
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Amerigo Vitagliano
- Department of Women and Children’s Health, University of Padua, Padua, Italy
- Unit of Obstetrics and Gynecology, Madonna della Navicella Hospital, Venice, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
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De Cosmi V, Parazzini F, Agostoni C, Noli S, Cipriani S, La Vecchia I, Ferrari S, Esposito G, Bravi F, Ricci E. Antioxidant Vitamins and Carotenoids Intake and the Association With Poor Semen Quality: A Cross-Sectional Analysis of Men Referring to an Italian Fertility Clinic. Front Nutr 2021; 8:737077. [PMID: 34671631 PMCID: PMC8520935 DOI: 10.3389/fnut.2021.737077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Several studies suggested that male's diet affects fertility. This cross-sectional analysis from a prospective cohort study aims to explore the relation between antioxidants intake and sperm parameters in sub-fertile couples referring to a Fertility center. Socio-demographic characteristics, health history, lifestyle habits, and diet information were obtained. A semen sample was analyzed to proceed with assisted reproduction. Three hundred and twenty-three men were enrolled: 19.1% had semen volume (SV) < 1.5 mL, 31.4% sperm concentration (SC) < 15.0 mil/mL, 26.8% sperm motility < 32%, and 33.0% had total sperm count (TSC) < 39.0 mil. Higher levels of α-carotene were associated to lower risk of low SC [4th vs. 1st quartile, adjusted OR (aOR) 0.43, 95% CI 0.20–0.91) and low TSC (aOR 0.46, 95% CI 0.22–0.95). Higher intake of β-carotene was inversely associated with risk of low TSC. Lycopene intake was associated with higher risk for these conditions (aOR 2.46, 95%CI 1.01–5.98, SC), and (aOR 3.11, 95%CI 1.29–7.50, TSC). Risk of low semen volume was lower in men with higher level of vitamin D intake (aOR 0.25, 95%CI 0.09–0.66)]. Further research, especially, well-designed randomized clinical trials (RCT), is needed to understand how diet modifications may have a role in modulating male fertility and fecundability.
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Affiliation(s)
- Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,SIGENP (Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition), Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,SIGENP (Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition), Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Noli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sonia Cipriani
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefania Ferrari
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Leisegang K, Finelli R. Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review. Arab J Urol 2021; 19:323-339. [PMID: 34552783 PMCID: PMC8451697 DOI: 10.1080/2090598x.2021.1926753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives: To systematically review and discuss the current evidence from placebo-controlled clinical trials that investigated the use of alternative medicines and herbal remedies in the management of erectile dysfunction (ED). Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based systematic review using specific keyword combinations was conducted on the PubMed and Scopus databases. Randomised controlled trials investigating herbal medicine in at least one group and using the International Index of Erectile Function (IIEF) as an outcome in patients primarily diagnosed with ED were included for review. Results: Following the literature search, screening and eligibility analysis, a total of 42 articles were included. The 42 articles were categorised as single herb extractions (n = 14), combination herbal formula (n = 5), combination of herbal formula and non-herbal nutraceuticals (n = 7), non-herbal nutraceuticals (n = 5), acupuncture and moxibustion (n = 2), diet and nutrition (n = 3), exercise (n = 5), and topical treatments (n = 1). Based on the results, Korean ginseng, Pygnogenol and Prelox, Tribulus terrestris, Lepidium meyenii, L-arginine, acupuncture and lifestyle interventions were the more predominantly investigated treatments interventions for ED. Conclusions: Panax ginseng, Pygnogenol, Prelox and Tribulus terrestris have promising evidence as herbal products, alongside L-arginine as a nutritional supplement, for ED based on IIEF outcomes, and warrant further clinical investigation. The mechanisms of action remain unclear, but each of these appears to in part increase nitric oxide synthesis. Importantly, improved diet and exercise should be considered, particularly in patients with obesity or diabetes mellitus.
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Affiliation(s)
- Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Alternative Treatment for Erectile Dysfunction: a Growing Arsenal in Men's Health. Curr Urol Rep 2021; 22:11. [PMID: 33420972 DOI: 10.1007/s11934-020-01023-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To highlight and review encouraging preliminary studies behind several alternative products and interventions for erectile dysfunction (ED). RECENT FINDINGS Alternative treatments for ED are becoming more prevalent with increased consumer interest. "Natural" products are sold online, and numerous clinics offer various off-label and investigational interventions. These alternative treatments have demonstrated varying degrees of efficacy in randomized trials and meta-analyses, but none of these interventions has robust enough evidence to be considered first-line therapy. These treatments may find a role in combination with guideline treatments or may be used in novel penile rehabilitation research protocols. With growing interest in alternative treatment for men's health, an awareness of the literature is imperative for patient counsel. Alternative treatments, like L-arginine, have a growing body of evidence for efficacy in combination with PDE5i, and low-intensity shock wave therapy and stem cell therapy continue to demonstrate encouraging outcomes in ED trials.
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Garolla A, Petre GC, Francini-Pesenti F, De Toni L, Vitagliano A, Di Nisio A, Foresta C. Dietary Supplements for Male Infertility: A Critical Evaluation of Their Composition. Nutrients 2020; 12:nu12051472. [PMID: 32438678 PMCID: PMC7284793 DOI: 10.3390/nu12051472] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022] Open
Abstract
Dietary supplements (DS) represent a possible approach to improve sperm parameters and male fertility. A wide range of DS containing different nutrients is now available. Although many authors demonstrated benefits from some nutrients in the improvement of sperm parameters, their real effectiveness is still under debate. The aim of this study was to critically review the composition of DS using the Italian market as a sample. Active ingredients and their minimal effective daily dose (mED) on sperm parameters were identified through a literature search. Thereafter, we created a formula to classify the expected efficacy of each DS. Considering active ingredients, their concentration and the recommended daily dose, DS were scored into three classes of expected efficacy: higher, lower and none. Twenty-one DS were identified. Most of them had a large number of ingredients, frequently at doses below mED or with undemonstrated efficacy. Zinc was the most common ingredient of DS (70% of products), followed by selenium, arginine, coenzyme Q and folic acid. By applying our scoring system, 9.5% of DS fell in a higher class, 71.4% in a lower class and 19.1% in the class with no expected efficacy. DS marketed in Italy for male infertility frequently includes effective ingredients but also a large number of substances at insufficient doses or with no reported efficacy. Manufacturers and physicians should better consider the scientific evidence on effective ingredients and their doses before formulating and prescribing these products.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
- Correspondence:
| | - Gabriel Cosmin Petre
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | | | - Luca De Toni
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | - Amerigo Vitagliano
- Department of Women and Children’s Health, University of Padua, 35122 Padua, Italy;
- Unit of Obstetrics and Gynecology, Madonna della Navicella Hospital, Chioggia, 30015 Venice, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
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11
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Kuchakulla M, Narasimman M, Soni Y, Leong JY, Patel P, Ramasamy R. A systematic review and evidence-based analysis of ingredients in popular male testosterone and erectile dysfunction supplements. Int J Impot Res 2020; 33:311-317. [PMID: 32358510 DOI: 10.1038/s41443-020-0285-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
The objective was to study available evidence for ingredients of popular over-the-counter testosterone and erectile dysfunction (ED) supplements. The top 16 male testosterone and 16 ED supplements in the USA were identified from the most popular online retailers: A1 Supplements, Amazon, Vitamin Shoppe, and Walmart. In total, 37 ingredients were identified and PUBMED online database was reviewed for randomized-controlled trials (RCT) studying their efficacy. Ingredients were categorized based on evidence quantity using an adapted version of the American Heart Association scoring system. In total, 16 ingredients from testosterone supplements and 21 from ED supplements were identified. Tribulus, Eurycoma longifolia, Zinc, L-arginine, Aspartate, Horny goat weed, and Yohimbine were most common. In all, 105 RCTs studying the identified ingredients were found. No whole supplement products have published RCT evidence. 19% of ingredients received an A grade for strong positive evidence with net positive evidence in two or more RCTs. In total, 68% received C or D grades for contradicting, negative, or lacking evidence. Overall, 69% of ingredients in testosterone supplements and 52% of ingredients in ED supplements have published RCT evidence. Many male supplements claim to improve testosterone or ED parameters; however, there is limited evidence, which should be considered when counseling patients.
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Affiliation(s)
- Manish Kuchakulla
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Manish Narasimman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yash Soni
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Balasubramanian A, Thirumavalavan N, Srivatsav A, Yu J, Lipshultz LI, Pastuszak AW. Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. J Sex Med 2020; 16:203-212. [PMID: 30770069 DOI: 10.1016/j.jsxm.2018.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Testosterone-boosting supplements (T-Boosters) are prominently featured on Amazon.com, with numerous dedicated pages and claims that they "naturally" increase testosterone levels. AIM To evaluate the highest rated and frequently reviewed T-Boosters on Amazon.com to facilitate patient counseling regarding marketing myths, T-Booster formulations, and evidence for efficacy and safety. METHODS The Amazon marketplace was queried using the key words "testosterone" + "booster," with default search settings and ranking items based on relevance. The top 5 T-Boosters identified on July 22, 2018, were reviewed based on price, ratings, reviews, manufacturer details, and ingredients. Consumer reviews were categorized using core themes in the Androgen Deficiency in the Aging Male (ADAM) questionnaire as a proxy to understand T-Booster efficacy and reanalyzed after filtration of untrustworthy comments using ReviewMeta.com, a proprietary Amazon customer review analysis software. MAIN OUTCOME MEASURES Quantitative and qualitative evaluation of T-Boosters on Amazon.com was performed. RESULTS The top 5 T-Boosters had an average ± SD of 2,761 ± 5,112 reviews and a rating of 4.56 ± 0.25 stars. 19 unique ingredients were identified across these T-Boosters, and literature review revealed 191 studies involving the 10 most common ingredients, of which 19% involved human subjects, 53% animal models, 15% in vitro studies, and 12% case reports or review articles. Among 37 human studies, 30% observed an increase in T levels, 3% a decrease, 46% no effect, and 22% were indeterminate. Analysis of top customer reviews from the first 2 pages of reviews for each supplement revealed differences in the ADAM score before and after ReviewMeta.com filtration. After filtration, there was a 91% decrease in users reporting increased libido, a 59% decrease in reports of increased energy, a 93% decrease in reports of improved strength/endurance, a 60% decrease in reports of improved erections, an elimination of reports of improved work performance, a 67% decrease in reports of improved sleep, and an 89% decrease in reports of improved sports ability. CLINICAL IMPLICATIONS Our study can serve as a guide for providers to counsel patients about the efficacy of popular online T-Boosters as well as the prevalence of disingenuous reviews associated with these products on online marketplaces like Amazon.com. STRENGTHS & LIMITATIONS Strengths include the novel approach to assess consumers' perceptions and satisfaction of T-Boosters, as well as summary information that clinicians can provide patients. Limitations include selection bias, a small number of supplements analyzed, and the proprietary nature of the Amazon review analysis software. CONCLUSION T-Boosters are easily available online. Our investigation revealed that limited human studies have evaluated T-Boosters, resulting in no definitive findings of efficacy. In the absence of additional human studies, patients should be cautioned before considering T-Boosters, given the availability of highly effective therapies approved by the Food and Drug Administration. Balasubramanian A, Thirumavalavan N, Srivatsav A, et al. Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. J Sex Med 2019;16:203-212.
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Affiliation(s)
| | - Nannan Thirumavalavan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Justin Yu
- Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Department of Surgery-Urology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Efficacy and Safety of Common Ingredients in Aphrodisiacs Used for Erectile Dysfunction: A Review. Sex Med Rev 2020; 8:431-442. [PMID: 32139335 DOI: 10.1016/j.sxmr.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is the inability to attain or sustain an erection for sexual intercourse. Affected men endorse difficulties with intimacy and feelings of guilt and shame. Although medical treatments are available, patients are reluctant to discuss ED with physicians and often use dietary supplements to attempt to treat their ED. As such, there is a need to better understand the effects of ingredients used in nutraceuticals for ED treatment. OBJECTIVES To summarize the literature on the efficacy and safety of the most common ingredients used in ED supplements. METHODS 10 of the most common ingredients in ED supplements were reviewed using PubMed-indexed literature to assess their efficacy and safety in treating ED. Key findings were summarized to include historical use, active ingredients, prior animal studies, human studies, and toxicity. RESULTS Nutraceuticals used in ED treatment include a variety of ingredients. Although L-arginine is a safe supplement with clinical data supporting improved erectile function, limited data exist on the efficacy of other ingredients in the treatment of ED. CONCLUSION Despite the growing use of supplements for treatment of sexual dysfunction, ED supplements remain poorly studied, with limited data demonstrating efficacy of individual ingredients. Further study is required to definitively determine the efficacy of nutraceuticals in ED treatment. Srivatsav A, Balasubramanian A, Pathak UI, et al. Efficacy and Safety of Common Ingredients in Aphrodisiacs Used for Erectile Dysfunction: A Review. J Sex Med 2020;8:431-442.
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Onder A, Yilmaz-Oral D, Jerkovic I, Akdemir AO, Gur S. Evaluation of relaxant responses properties of cinnamon essential oil and its major component, cinnamaldehyde on human and rat corpus cavernosum. Int Braz J Urol 2019; 45:1033-1042. [PMID: 31408283 PMCID: PMC6844336 DOI: 10.1590/s1677-5538.ibju.2019.0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/20/2019] [Indexed: 01/14/2023] Open
Abstract
Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10μM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.
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Affiliation(s)
- Alev Onder
- Department of Pharmacognosy, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey.,Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey
| | - Igor Jerkovic
- Department of Organic Chemistry, Faculty of Chemistry and Technology, University of Split, Split, Croatia
| | - Alp Ozgur Akdemir
- Department of Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serap Gur
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Plant-Derived Supplements for Sexual Health and Problems: Part 1—Trends over the Past Decade. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Silva T, Jesus M, Cagigal C, Silva C. Food with Influence in the Sexual and Reproductive Health. Curr Pharm Biotechnol 2019; 20:114-122. [PMID: 30255750 DOI: 10.2174/1389201019666180925140400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sexual dysfunction and infertility are conditions with high prevalence in the general population. Nutritional factors have been reported to have an impact on sexual and reproductive health. OBJECTIVE The aim of this review is to summarize the data on nutritional factors that have influence on male and female sexual and reproductive function, including nutritional status, specific foods (e.g. dairy food), nutrients and other food components and dietary supplements. METHOD A literature search was performed using Cochrane Library, Medline and Science Direct databases without time limitations. RESULTS Obesity has a negative influence on male fertility, and weight loss improves male fertility. Food insufficiency is associated with increased sexual risk behaviours, more significant in women. Regarding macronutrients and group foods, trans-fatty acids, high glycemic index food, high carbohydrate diet and high animal protein intake prejudices fertility; omega-3 and omega-6 fatty acids, low glycemic index food and low carbohydrate diet, vegetable proteins and antioxidants improve fertility. Isoflavones have a negative impact on men fertility and improve sexual health of menopausal women. Whole milk improves women fertility, but men benefit from skim milk. Concerning dietary supplements, there is weak evidence sustaining efficacy, and the most promising supplements are yohimbine, vitamin B, L-arginine and vitamin D. CONCLUSION The compiled results indicate that despite the multifactorial etiology of sexual/ reproductive dysfunction, nutritional factors may affect the sexual and reproductive health in both men and women. However, it is necessary to further study to clarify this association and simultaneously improve the approach and treatment of patients with sexual and/or reproductive problems.
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Affiliation(s)
- Tânia Silva
- Psychiatry Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Mariana Jesus
- Psychiatry Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - César Cagigal
- Psychiatry Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Carla Silva
- Psychiatry Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
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Borrelli F, Colalto C, Delfino DV, Iriti M, Izzo AA. Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis. Drugs 2019; 78:643-673. [PMID: 29633089 DOI: 10.1007/s40265-018-0897-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Erectile dysfunction (ED) is a common condition that significantly affects quality of life and interpersonal relationships. OBJECTIVE Our objective was to perform a systematic review and meta-analysis to evaluate the efficacy of herbal dietary supplements in the treatment of ED. MATERIALS AND METHODS We searched five databases to identify randomized controlled trials (RCTs) that evaluated the clinical efficacy of herbal medicines in ED. Quality was assessed and risk of bias was estimated using the Jadad score and the Cochrane risk-of-bias tool. RESULTS In total, 24 RCTs, including 2080 patients with ED, were identified. Among these, 12 evaluated monopreparations (five ginseng [n = 399], three saffron [n = 397], two Tribulus terrestris [n = 202], and one each Pinus pinaster [n = 21] and Lepidium meyenii [n = 50]), seven evaluated formulations (n = 544), and five investigated dietary supplements in combination with pure compounds (n = 410). Ginseng significantly improved erectile function (International Index of Erectile Function [IIEF]-5 score: 140 ginseng, 96 placebo; standardized mean difference [SMD] 0.43; 95% confidence interval [CI] 0.15-0.70; P < 0.01; I2 = 0), P. pinaster and L. meyenii showed very preliminary positive results, and saffron and T. terrestris treatment produced mixed results. Several herbal formulations were associated with a decrease of IIEF-5 or IIEF-15, although the results were preliminary. The quality of the included studies varied, with only seven having a prevalent low risk of bias. The median methodological quality Jadad score was three out of a maximum of five. Adverse events were recorded in 19 of 24 trials, with no significant differences between placebo and verum in placebo-controlled studies. CONCLUSIONS Encouraging evidence suggests that ginseng may be an effective herbal treatment for ED. However, further, larger, and high-quality studies are required before firm conclusions can be drawn. Promising (although very preliminary) results have also been generated for some herbal formulations. Overall, more research in the field, adhering to the CONSORT statement extension for reporting trials, is justified before the use of herbal products in ED can be recommended.
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Affiliation(s)
- Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Napes Federico II, Via D. Montesano 49, 80131, Naples, Italy. .,Working Group "Pharmacognosy and Phytotherapy" of the Italian Pharmacological Society, Viale Abruzzi 32, 20131, Milan, Italy.
| | - Cristiano Colalto
- Farmacia San Paolo dr Colalto, Piazza Dè l'Osto 37, 37035, San Giovanni Ilarione, Verona, Italy.,Working Group "Pharmacognosy and Phytotherapy" of the Italian Pharmacological Society, Viale Abruzzi 32, 20131, Milan, Italy
| | - Domenico V Delfino
- Section of Pharmacology, Department of Medicine, University of Perugia, Piazzale Severi, 06132, S. Andrea delle Fratte, Perugia, Italy.,Working Group "Pharmacognosy and Phytotherapy" of the Italian Pharmacological Society, Viale Abruzzi 32, 20131, Milan, Italy
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences, Milan State University, Via Celoria 2, 20133, Milan, Italy.,Working Group "Pharmacognosy and Phytotherapy" of the Italian Pharmacological Society, Viale Abruzzi 32, 20131, Milan, Italy
| | - Angelo A Izzo
- Department of Pharmacy, School of Medicine and Surgery, University of Napes Federico II, Via D. Montesano 49, 80131, Naples, Italy. .,Working Group "Pharmacognosy and Phytotherapy" of the Italian Pharmacological Society, Viale Abruzzi 32, 20131, Milan, Italy.
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Pyke RE. Toward a Scientific Nutritional Supplement Combination for Prostatism and Erectile Dysfunction I: From Known Pharmacology to Clinical Testing. J Med Food 2019; 22:529-537. [PMID: 30864860 DOI: 10.1089/jmf.2018.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prostatism and erectile dysfunction (ED) are highly prevalent and closely comorbid. Prescription treatments are limitingly expensive but robust in mechanisms of action (MoA). Nutritional supplements (NS) are low-cost but inadequately supported by evidence. Do any NS use robust MoA? Could their efficacy be amplified via dosing, concentration of active principles, and/or use in combination? The goal is to develop an effective NS for prostatism and ED using the MoA of prescription treatments. Literature reviews were conducted on dietary supplements for prostatism or ED and MoA of relevant drugs. The most promising NS employing these MoA were chosen. A pilot study of a prototype combination was conducted. A protocol was created for an adequate dose-response trial to test the NS combination in men with ED and prostatism. The main measures were response rates, International Prostate Symptom Score, and International Index of Erectile Function. For drugs, the MoAs best proven for prostatism and ED were nitric oxide augmentation, mild androgen inhibition, and anti-inflammatory effects. The following NS best simulate these MoA and are best supported for efficacy; for prostatism: beta sitosterol; for ED: panax ginseng, arginine, and citrulline. Pilot clinical data provided support. A plan for a formal dose-response clinical trial was approved by a central institutional review board. NS using effective MoA might suffice for prostatism and ED. Pilot testing of a combination NS with the best-supported MoA supported further development. A dose-response trial should be conducted using adequate doses of L-citrulline, beta-sitosterol, ginseng, and vitamin D3.
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Ferrini MG, Garcia E, Abraham A, Artaza JN, Nguyen S, Rajfer J. Effect of ginger, Paullinia cupana, muira puama and l- citrulline, singly or in combination, on modulation of the inducible nitric oxide- NO-cGMP pathway in rat penile smooth muscle cells. Nitric Oxide 2018; 76:81-86. [PMID: 29551532 DOI: 10.1016/j.niox.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/05/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION COMP-4 is a natural compound-based dietary supplement consisting of the combination of ginger, Paullinia cupana, muira puama and l-citrulline, which when given long-term has been shown in the aged rat to a) upregulate iNOS in the penile smooth muscle cells (SMC), b) reverse the corporal SMC apoptosis and fibrosis associated with corporal veno-occlusive dysfunction (CVOD), and c) improve resulting erectile function. To elucidate the mechanism of how COMP-4 and its individual components modulate the iNOS-cGMP pathway, an in vitro study was conducted using a rat corporal primary SMC culture to determine its effect on NOS, soluble guanylate cyclase (sGC), cGMP and the phosphodiesterase 5 enzyme (PDE5). MATERIALS AND METHODS Primary SMC cultures using the explant technique were initiated by cutting small pieces of corporal tissue from 8 week old Sprague-Dawley rats. The SMC were grown in Dulbecco media with 20% fetal calf serum. The SMC were then incubated with or without COMP-4 (0.69 mg/ml) or its ingredients alone (ginger: 0.225 mg/ml; muira puama, Paullinia cupana and l-citrulline each at 0.9 mg/ml) for up to 24 h mRNA and protein were extracted and used for the determination of NOS, sGC and PDE5 content. cGMP content was determined by ELISA. L-NIL (4 μM) was used as an inhibitor of iNOS activity. RESULTS Compared to the control values, COMP-4 upregulated expression of cGMP by 85%, induced a 42 fold increase in sGC as well as a 15 fold increase in both iNOS protein and mRNA content while it decreased both PDE5 mRNA and protein content each by about 50%. L-NIL completely inhibited the effect of COMP-4 on cGMP production. When compared with each of the individual four components of COMP-4, it appears that COMP-4 itself had the most profound effect in modulating each one the specific steps within the iNOS-cGMP pathway. CONCLUSIONS This in vitro study demonstrates that COMP-4 is capable of activating the endogenous cellular iNOS-cGMP pathway within the CSM cells, which is theorized to be responsible for reducing the fibrosis and apoptosis as well as the CVOD observed in the aging rat penis. Further studies will be necessary in order to determine whether supplementation of COMP-4 on a daily basis may be beneficial in halting or reversing this aging related erectile dysfunction in the clinical setting.
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Affiliation(s)
- Monica G Ferrini
- Department of Health and Life Sciences, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Eduardo Garcia
- Department of Health and Life Sciences, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Andrea Abraham
- Department of Health and Life Sciences, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Jorge N Artaza
- Department of Health and Life Sciences, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sabine Nguyen
- Department of Health and Life Sciences, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Jacob Rajfer
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Santillo MF, Mapa MST. Phosphodiesterase (PDE5) inhibition assay for rapid detection of erectile dysfunction drugs and analogs in sexual enhancement products. Drug Test Anal 2018; 10:1315-1322. [PMID: 29488328 DOI: 10.1002/dta.2375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 02/28/2024]
Abstract
Products marketed as dietary supplements for sexual enhancement are frequently adulterated with phosphodiesterase-5 (PDE5) inhibitors, which are erectile dysfunction drugs or their analogs that can cause adverse health effects. Due to widespread adulteration, a rapid screening assay was developed to detect PDE5 inhibitors in adulterated products. The assay employs fluorescence detection and is based on measuring inhibition of PDE5 activity, the pharmacological mechanism shared among the adulterants. Initially, the assay reaction scheme was established and characterized, followed by analysis of 9 representative PDE5 inhibitors (IC50 , 0.4-4.0 ng mL-1 ), demonstrating sensitive detection in matrix-free solutions. Next, dietary supplements serving as matrix blanks (n = 25) were analyzed to determine matrix interference and establish a threshold value; there were no false positives. Finally, matrix blanks were spiked with 9 individual PDE5 inhibitors, along with several mixtures. All 9 adulterants were successfully detected (≤ 5 % false negative rate; n = 20) at a concentration of 1.00 mg g-1 , which is over 5 times lower than concentrations commonly encountered in adulterated products. A major distinction of the PDE5 inhibition assay is the ability to detect adulterants without prior knowledge of their chemical structures, demonstrating a broad-based detection capability that can address a continuously evolving threat of new adulterants. The PDE5 inhibition assay can analyze over 40 samples simultaneously within 15 minutes and involves a single incubation step and simple data analysis, all of which are advantageous for combating the widespread adulteration of sex-enhancement products.
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Affiliation(s)
- Michael F Santillo
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Laurel, Maryland, USA
| | - Mapa S T Mapa
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Laurel, Maryland, USA
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Calogero AE, Aversa A, La Vignera S, Corona G, Ferlin A. The use of nutraceuticals in male sexual and reproductive disturbances: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS). J Endocrinol Invest 2017; 40:1389-1397. [PMID: 28589384 DOI: 10.1007/s40618-017-0699-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023]
Affiliation(s)
- A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - A Ferlin
- Deparment of Medicine, University of Padova, Padua, Italy.
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Household expenditures on dietary supplements sold for weight loss, muscle building, and sexual function: Disproportionate burden by gender and income. Prev Med Rep 2017; 6:236-241. [PMID: 28377850 PMCID: PMC5377432 DOI: 10.1016/j.pmedr.2017.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Dietary supplements sold for weight loss (WL), muscle building (MB), and sexual function (SF) are not medically recommended. They have been shown to be ineffective in many cases and pose serious health risks to consumers due to adulteration with banned substances, prescription pharmaceuticals, and other dangerous chemicals. Yet no prior research has investigated how these products may disproportionately burden individuals and families by gender and socioeconomic position across households. We investigated household (HH) cost burden of dietary supplements sold for WL, MB, and SF in a cross-sectional study using data from 60,538 U.S. households (HH) in 2012 Nielsen/IRi National Consumer Panel, calculating annual HH expenditures on WL, MB, and SF supplements and expenditures as proportions of total annual HH income. We examined sociodemographic patterns in HH expenditures using Wald tests of mean differences across subgroups. Among HH with any expenditures on WL, MB, or SF supplements, annual HH first and ninth expenditure deciles were, respectively: WL $5.99, $145.36; MB $6.99, $141.93; and SF $4.98, $88.52. Conditional on any purchases of the products, female-male-headed HH spent more on WL supplements and male-headed HH spend more on MB and SF supplements compared to other HH types (p-values < 0.01). High-income ($30,000 < annual income < $100,000), compared to low-income (annual income < $30,000) HH, spent more on all three supplements types (p-values < 0.01); however, proportional to income, low-income HH spent 2–4 times more than high-income HH on WL and MB supplements (p-values < 0.01). Dietary supplements sold for WL, MB, and SF disproportionately burden HH by income and gender. Female-male-headed households spend more than others on weight-loss supplements. Male-headed households spend more than others on muscle-building and sexual-function supplements. Low-income households bear the heaviest financial burden in terms of proportion of household income spent.
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Lee JKC, Tan RBW, Chung E. Erectile dysfunction treatment and traditional medicine-can East and West medicine coexist? Transl Androl Urol 2017; 6:91-100. [PMID: 28217454 PMCID: PMC5313309 DOI: 10.21037/tau.2016.11.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Erectile dysfunction (ED) is a common sexual problem affecting many men irrespective of cultures, beliefs and nationalities. While medical therapy for ED has been revolutionized by the advent of oral phosphodiesterase type 5 inhibitors and intracavernosal injection of vasoactive agents, recent technological advances such stem cell therapy, low intensity shock wave and newer generation of penile prosthesis implant offer hope to men who do not respond to conventional medical therapy. In contrast, traditional and complementary medicine (TCM) focuses on the restoration and better overall bodily regulation with the use of various herbal and animal products as well as exercises to invigorate qi (energy) in vital organs. Western medicine involves an analysis of ED symptom and underlying causes that contribute to ED, while TCM emphases the concept of holism and harmonization of body organs to achieve natural sexual life. The following article reviews our current understanding regarding the philosophical approach, and evaluates the evidence surrounding various ED therapies between mainstream Western Medicine and TCM.
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Affiliation(s)
- Joe K C Lee
- Department of Urology, National University Hospital, Singapore 119074, Singapore
| | - Ronny B W Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore ; Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore - Imperial College, London, UK
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia;; Andro Urology Centre, St Andrew's War Memorial Hospital, Brisbane, Australia
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Mahmood J, Shamah AA, Creed TM, Pavlovic R, Matsui H, Kimura M, Molitoris J, Shukla H, Jackson I, Vujaskovic Z. Radiation-induced erectile dysfunction: Recent advances and future directions. Adv Radiat Oncol 2016; 1:161-169. [PMID: 28740886 PMCID: PMC5514009 DOI: 10.1016/j.adro.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the United States. A large number of patients undergo radiation therapy (RT) as a standard care of treatment; however, RT causes erectile dysfunction (radiation-induced erectile dysfunction; RiED) because of late side effects after RT that significantly affects quality of life of prostate cancer patients. Within 5 years of RT, approximately 50% of patients could develop RiED. Based on the past and current research findings and number of publications from our group, the precise mechanism of RiED is under exploration in detail. Recent investigations have shown prostate RT induces significant morphologic arterial damage with aberrant alterations in internal pudendal arterial tone. Prostatic RT also reduces motor function in the cavernous nerve which may attribute to axonal degeneration may contributing to RiED. Furthermore, the advances in radiogenomics such as radiation induced somatic mutation identification, copy number variation and genome-wide association studies has significantly facilitated identification of biomarkers that could be used to monitoring radiation-induced late toxicity and damage to the nerves; thus, genomic- and proteomic-based biomarkers could greatly improve treatment and minimize arterial tissue and nerve damage. Further, advanced technologies such as proton beam therapy that precisely target tumor and significantly reduce off-target damage to vital organs and healthy tissues. In this review, we summarize recent advances in RiED research and novel treatment modalities for RiED. We also discuss the possible molecular mechanism involved in the development of RiED in prostate cancer patients. Further, we discuss various readily available methods as well as novel strategies such as stem cell therapies, shockwave therapy, nerve grafting with tissue engineering, and nutritional supplementations might be used to mitigate or cure sexual dysfunction following radiation treatment.
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Affiliation(s)
- Javed Mahmood
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Aksinija A Shamah
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - T Michael Creed
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Radmila Pavlovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hotaka Matsui
- The James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaki Kimura
- Department of Urology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Jason Molitoris
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hem Shukla
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Isabel Jackson
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Zeljko Vujaskovic
- Division of Translational Radiation Sciences, Department of Radiation Oncology, School of Medicine, University of Maryland, Baltimore, Maryland
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