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Cabergoline for erectile dysfunction
erectile dysfunction

Cabergoline for erectile dysfunction

If you have been diagnosed with hyperprolactinemia, your doctor may have prescribed Cabergoline as one of the treatments available to you. Hyperprolactinemia is a condition that results in an abnormally high level of prolactin in the blood. Prolactin is a hormone that is responsible for milk production in women who are breastfeeding, and it also plays a role in male fertility. Cabergoline is a drug that helps to lower prolactin levels by blocking the effects of dopamine on the pituitary gland. In this blog post, we will discuss the benefits of Cabergoline and how it can help to improve your symptoms!

Introduction

Cabergoline is a synthetic dopamine agonist that has a long half-life and binds strongly to D2 receptors, making it useful in the treatment of Parkinson’s disease and hyperprolactinemia. Patients with Parkinson’s disease who took dopamine agonists such as apomorphine, Ropinirole, or Cabergoline had improved penile erection and libido.

During the study, Krueger discovered that Cabergoline altered prolactin plasma levels in healthy men and maybe a possible explanation for their reduced sexual interest and performance. De Rosa reported that Cabergoline normalized serum prolactin levels in hyperprolactinemic patients after six months of therapy and maintained gonadal function.

The purpose of this research was to see whether Cabergoline has a significant beneficial impact on sexual desire and functioning in individuals with psychogenic erectile dysfunction (ED), as well as patient and sexual partner quality of life.

Subjects and methods

erectile dysfunction

This study was conducted on 60 men who had ED for at least one year, with a mean age of 50 years (range 27-74).

Subjects

73 men with hyperprolactinemia were admitted to our department from 1996 to 2000, and 51 of them agreed to participate in this study after their informed consent was obtained. Serum PRL levels greater than 200 picograms per liter were required for macroprolactinomas, and serum PRL levels of 50 picograms per liter or more were necessary for macroprolactinomas with a pituitary tumor less than 1 cm in diameter. A macroprolactinoma is a tumor affecting the pituitary gland that causes hyperprolactinemia. A macroprolactinoma was found in 41 men, whereas 10 had highly elevated prolactin levels. The control group consisted of 51 males from among cashiers, students, and physicians who were statistically matched with the study population lived in the same region and did not have any known illness.

Study protocol

erectile function improved significantly,

Serum PRL levels were measured as the mean value of a 6-h profile by blood sampling every 30 min (0800–1400 h) at study entry. After 6, 12, 18, and 24 months of treatment, PRL levels were tested at 0800, 0815, and 0830 h; the average was calculated for statistical analysis. At baseline, all subjects underwent a general clinical examination including serum FSH, LH, and testosterone testing; all measurements were repeated in the patients only after 6 months following Cabergoline administration. At diagnosis, 10 macroprolactinomas were diagnosed with secondary hypothyroidism that was treated with L-thyroxin (50–100 μg by mouth daily) and three had hypercorticism that was treated with cortisone acetate (25–37.5 mg/d); none of the patients were receiving testosterone replacement. The adequacy of hormone replacement therapy was monitored by serum testosterone, IGF-I, and free thyroid hormones, as well as serum and urinary Na+ and K+ levels on a regular basis.

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Treatment protocol

Cabergoline was the first-choice treatment for all patients. Treatment was begun orally at a dose of 0.5 mg once weekly for the first week, twice weekly during the second week, and then 0.5 mg twice weekly in accordance with previous research. When hormone levels were >15 μg/liter, the dose was increased by 2.0 mg every 2 months until hormone levels reached 15 μg/liter or lower; thereafter, doses were adjusted according to PRL suppression.

Assessment of erectile dysfunction

validated psychological tests

We assessed erectile function using the Rigiscan by Dacomed (Minneapolis, MN). This gadget measures duration, frequency, and degree of rigidity and tumescence during sleep (nocturnal mode); it also provides the total number of qualified (>20%) erectile events and the average event rigidity at the tip and base of the penis for every session, which lasts three nights.

A rigidity activity unit (RAU) is a time-intensity measurement that represents the area under the rigidity curve during a qualifying event. The tumescence activity unit (TAU) is calculated by adding up all of the rigidity values throughout a particular event and dividing it by 2 multiplied by 100. The tumescence activity unit (TAU) measures the increase in tumescence above baseline, proportional to the percent rise in tumescence over baseline.

The ratio of the rise in blood pressure over time to the resting value is known as the systolic/diastolic ratio. The percentage change in blood pressure from one night to the next is termed diastolic fluctuation, and it measures how well a heat pump works. It’s calculated by adding together the tumescence value from one night and dividing by four multiplied by the baseline. RAU and TAU do not change with age, but both variables appear more constant on nights. According to the literature, one episode of rigidity lasting more than 70 percent of the night with a variation intumescence of 30 mm at the base and 20 mm at the tip was considered penis normal, with a frequency of three occurrences per night.

Assays

RIA was used to measure the following hormones in the serum: FSH, LH, and PRL. Testosterone levels were measured using Immulite solid-phase chemiluminescent enzyme immunoassay commercial kits. RIA commercial kits were utilized to assess serum PRL levels. The intra- and interassay CVs were 5% and 7%, respectively. In our laboratory, the normal ranges for FSH and LH are 3–8 IU/liter, with a limit of 3–9 μg/liter for testosterone, and 5–15 μg/liter for PRL.

Statistical analysis

The mean and standard deviation (SD) were used to describe the data. The analysis was completed with the SPSS Inc. (Cary, NC) program using ANOVA. Statistic significance was established at 5%. Spearman’s coefficient was calculated for correlations. When appropriate, the χ2 test was utilized instead of a χ2 test.

Results

subjectively satisfactory sexual intercourse

All patients were evaluated for the presence of a pituitary adenoma and/or hypothalamic dysfunction. Of the four patients, three had microadenomas without any evidence of tumor growth.

10 male patients with invasive giant prolactinoma were diagnosed over a period of 1 year; at diagnosis, the average age was 37.4±4 years (range, 25-59 years). Four of these ten persons had visual field defects and headaches, while three others just suffered from headaches. One guy (No. 10) had nasal blockage and bleeding as a result of a tumor growing downward to the intrasellar region. The remaining two people had no signs or symptoms; their tumors were discovered by accident during a routine head MRI or CT scan. Seven patients had low testosterone levels (less than 2.8 ng/mL), and one (No. 2) was diagnosed with panhypopituitarism. Mean serum prolactin level before therapy was 11,426 ng/mL (range, 1,450-33,200 µg/mL), whereas mean maximal tumor diameter was 51 mm (range, 40-77 mm).

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In six patients, 0.5-1 mg Cabergoline per week was given for the entire treatment duration. The dosage of Cabergoline was increased to 2 mg per week in two patients (Nos. 7 and 10) and to 3 mg per week in one patient (No. 6). Cabergoline was well tolerated by all subjects. None of the patients had their doses reduced or discontinued due to adverse effects.

Nocturnal penile tumescence at study entry

marital and sexual health. sexual intercourse

The researchers noted that testosterone levels were severely reduced in patients with either micro- or macroprolactinoma and that erectile function was severely disrupted. Testosterone insufficiency was documented in 30 of the macroprolactinomas (73.2%) and five of the microprolactinomas (50%; P = 0.3). Prolactinomas were found to cause a variety of symptoms, including decreased sexual desire and potency (53.6%), five microprolactinomas (50%), and no controls. However, NPT was reduced in the patients compared to controls, with less than three erectile events per night being reported in 49 patients (96.7%) and seven controls (13.7%; P < 0.0001), as well as prolactin abnormalities in all macroprolactinomas and eight of ten microprolactinomas. All seven controls were older than 50 years (57–70 years). In patients, the number of qualified erectile events per night during NPT was correlated with PRL levels (r = −0.5; P = 0.0002) but not with age (r = 0.00052; P = 0.98) or testosterone levels (r = 0.23; P = 0.09), whereas in controls, it was linked to age (r = -0.77; P < 0.0001), PRL levels (r2 = -0.3; P = 0 .02), and testosterone levels (r2  = r3  = nd). PRL levels were also associated with testosterone levels in the patients (r = -0.43; P = 0.0015) and somewhat so in controls (r = -0.29; P = 0.04), as predicted.

Conclusion

The most significant finding of this long-term open study aimed at detecting and reversing erectile dysfunction in men with hyperprolactinemia is that there is a significant difference between the subjective experience of sexual failure and objective evidence by measuring nocturnal penile tumescence. According to our data, approximately 50% of patients presenting for hyperprolactinemia complained of sexual problems, whereas 96.7% had an impairment of erectile events per night compared with 13.7% of controls. To sum up, we observed that testosterone levels and NPT events decreased with age; in fact, our patients above the age of 50 years had testosterone levels and NPT events that were similar to those seen in healthy controls with a lower median number of occurrences per night. In reality, aging is a significant factor in sexual dysfunction. In elderly males, the communication between electrical signals guiding irregular LH secretion and those regulating sleep-associated penile tumescence is disrupted. Furthermore, age and erectile dysfunction duration were found to be the most significant variables influencing outcomes following an intracavernous injection test, with NPT evaluation, possibly owing to venous insufficiency. It’s also worth noting that patients under 50 years old who achieved normal PRL levels did not completely restore testosterone production and NPT in their age-matched controls. Several studies have shown that achieving normal testosterone levels is important for restoring sexual activity. In fact, androgen therapy to boost testosterone levels has been found to result in increased sexual interest and activity as well as spontaneous erections. It’s probable that 6 months of PRL normalization isn’t long enough to fully restore testosterone secretion, thus sexual function.

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According to certain writers, severe erectile dysfunction might be considered as a sign of hyperprolactinemia even if only a few cases were researched. Healthy men have erectile activity during the rapid eye movement (REM) phase of sleep, with the number and duration of those erectile episodes relating to patient age. In 1970, Karacan proposed that monitoring NPT might help distinguish between organic and psychogenic erectile difficulties. In fact, mental factors that might prevent a sexual erection are inactive during sleep, whereas clearly neurological and/or vascular elements are present throughout sleep, preventing nocturnal erections. Based on this reasoning, hyperprolactinemia can justifiably be regarded as an organic cause of decreased response to the NPT test. Because the NPT test is capable of identifying hyperprolactinemia in males in up to 96.7% of cases, it may be used as an additional diagnostic tool.

In addition to the obvious PRL-inhibiting effect, Cabergoline, like other dopamine agonists, may also improve erectile function directly at a central level. This central action has been more clearly demonstrated by apomorphine in the treatment of erectile dysfunction. It is still uncertain whether dopamine plays a role in male sexual motivation and genital arousal control, however, experimental data in male rats suggest that it does. Dopamine released at the nucleus accumbens (innervated by the mesolimbic dopaminergic pathway) and the medial hypothalamic preoptic area (innervated by the dopaminergic incertohypothalamic pathway) regulate the anticipatory/motivational phase of copulatory behavior, but dopamine released at the median hypothalamic preoptic area has been shown to have a permissive role.

Finally, 50% of the individuals visiting our hyperprolactinemic observation complained of sexual issues, whereas 96.7 percent of them had a decline in erectile performance per night compared with 13.7% of controls, according to the results. Cabergoline six-month therapy was successful not only in generating a fast normalization of serum PRL levels but also in restoring and maintaining gonadal function in hyperprolactinemic males. Treatment should be seen as a first choice in hyperprolactinemic hypogonadism, bringing about normalization of gonadotropin pulsatile secretion and, as a result, testosterone levels in most cases. Treatment allows for the restoration and maintenance of male patients’ ability to engage in sexual activity.

Frequently Asked Questions

Does Cabergoline help erectile dysfunction?

There is evidence that cabergoline helps improve erectile function directly at a central level. In addition, it is likely that cabergoline helps restore sexual activity by normalizing serum PRL levels.

What should I do if I have erectile dysfunction and hyperprolactinemia?

If you have both erectile dysfunction and hyperprolactinemia, you should speak to your doctor about treatment options. Treatment should be seen as a first choice in hyperprolactinemic hypogonadism, bringing about the normalization of gonadotropin pulsatile secretion and, as a result, testosterone levels.

What is the mechanism of action for Cabergoline?

Cabergoline has been shown to cause significant suppression of the hormone prolactin. This is thought to be due to its ability to act as a dopamine D₂ receptor agonist in lactotrophs, reducing prolactin secretion from these cells.

What does Cabergoline do for the brain?

Cabergoline acts on the brains of those who take it by increasing levels of dopamine in their brain. Cabergoline is used to treat women who have high levels of prolactin because of a pituitary tumor (prolactinoma).

Does dopamine play a role in male sexual motivation and genital arousal control?

Experimental data in male rats suggest that dopamine does play a role in male sexual motivation and genital arousal control.

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Malik

Malik

Gynecologist, Reproductologist
Specialist in Actual Problems of Gynecological Endocrinology

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