• AACE Male Sexual Dysfunction Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update. Endocr Pract 2003 Jan-Feb;9(1):77-95. [26 references]

This is the current release of the guideline.

This guideline updates a previous version: American Association of Clinical Endocrinologists (AACE), American College of Endocrinology. AACE clinical practice guidelines for the evaluation and treatment of male sexual dysfunction. Endocr Pract 1998 Jul-Aug;4(4):219-35.

System of Care for Male Sexual Dysfunction

Step 1: Accurate history (preferably with the couple)

1. Make sure concerns are not just aging-related changes
2. Inquire about relationship problems
3. Question about performance anxiety

   Action: Reassure if A
   Send to sex therapist if B or C
   Do nocturnal penile test if uncertain.

4. Outline medical risk factors and medications

   Action: Change or discontinue medications
   Stop any substance abuse

Step 2: General examination

1. Blood pressure
2. Breasts for gynecomastia
3. Secondary sex characteristics
4. Peripheral circulation
5. Genital examination
   Especially for penile fibrosis, testicular atrophy, bulbocavernosal reflex
6. Rectal examination
   Especially assess prostate

   Action: Follow-up on abnormal findings--that is, cardiovascular findings, suspected endocrine diseases, or abnormal prostate

Step 3: Laboratory tests

1. Plasma glucose
2. Prolactin
3. Free testosterone
4. Luteinizing hormone and follicle-stimulating hormone if testicular atrophy suspected
5. Thyroid-stimulating hormone or free thyroxine (or both) if hypothyroidism is suspected
6. Other tests, depending on history and physical examination

Step 4: Treatments

1. Related to risk factors

   Action: Diagnose diabetes
   Stop any substance abuse
   Change medications
   Treat abnormal hormones (testosterone or prolactin)
   A 3-month testosterone trial, if indicated
   Nocturnal penile tumescence and rigidity testing if risk factors changed and nonresponse may be due to psychologic factors

2. If good erections but early detumescence--venous constriction rings
3. Nonspecific treatments:
   Trial sildenafil
   Trial yohimbine
   Other orally administered drugs, phentolamine, apomorphine (when approved)
   Apomorphine (sublingually)
   Vacuum pump
   Medicated urethral system for erection (intraurethral prostaglandin pellet)
   Penile injections
   • Papaverine and phentolamine
   • Papaverine, phentolamine, alprostadil
   • Alprostadil alone

   Penile implants (as last resort)

4. Surgical referrals (urologist)
   Severe Peyronie's disease
   Penile injections (if not done by endocrinologist)
   Penile implant
   Selected cases of arterial damage or venous ligation

An algorithm for office evaluation of erectile dysfunction is provided in the original guideline document.

The type of supporting evidence is not specifically stated for each recommendation.

• AACE Male Sexual Dysfunction Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update. Endocr Pract 2003 Jan-Feb;9(1):77-95. [26 references]

Not applicable: The guideline was not adapted from another source.

1998 (revised 2003)

American Association of Clinical Endocrinologists - Medical Specialty Society
American College of Endocrinology - Medical Specialty Society

American Association of Clinical Endocrinologists (AACE)

American Association of Clinical Endocrinologists (AACE) Male Sexual Dysfunction Task Force

Taskforce Members: Andre T. Guay, MD, FACE (Co-Chairman); Richard F. Spark, MD, FACE (Co-Chairman); Sudhir Bansal, MD, FACE; Glenn R. Cunningham, MD; Neil F. Goodman, MD, FACE; Howard R. Nankin, MD, FACE; Steven M. Petak, MD, FACE, Jesus B. Perez, MD, FACE

Not stated

This is the current release of the guideline.

This guideline updates a previous version: American Association of Clinical Endocrinologists (AACE), American College of Endocrinology. AACE clinical practice guidelines for the evaluation and treatment of male sexual dysfunction. Endocr Pract 1998 Jul-Aug;4(4):219-35.

None available

This summary was completed by ECRI on October 1, 1998. The information was verified by the guideline developer on December 15, 1998. This summary was updated by ECRI on June 25, 2003. The updated information was verified by the guideline developer on July 21, 2003. This summary was updated by ECRI on July 15, 2005 following the FDA advisory on Cialis, Levitra, and Viagra. This summary was updated by ECRI Institute on November 6, 2007, following the updated U.S. Food and Drug Administration advisory on Viagra, Cialis, Levitra, and Revatio.

All rights reserved. No part of these materials may be reproduced or retransmitted in any manner without the prior written permission of American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE).