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Sex Med. 2018 Dec;6(4):291-296. doi: 10.1016/j.esxm.2018.07.001. Epub 2018 Aug 24.

Oral L-citrulline and Transresveratrol Supplementation Improves Erectile Function in Men With Phosphodiesterase 5 Inhibitors: A Randomized, Double-Blind, Placebo-Controlled Crossover Pilot Study.

Author information

1
Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan.
2
Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.
3
Department of Urology, Osaka University, Graduate School of Medicine, Osaka, Japan.
4
Iwasa Clinic, Osaka, Japan.
5
Kageyama Clinic, Shizuoka, Japan.
6
Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan. Electronic address: atsujimu@juntendo.ac.jp.

Abstract

INTRODUCTION:

Phosphodiesterase type 5 inhibitors (PDE5i) are first-line therapy for most men with erectile dysfunction (ED). If ineffective, vacuum erection devices, intracavernous injections, and penile prosthesis implantation are suitable as second- or third-line therapies. However, very few patients select these therapies. It is critically important to improve erectile function with oral administration of effective agents. Administration of L-citrulline or transresveratrol in animal experiments has been reported to improve erectile function, but few such experiments have been performed on humans with ED.

AIM:

We aimed to investigate the efficacy of combination therapy of L-citrulline and transresveratrol in patients with ED despite their use of PDE5i.

METHODS:

In this randomized, double-blind, placebo-controlled crossover pilot study, men with ED (Sexual Health Inventory for Men [SHIM] score below 16) despite on-demand use of PDE5i received a placebo for 1 month or the active treatment (L-citrulline 800 mg/day and transresveratrol 300 mg/day) for another month. Patients continued on-demand use of PDE5i.

MAIN OUTCOME MEASURE:

The SHIM score, Erection Hardness Score (EHS), Aging Male Symptoms Scale-sexual domain (AMS-SD), and adverse events were examined.

RESULTS:

20 patients ages 29-78 years were enrolled, and after 6 men withdrew, 13 concluded the study without adverse events. Mean SHIM score for the active treatment increased significantly (10.96 ± 1.21) compared with baseline (8.32 ± 1.21) and placebo (8.31 ± 1.23) (both P < .05). Mean EHS score for the active treatment (2.56 ± 0.26) also increased from baseline (2.31 ± 0.26), but not significantly (P = .79). Mean AMS-SD score was not significantly different in either group.

CONCLUSION:

To our knowledge, this is the first study to show that combination therapy of L-citrulline and transresveratrol is effective for ED treatment in men with added on-demand use of PDE5i. This combination supplement may be added if PDE5i is insufficient. Shirai M, Hiramatsu I, Aoki Y, et al. Oral L-citrulline and Transresveratrol Supplementation Improves Erectile Function in Men With Phosphodiesterase 5 Inhibitors: A Randomized, Double-Blind, Placebo-Controlled Crossover Pilot Study. Sex Med 2018;6:291-296.

KEYWORDS:

Erectile Dysfunction; L-Citrulline; PDE5i; Transresveratrol

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