Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case‐control study

Abstract

BackgroundErectile dysfunction (ED) has common risk factors with many cardiovascular (CV) impairments. In view of these facts, hyperhomocysteinemia (HHcys) has been postulated for involvement in endothelial dysfunction.ObjectivesWe evaluated peripheral and penile homocysteine (Hcys) plasma levels before and after folic acid supplementation in idiopathic vasculogenic erectile dysfunction (ED) patients. Materials and methods: This study included 50 consecutive patients and 50 consecutive healthy controls that were recruited from December 2017 to December 2018. The patients received folic acid (FA) daily for 3 months and were evaluated by the abridged 5‐item International Index of Erectile Function (IIEF‐5) and penile duplex before and after therapy, in addition to plasma Hcys levels.ResultsOur study showed improvement in the severity of ED in our patients as all of them became mild to moderate ED after folic acid administration. Additionally, the median scores of IIEF‐5 significantly increased from 6 to 14, respectively (p < 0.001). Furthermore, the median peripheral and penile Hcys plasma levels (μmol/l) significantly decreased after folic acid administration as 39 patients with moderate ED and 11 patients with severe ED were 0.62, 0.34, 5.37, 0.37, respectively, became mild to moderate ED with their median peripheral and penile Hcys plasma levels became 0.19, 0.15, p < 0.001, <0.001, respectively. Peripheral Hcys level correlates significantly with penile Hcys before and after folic acid administration (r: −0.06 p: 0.8, r: 0.9, p < 0.001, respectively).Discussion and conclusionRecently, an emerging body of evidence suggests a role for Hcys and folate in erectile function. Interestingly, our interventional study is one of the first that evaluated the effect of folic acid supplementation on HHcys where it demonstrated a significant decrease in peripheral and penile Hcys plasma levels after folic acid administration. Thus, FA should be prescribed concomitantly with phosphodiesterase type 5 inhibitors in ED patients.

Low dose of isotretinoin: A comprehensive review

“…Dermcidin level was significantly low in the studied cohort of acne vulgaris patients and both isotretinoin regimens significantly raised dermcidin levels compared to pretreatment values. No significant difference in relapse rate over a 12-month follow-up period was noted among the two isotretinoin regimens (El Aziz Ragab, Omar, Collier, El-Wafa, & Gomaa, 2018).…”

“…Very recently, folic acid administration demonstrated a significant decrease in peripheral and penile homocysteine plasma levels in Egyptian patients with idiopathic vasculogenic erectile dysfunction (Elshahid et al, ). Deficiency in folate may pose a much greater risk for the development of peripheral neuropathy, particularly patients younger than 40 years (Taverner et al, ).…”

Novel predictive risk factor for Erectile Dysfunction: Serum folic acid

“…with no abnormalities in routine investigations except decreased FA levels. In various studies, age has not been significantly different between the groups and also did not correlate with FA levels (Elshahid et al, 2020;Karabakan et al, 2016;Sansone et al, 2017;Yang et al, 2014). Study by Attia et al (2019) demonstrated negative correlations between FA levels and age.…”

Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis

“…The changes of the IIEF-5 after the folic acid administration only were reported in two articles. 23 , 24 Fixed-effect model was used to calculate the SMD owing to the no significant heterogeneity (I 2 = 0.00%, P = .645). The SMD was 1.89 with the 95%CI (1.60, 2.17).…”