Antipsychotics Antipsychotic medications are also implicated in ED. These drugs exert their effects primarily by antagonism of dopamine receptors but have effects on several other receptors.

In addition, dopamine antagonism causes hyperprolactinemia which contributes to the sexual dysfunction associated with these drugs. Antiandrogens Antiandrogens are a well-known cause of sexual dysfunction and ED. In recent studies, finasteride has been shown to cause minimal ED at higher doses (5 mg) for prostate cancer prevention, and almost no effect on erectile function at low doses (1 mg) for the treatment of alopecia Illicit Substances and Nicotine Several illicit substances cause ED. In addition, men on methadone maintenance therapy for heroin dependence have been reported to have significant impairment of erectile function.

The use of tobacco products, and specifically nicotine, is associated with ED in both chronic and acute exposure. Nicotine produces vasoconstriction through its actions on endothelial cells through a likely underproduction and degradation of nitric oxide.

A recent study of healthy men between the ages of 18 and 27 reported that the use of nicotine gum immediately decreased erectile response to visual stimuli despite unchanged subjective measurements of sexual arousal. This study may imply an immediate neurogenic and hemodynamic response of the penile tissue to nicotine. Furthermore, chronic cigarette smoking is also associated with an independently increased risk of ED and clinically significant damage to penile vasculature

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