Several classes of medications and recreational drugs have been linked to the manifestation of ED (Table 5.3). This list is not meant to be inclusive of all medications that could cause ED. Drugs exhibit their adverse effects either through central inhibitory neuroendocrine mechanisms and/or local neu-rovascular actions, or they have an impact on the hormonal milieu (testosterone, prolactin). Psy-chotropic medications may exert their inhibitory effects through their effect on central neurotrans-mitter pathways (serotonergic, adrenergic or dopaminergic). Beta-adrenergic blockers may exhibit central inhibitory effects or allow predominance of peripheral a-mediated vasoconstrictive effects . Antiandrogens may suppress libido. Almost all recreational drugs have been reported to be associated with sexual dysfunctions, including Marijuana, opiates and cocaine [58,59]. In addition to the central nervous system (CNS) inhibitory effect, opiates have demonstrated an acute suppression of luteinizing hormone (LH) release from the pituitary gland, followed by a secondary drop in plasma testosterone levels .
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