Intravenous peptides and amino acids for erectile dysfunction: a narrative review of current applications and future directions.

INTRODUCTION: Erectile dysfunction (ED) pathophysiology involves complex interactions between vasculogenic, hormonal, and neurological mechanisms, with endothelial dysfunction and oxidative stress playing crucial roles. There is growing interest in intravenous (IV) peptides and amino acids as potential therapeutic options for ED treatment. AREAS COVERED: This narrative review examines recent developments in peptide and amino acid therapies for ED, focusing on PT-141, PnPP-19, L-arginine, and L-citrulline. The literature search utilized PubMed to identify relevant English-language publications up to October 2024, emphasizing studies from the past decade. EXPERT OPINION: IV peptides and amino acids offer promising therapeutic options for ED through mechanisms of action distinct from PED5 inhibitors. PT-141 and PnPP-19 show efficacy through central nervous system activation and nitric oxide regulation, while L-arginine and L-citrulline enhance endothelial function. Although evidence suggests potential benefits, large-scale clinical trials are needed to establish safety profiles, optimal dosing regimens, and possible synergistic effects with existing ED treatments.