madman
Super Moderator
* L-citrulline supplementation is increasingly used as an adjunct to penile rehabilitation and for ED; however, substantial heterogeneity in the literature limits consensus regarding its primary benefit, optimal formulation, and target population.
Introduction
Erectile dysfunction (ED) is common, and interest in adjunctive non-pharmacologic therapies continues to grow. L-citrulline is increasingly used both over-the-counter and within post-prostatectomy penile rehabilitation programs due to its role as a precursor to L-arginine and nitric oxide production; however, evidence supporting L-citrulline for ED remains heterogeneous, with substantial variability in study design, dosing, formulations, and outcome measures, underscoring the need for a systematic review.
Methods
A systematic review of the literature (PubMed, EMBASE, LILACS, Web of Science, Cochrane) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating L-citrulline for erectile function were included. Secondary outcomes included fertility and libido.
Results
A total of 462 articles were screened, with 32 studies included. These comprised 16 human clinical studies, 13 preclinical in vivo animal studies, and three in vitro experimental studies. Eleven studies evaluated L-citrulline monotherapy, while the remainder assessed L-citrulline in combination with nutraceutical formulations or as part of penile rehabilitation regimens. Outcomes were heterogeneous and included biochemical parameters (n=12), validated questionnaires (n=9), semen parameters (n=5), intracavernosal pressure/mean arterial pressure ratios (n=4), subjective erectile function (n=1), erections per night (n=1), and penile length or girth (n=1). Overall, 24 studies reported significant improvement in at least one outcome with L-citrulline use.
Conclusions
L-citrulline supplementation is increasingly used as an adjunct to penile rehabilitation and for ED; however, substantial heterogeneity in the literature limits consensus regarding its primary benefit, optimal formulation, and target population. Well-designed studies with standardized dosing and validated outcome measures are needed to clarify the clinical role of L-citrulline in ED.
Introduction
Erectile dysfunction (ED) is common, and interest in adjunctive non-pharmacologic therapies continues to grow. L-citrulline is increasingly used both over-the-counter and within post-prostatectomy penile rehabilitation programs due to its role as a precursor to L-arginine and nitric oxide production; however, evidence supporting L-citrulline for ED remains heterogeneous, with substantial variability in study design, dosing, formulations, and outcome measures, underscoring the need for a systematic review.
Methods
A systematic review of the literature (PubMed, EMBASE, LILACS, Web of Science, Cochrane) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating L-citrulline for erectile function were included. Secondary outcomes included fertility and libido.
Results
A total of 462 articles were screened, with 32 studies included. These comprised 16 human clinical studies, 13 preclinical in vivo animal studies, and three in vitro experimental studies. Eleven studies evaluated L-citrulline monotherapy, while the remainder assessed L-citrulline in combination with nutraceutical formulations or as part of penile rehabilitation regimens. Outcomes were heterogeneous and included biochemical parameters (n=12), validated questionnaires (n=9), semen parameters (n=5), intracavernosal pressure/mean arterial pressure ratios (n=4), subjective erectile function (n=1), erections per night (n=1), and penile length or girth (n=1). Overall, 24 studies reported significant improvement in at least one outcome with L-citrulline use.
Conclusions
L-citrulline supplementation is increasingly used as an adjunct to penile rehabilitation and for ED; however, substantial heterogeneity in the literature limits consensus regarding its primary benefit, optimal formulation, and target population. Well-designed studies with standardized dosing and validated outcome measures are needed to clarify the clinical role of L-citrulline in ED.
