Antiandrogens in the treatment of priapism

Recurrent priapism in young men is a potentially devastating condition that may result in irreversible penile fibrosis. Hormonal manipulation using estrogens and gonadotropin-releasing hormone analogues has been successful in treating episodes of priapism refractory to other treatment forms, but it is associated with significant adverse effects, in particular the loss of libido and erectile function. We present 2 patients with sickle-cell disease and 1 patient with a spinal cord injury who had recurrent and refractory priapism. All 3 patients were successfully treated with low-dose antiandrogens without major side effects. Our observations suggest a role for antiandrogens in the treatment of men with refractory priapism that should be evaluated in the setting of a controlled study.