Global Andrology Forum Position Statements on Regenerative Therapies for Erectile Dysfunction

Phosphodiesterase type 5 inhibitors (PDE5i) are widely used to treat erectile dysfunction (ED). However, a subset of men does not respond to these agents or seek restoration of natural erections. Regenerative therapies (RT), including low-intensity shock wave therapy (LiSWT), platelet-rich plasma (PRP) therapy, and stem cell therapy (SCT), have emerged as potential alternative treatment options. This article reviews the available evidence and presents the Global Andrology Forum (GAF) graded statements and recommendations for the use of RT in ED.

A GAF expert panel conducted a literature review of the PubMed and Scopus databases up to February 2025 to identify studies on RT for ED. Surveys and a modified Delphi consensus method were employed to develop position statements and clinical recommendations. These were graded according to the "GRADE" classification system as either "strong" or "weak." Recommendations receiving strong ratings from at least 80% of experts were classified as "strong," while others were classified as "weak."

Seventeen statements and recommendations were accepted and graded by a panel of 36 GAF experts from 18 countries. Eleven were classified as "strong," and six as "weak."

Current evidence indicates modest short-term benefits of LiSWT in young and middle-aged men with mild-to-moderate vasculogenic ED. The efficacy of PRP and SCT remains uncertain. The GAF statements and recommendations highlight the lack of standardized treatment protocols and insufficient evidence of long-term effectiveness and emphasize the need for further research and clinical trials. Meanwhile, patients and healthcare providers should remain cautious when applying RT for ED. Clinicians should avoid overclaiming the benefits of RT to patients and provide a realistic prognosis based on current evidence.