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Clinical Application Comparison# When Alprostadil Is the Clear Choice# Organic ED with identified vascular or neurogenic cause alprostadil's mechanical mechanism works regardless of etiology PDE5 inhibitor failure alprostadil is the established second-line therapy Post-prostatectomy ED nerve-independent mechanism is particularly valuable when cavernosal nerves have been damaged Diabetes-related ED high efficacy in diabetic ED where vascular and neurological pathology coexist Need for reliable, predictable erection alprostadil's direct mechanism produces erection more reliably than any centrally-acting agent When PT-141 May Be Relevant# Hypoactive sexual desire disorder PT-141's approved indication, targeting the desire deficit rather than erectile mechanics Psychogenic sexual dysfunction central mechanism may address brain-level arousal and desire issues Patients who decline penile injection subcutaneous autoinjection is less invasive than intracavernosal injection Combined desire and arousal dysfunction PT-141 may complement (not replace) peripheral ED treatments by addressing the desire component Can They Be Combined?# Combining alprostadil and PT-141 is theoretically logical since they act at completely different levels peripheral mechanics (alprostadil) and central desire (PT-141)