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Male erectile dysfunction unresponsive to PDE5 inhibitors Alprostadil Direct peripheral vasodilation produces erections independent of CNS arousal, with over 80% response rate across all ED etiologies Hypoactive sexual desire disorder (clinical) PT-141 Only FDA-approved treatment targeting central desire pathways through MC4R activation in the hypothalamus Post-prostatectomy erectile dysfunction Alprostadil Neurogenic ED after prostatectomy responds well to direct smooth muscle relaxation via alprostadil when nerve-dependent mechanisms are impaired Psychogenic sexual dysfunction with desire component PT-141 Central mechanism addresses the brain-level desire deficit that characterizes psychogenic dysfunction better than peripheral vasodilators Combined desire and erectile dysfunction Alprostadil Alprostadil is the only FDA-approved option for men between these two