What is the current consensus regarding the pharmacological management of erectile dysfunction in patients with compromised penile hemodynamics? Specifically, how do agents such as phosphodiesterase type 5 inhibitors compare to alternative therapeutic approaches (e.g., intracavernosal injections, hormonal therapies) in terms of efficacy, safety profile, and patient compliance? Additionally, could the discussion address recent advances in combination therapies or emerging pharmacologic targets that might provide superior outcomes for individuals exhibiting suboptimal responses to first-line treatments?