Summary.In a survey of 541 diabetic males, aged 20-59 years, 190 (35%) had erectile impotence. Using linear logistic regression models for analysis the five most significant associations with impotence were age (p < 0.001), treatment with either insulin or oral hypoglycaemic agents (p < 0.001), retinopathy (p < 0.001), symptomatic peripheral neuropathy (p < 0.001) and symptomatic autonomic neuropathy (p < 0.005). The greatest correlations were found in patients with severe microangiopathy, as demonstrated by proliferative retinopathy and symptomatic autonomic neuropathy. In addition the duration of diabetes and the presence of ischaemic heart disease, nephropathy and poor diabetic control may also be associated with diabetic impotence. It is concluded that diabetic impotence is still a common problem and may have a multifactorial aetiology.Key words: Diabetic impotence, prevalence, aetiological factors.The increased frequency of impotence in the diabetic male has long been recognised [7]. Despite improvement in the treatment of diabetes since the early insulin era there has been no decrease in recent reports of the frequency of diabetic impotence [7,10,14]. Thus the prevalence of impotence with increasing age in diabetic men aged between 20-60 years is still approximately 18-71% [19] and considerably greater than 0.1-18.4% for the corresponding normal male population [13].There has been no previous extensive survey of the prevalence of diabetic impotence in the United Kingdom. The aim of the present study was therefore to ascertain the prevalence in males attending a large U. K. diabetic clinic. An assessment was also made of possible contributing factors involved in the aetiology of diabetic impotence. Materials and MethodsDuring a nine month period 563 males attending the Diabetic Out-Patient Department were interviewed. A total of 132 clinics were covered and at each clinic every male aged between 20-59 years was included. After three months an initial non-randomised group of 319 men (Group 1) had been interviewed. At this time it was decided to interview a random group of approximately 100 men to exclude the possibility of bias in the original group. The total clinic male population aged 20-59 years was 887 and from the remaining 568, a random sample of 101 men (Group 2) was drawn who were subsequently interviewed over a six month period. Over this latter period a second non-random group of 121 men (Group 3) who were attending the clinic and not included in the random sample were also interviewed.The total number of men included for study was thus 541, representing 61% of the male clinic population aged between 20-59 years. A further 22 who were unable to give satisfactory interviews were omitted: in the two non-random groups (Groups 1 and 3) 9 were mentally defective, 2 had cerebrovascular accidents with dysphasia and 2 were unable to speak English; in the random group (Group 2) 5 had recently left the area, 1 was hospitalised elsewhere, 2 were mentally defective and 1 had a cerebrovascular accident.A deta...

Male hypogonadism is characterized by abnormally low serum testosterone levels associated with typical symptoms, including mood disturbance, sexual dysfunction, decreased muscle mass and strength, and decreased bone mineral density. By restoring serum testosterone levels to the normal range using testosterone replacement therapy, many of these symptoms can be relieved. For many years, injectable testosterone esters or surgically implanted testosterone pellets have been the preferred treatment for male hypogonadism. Recently, newer treatment modalities have been introduced, including transdermal patches and gels. The development of a mucoadhesive sustained-release buccal tablet is the latest innovation, which will provide patients with an additional option. The availability of new treatment modalities has helped to renew interest in the management of male hypogonadism, highlighting the need to address a number of important but previously neglected questions in testosterone replacement therapy. These include the risks and benefits of treatment in different patient populations (e.g. the elderly) and the need for evidence-based diagnosis and treatment monitoring guidelines. While some recommendations have been developed in individual countries, up-to-date, internationally accepted evidence-based guidelines that take into account national differences in clinical practice and healthcare delivery would optimize patient care universally.

Erections in response to erotic films and fantasies were measured in eight hypogonadal men, with and without androgen replacement, and eight age-matched controls. Erections to films in the hypogonadal men did not differ from those of the controls and were not affected by androgen replacement. Erections to fantasy were significantly smaller and slower to develop in the hypogonadal men and did show significant improvement during androgen replacement. These preliminary results suggest that erections to certain types of stimuli are relatively independent of androgens, whereas the response to fantasy may be androgen dependent. The implications of these findings are discussed.

Background: Salivary testosterone (Sal-T) may be a useful surrogate of serum free testosterone. The study aims were to use a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay to determine whether Sal-T concentrations accurately reflect Sal-T concentrations in both sexes and to investigate practical aspects of sample collection. Methods: Saliva and serum samples were collected in 104 male and 91 female subjects. A more sensitive LC-MS/MS assay was developed to enable Sal-T quantitation in the low concentrations found in females. Saliva (200 mL) was extracted with 1 mL of methyl-tert-butyl ether following the addition of D5-testosterone. Quantitation was performed using a Waters TQ-S mass spectrometer. Results: The assay achieved a lower limit of quantification of 5 pmol/L, sufficiently sensitive to measure testosterone in female saliva. Sal-T showed a diurnal variation but samples taken at weekly and monthly intervals showed no significant differences. Sal-T was stable at ambient temperature for up to 5 days, after freeze-thawing and 3 years frozen storage. Reference intervals for Sal-T were 93-378 pmol/L in males and 5-46 pmol/L in females. Sal-T correlated significantly with serum calculated free-T in males (r ¼ 0.71, P < 0.001) and in females (r ¼ 0.39, P < 0.001). Conclusions: These results confirm that testosterone can be reliably and accurately measured by LC-MS/MS in both adult male and female saliva samples. These results lay the foundation for further exploration of the clinical application of Sal-T as a reliable alternative to serum testosterone in the diagnosis and management of androgen disorders and assessment of androgen status in clinical research.