Erectile dysfunction as a marker of endocrine and glycemic disorders

Abstract

Purpose The aim of this study was to evaluate in a population of patients with erectile dysfunction (ED): (a) the prevalence of a previously unknown endocrine/glycemic disorders; (b) the correlation between ED severity and endocrine/glycemic disorders. Methods 1332 patients referred for ED from 2013 to 2020 were included. The ED diagnosis was made using the International-Erectile-Function-Index-5 questionnaire. ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency. All patients were subjected to search for sociodemographic and clinical characteristics: age, ethnicity, marital status, previous use of PDE5i, previous prostatectomy, diabetes mellitus (DM), prediabetes, endocrine dysfunctions. Results The mean ± SD age was 54.3 ± 13.7 years. The 19.1% (255/1332) of patients were already in treatment for prediabetes/diabetes or endocrine dysfunctions. Among the remaining 1077, the prevalence of previously unknown endocrine and glycemic disorders was 30% (323/1077). Among them, 190/323 subjects (58.8%) were affected by hypogonadism, with high estradiol level observed in 8/190 (4.2%). The prevalence of new glycemic alterations was 17.3% (56/323) [specifically, 32/56 (57.1%) DM, and 24/56 (42.9%) prediabetes]. A thyroid dysfunction was observed in 40/323 subjects (12.3%) and hyperprolactinemia in 37/323 (11.5%). Patients with new diagnosis of DM showed more severe form of ED compared to the total group {difficulty in the achievement of erection: 46/56 [82.2%, vs 265/1332 (19.9%), p < 0.05]; absence of spontaneous erection 23/56 [41.1%, vs 321/1332 (24.1%), p < 0.05]}. Conclusion ED is an early marker of endocrine/glycemic disorder, and a previously unknown dysfunction was found in more than a quarter of patients. A newly diagnosed DM is associated with ED severity, especially in elderly man and in presence of hypertension.

The Role of Antihyperglycemic Drugs and Diet on Erectile Function: Results from a Perspective Study on a Population with Prediabetes and Diabetes

“…In this regard, current evidence shows that central obesity is particularly associated with arteriogenic ED [ 33 ]. Furthermore, endothelial dysfunction is a common link between ED and hypertension (de Oliveira 2021), and the ED severity in DM patients seems to be related to age and hypertension [ 34 ].…”

Erectile Dysfunction Severity: The Role of Glycometabolic Compensation and Antihyperglycemic Drugs

“…For the evaluation of severity of ED, according to a previous study [ 11 ], the following parameters were considered: (a) achievement or maintenance of erections (yes/no; this parameter is also evaluated by questions n.2 and n.3 of the IIEF-5 [ 12 ]); (b) presence or absence of spontaneous erections (that means an increase in blood flow in the corpora cavernosa and a contraction of the ischiocavernosus and bulbospongiosus muscles [ 13 ]); (c) response to PDE5-i drugs (good, poor or absent).…”

Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update

“…Among organic diseases, the most important endocrine cause is a condition of hypogonadism; in fact, testosterone is the main driver of sexual desire. Hyperprolactinemia also causes a decrease in sexual desire and, therefore, in sexual performance; finally, hypothyroidism can cause a decrease in desire, probably due to hyperprolactinemia resulting from hypothyroidism [ 5 ]. Among psychiatric causes, certainly depression, which is characterized by an inability to “feel pleasure” and a mood oriented towards sadness, represent a cause of ED [ 6 ]; other chronic systemic diseases can lead to a deterioration in the QoL and therefore a decreased desire for sex.…”