The authors of this large study sought to define the relationship between these three conditions and identify risk factors for ED among infertile men.
Men presenting for infertility evaluation prospectively completed Androgen Deficiency in the Aging Male (ADAM) and Sexual Health Inventory for Men (SHIM) questionnaires. Serum hormonal testing included total testosterone (T), estradiol (E), luteinizing hormone (LH), and follicle-stimulating (FSH) levels. Risk factors for ED, vascular co-morbidities, and use of medications associated with ED were recorded.
A total of 2,466 men (mean age 36 years, range 18-71) met criteria. Prevalence of various conditions was as follows: ED - 28.4%, low libido - 23.9%, hypoandrogenism (defined as T <10nMol/L) - 31.8%. While age and diabetes were risk factors for ED, T, LH, and FSH were not.
Although the study population was comprised of relatively young men, both ED and hypoandrogenism were prevalent. The diagnosis or subfertility or infertility is very stressful for individuals and couples, and it is likely that many infertile men with ED have an adrenaline-mediated etiology. Penile duplex Doppler testing, rather than the SHIM questionnaire, would be required to make this distinction.
The fact that ED was unrelated to hormone levels in men in this study may further suggest an adrenaline-mediated etiology. The association of ED with total testosterone is more related to libido than physiologic dysfunction, unless T is extremely low. However, it has been shown clinically that patients with low-to-middle range T levels who do not respond to PDE5 inhibitors become responders when T is restored. Further study is clearly warranted to evaluate predictors of ED in the infertile population.
Presented by R. Satkunasivam, B. Mullen, K. Lo, E. Grober, and K. Jarvi at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Doron S. Stember, MD
View Full AUA 2011 Meeting Coverage
