Retrospective observational study finds hypogonadism prevalent in men with sexual dysfunction and related to a range of chronic illnesses
Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses. Guay A, Seftel AD, Traish A. Int J Impot Res 2010; 22(1):9-19 [Erratum in: Int J Impot Res 2010; 22(3):210].
This retrospective, observational study evaluated the prevalence of hypogonadism among men with sexual dysfunction, and examined its association with medical and psychological factors. The study involved 990 men (90% Caucasian) who attended an endocrinology specialist centre for sexual function as a new consultation between July 1995 and July 1997.1 To identify medical and psychological conditions, patients underwent a detailed clinical evaluation and their medical history was examined. A diagnosis of hypogonadism was made based on a total testosterone level of <300 ng/dL (<10.4 nmol/L) accompanied by three or more signs/symptoms of hypogonadism. Primary hypogonadism was identified when low testosterone levels were accompanied by normal levels of luteinizing hormone (≥9 IU/L). Associations between conditions (medical and psychological) and hypogonadism were examined using the Mantel−Haenszel2 test.
The mean age of the men was 57.4 years and all had sexual dysfunction. Overall, 359 men (36.3%) had hypogonadism, most of whom were diagnosed with secondary hypogonadism (301 men). The men in this study had a high prevalence of chronic medical and/or psychological conditions, including; diabetes mellitus (23.1%), hypertension (35.8%), atherosclerotic coronary artery disease (19.9%), work-related stress (27.5%) and anxiety/depression (21.0%), and 28.2% of men were on multiple medications.
What is known
Low testosterone levels, common in older men,2 are associated with a range of chronic illnesses including diabetes mellitus,3 vascular disease and the metabolic syndrome.4-7 To date, diabetes has been the most closely studied comorbid chronic illness, and 30−40% of men with diabetes are expected to have lower testosterone levels.3
Hypogonadism is also common in men with ED, with a prevalence of 36% according to the initial published results from this study.8 This high prevalence rate is reflected in other observational studies of men who attended healthcare centres.9,10 Guay and coworkers also identified a significant cardiovascular risk in these men with ED, a finding confirmed in subsequent studies.11-13
What this study adds
The results of this study confirm the association between hypogonadism and a range of chronic illnesses, and indicate that men with these conditions should have their testosterone levels checked, particularly when symptoms of sexual dysfunction are also present.
The prevalence of hypogonadism is widely accepted to increase with age, but in this study, the highest prevalence was in men aged 40−60 years of age, which may reflect referral bias and a high proportion of men reporting work-related stress. Indeed, there was a stronger association between hypogonadism and work-related stress than the more established association between hypogonadism and anxiety/depression. Perhaps surprisingly, the study identified a strong association between hypogonadism and sleep apnea.
Population studies have shown that lifestyle and health factors, in addition to age, have an impact on testosterone levels.14-16 The authors of this study hypothesize that chronic illness and stress may suppress the activity of the central hypothalamic−pituitary axis, leading to secondary hypogonadism. Further prospective studies are warranted to determine to what extent health-related lifestyle modifications may be able to correct low testosterone levels in these men.