Androgen Deficiency and Abnormal Penile Duplex Parameters in Obese Men with Erectile Dysfunction

Abstract

Introduction The clinical identification of metabolic syndrome is based on measures of abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and glucose intolerance. However, the impact of hypogonadism associated with obesity on penile hemodynamics is not well investigated. Aim In this retrospective study, we sought to evaluate the effect of obesity on serum total testosterone (TT) level and penile duplex parameters in men with erectile dysfunction (ED). Methods Our participants (N=158) were evaluated for erectile function using an abridged, five-item version of the International Index of Erectile Function-5. Determination of body mass index (BMI) was performed. Measurements of TT, fasting lipid profile, and blood sugar were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Main Outcome Measures Bivariate associations among BMI and serum testosterone, blood pressure, and lipid profile, as well as penile duplex parameters. We compared all clinical, laboratory, and penile duplex parameters between lean men (BMI<25) and overweight and obese men (BMI ≥ 25). Results The participants' age ranged between 20 and 56 years. A significant negative correlation between BMI and TT was detected (r =−0.431, P =0.0001). Hypogonadism was identified in 54/158 (34.2%) of men with ED. The incidence of hypogonadism varied from as low as 1/18 (5.6%) in lean men to as high as 18/36 (50%) to 21/35 (60%) in morbid and severe obesity, respectively. Vasculogenic ED was detected in 32/54 (59.3%) men with BMI ≥ 25, compared with 5/18 (27.8%) in lean men (P =0.029). In order to study the effect of obesity on erectile function, cases with other risk factors were excluded. Of 67 men suffering from ED with no other risk factor(s) apart from obesity, vasculogenic ED was detected in 32/54 (59.3%) men with BMI ≥ 25, compared with 3/13 (23.1%) in lean men (P =0.029). Conclusion Obesity is associated with lower TT and disturbances of penile hemodynamics. It is an independent clinical factor for vasculogenic ED.

Semen parameters and hormonal profile in obese fertile and infertile males

“…Several reports showed that the accumulation of fatty tissue in men was associated with decreased total, free T, and increased E 2 serum levels (17,18). Zohdy et al (19) reported significant negative correlation between BMI and serum total T. Zorn et al (20) demonstrated a link between leptin and testicular function, independent of FSH and LH, possibly involving T and SHBG through a regulation of Leydig cell function. Goncharov et al (21) concluded that there was a negative relationship between serum T and leptin in obese men.…”

The Emerging Link Between Hypogonadism and Metabolic Syndrome

“…In a recent study by Zhody et al (2007), the relationship between erectile dysfunction, androgen deficiency, and MS was solidified by another means: the measurement of BMI. With increasing BMI, the incidence of erectile dysfunction and hypogonadism increased in a strong positive correlation.…”

Obesity, low testosterone levels and erectile dysfunction

“…83 Obesity has also been related to lower testosterone and poor penile hemodynamics. 84 As anticipated, the metabolic syndrome and insulin resistance are associated with ED. 85,86 In the Massachusetts Male Aging Study, ED was predictive of the presence of the metabolic syndrome only in nonobese men.…”