High estradiol level is associated with erectile dysfunction: A systematic review and meta‐analysis

Abstract

Numerous studies conducted to study the role of testosterone in erectile dysfunction (ED) extensively, but less is known of the association between estradiol level and ED. To assess the strong association between estradiol and ED by quantitatively synthesizing all studies evaluating the relationship between estradiol and ED. An extensive literature search was conducted by two authors independently in three electronic databases, including PubMed, Web of Science and Cochrane Library, up to January 10, 2021. The Patient Population or Problem, Intervention, Comparison, Outcomes and Setting (PICOS) were used for inclusion criteria to identify studies. The Newcastle‐Ottawa Scale was applied to assess the quality of studies. The standardized mean difference (SMD) and their corresponding 95% confidence intervals (95% CIs) were used to compare the estradiol level between ED patients and healthy subjects, and the pooled OR and 95%CI were used to evaluate the strong association between estradiol level and ED. Finally, six studies were included in this meta‐analysis, satisfying predefined inclusion criteria. Five studies were considered to be high quality, and only one was judged of moderate quality. The estradiol level of ED patients was statistically higher than that in healthy subjects (SMD 0.45, 95%CI 0.28–0.63, p <0.0001). The pooled OR demonstrated that the estradiol was correlated to the ED significantly (OR 1.08, 95%CI 1.05–1.12, p <0.0001). Subgroup analyses were conducted based on age, diagnosis way, country, sample size, detection method and estradiol level. There was no substantial change in the result of SMD ranging from 0.41 (95% CI 0.31–0.51) to 0.53 (95% CI 0.44–0.62) when performing sensitivity analysis. No publication bias was detected by the Begg test or Egger test. This meta‐analysis demonstrated that the estradiol level is correlated to ED significantly.

The Indicative Effects of Apolipoproteins on organic Erectile Dysfunction Diagnosed by the Nocturnal Penile Tumescence and Rigidity Test

“…Our research revealed that patients with organic ED had considerably lower estrogen levels. Estrogens play an unidenti ed role in male sexual function, and studies reporting the impact of estrogens on erectile function have been inconsistent (35)(36)(37). The results of our study were signi cantly different from those of previous studies.…”

Association between Sex Hormones and Erectile Dysfunction in Men without Hypogonadism

“…In the present study, serum estradiol levels exhibited signi cant association with ED. This result is consistent with that of a previous metaanalysis, including 1,249 patients with ED and 1,270 healthy individuals 9 . However, the biological mechanisms that link ED with estradiol remain unclear.…”

“…Although its antagonistic effect on testosterone through the sympathetic and parasympathetic nervous systems is thought to be one of the mechanisms 27 , testosterone had no effect on ED in the present study. Since estradiol receptors are abundantly expressed in penile tissues 28 , estradiol has been reported to directly impact the erectile function, alongside its effects mediated by testosterone, including an increase in venous vascular permeability via vascular endothelial growth factor, impairment of the corpus cavernosum relaxation, and changes in the structure of the corpus cavernosum 9,29,30 . Although these mechanisms might support our results, drawing a de nitive conclusion is di cult owing to several limitations of the present study.…”

“…The Massachusetts Male Aging Study (MMAS) had revealed that out of 17 investigated hormones only DHEA-S exhibited signi cant correlation with ED 8 . Additionally, estradiol and prolactin have been reported to affect erectile function 9,10 . However, several con icting results have prevented us from reaching de nitive conclusions 11 .…”

Association between sex hormones and erectile dysfunction in men without hypoandrogenism

“…The Massachusetts Male Aging Study (MMAS) had revealed that out of 17 investigated hormones only DHEA-S exhibited significant correlation with ED 8 . Additionally, estradiol and prolactin have been reported to affect erectile function 9 , 10 . However, several conflicting results have prevented us from reaching definitive conclusions 11 .…”