Obesity, low testosterone levels and erectile dysfunction

Abstract

Obesity is an important risk factor for many common diseases including cardiovascular disease (CVD), type 2 diabetes, cancer and erectile dysfunction (ED). Adipose tissues produce a number of adipokines and cytokines, which affect endothelial and metabolic function resulting in insulin resistance and the metabolic syndrome (risks factors for CVD). Both ED and metabolic syndrome improve with a reduction in body mass index (BMI). The relationships among obesity, metabolic syndrome, ED, sex hormonebinding globulin (SHBG) and serum total and free testosterone levels are complex and often confusing to the physician. It is known that BMI is inversely proportional to serum total testosterone concentrations; low serum SHBG levels in obesity contribute to the low serum total testosterone. Recent studies show that BMI is also inversely proportional to free testosterone concentration. The characteristic low serum testosterone concentrations observed in obese men are also present in men with the metabolic syndrome and type 2 diabetes mellitus. A small proportion of men with ED have hypogonadism; however, the proportion increases if these men are obese with manifestations of the metabolic syndrome or type 2 diabetes mellitus. ED is a common symptom in patients with type 2 diabetes who also have low testosterone levels. This review describes the relationships between low serum testosterone concentrations and ED in obese patients and those with metabolic syndrome and type 2 diabetes mellitus.

Prevalence and predictors for low total testosterone levels among male type 2 diabetic patients: an Egyptian experience

“…17,34,35 In contrast, other studies correlated lower HDL-c and higher triglyceride levels were significantly with LST in T2DMs. 9,36 In the present study, smoker ratio was significantly higher in MHG patient but regression analysis showed no significant correlation between smoking and MHG, The relation of smoking with testosterone was controversial, some studies had shown a positive association between smoking and total or FT levels, also smoking cessation decreased testosterone levels in men followed for idiopathic infertility, while some studies found no association.…”

Association between Erectile Dysfunction and Obesity

“…14 In another study, health professionals found that patients with a BMI >28.7 kg/m 2 had a 30% higher risk of ED compared to those with a BMI <23.2 kg/m 2 . 15 However, there is still disagreement in the literature on whether obesity behaves as an isolated risk factor for ED. A study coordinated by Feldman et al 16 did not demonstrate any correlation between obesity and ED in the general population, but these authors stated that obesity correlates with other comorbidities such as hypertension, dyslipidemia, thyroid disease and diabetes mellitus, which have direct correlations with ED.…”

Testosterone: a metabolic hormone in health and disease

“…In fact, testosterone deficiency has been reported in population studies to be associated with an increase in all-cause mortality, and this has been shown to be accounted for mainly by CVD (Khaw et al 2007, Vikan et al 2009, Araujo et al 2011. Moreover, accumulating evidence suggests that testosterone deficiency is an independent cardiovascular risk factor and many recent reviews have focussed on the link between hypogonadism, MetS, T2DM and CVD (Makhsida et al 2005, Shabsigh et al 2008, Corona et al 2009, Diaz-Arjonilla et al 2009, Jones & Saad 2009, Stanworth & Jones 2009, Traish et al 2009, Zitzmann 2009a, Grossmann et al 2010, Jones 2010a,b, Muraleedharan & Jones 2010, Moulana et al 2011, Wang et al 2011, Saad et al 2012, Salam et al 2012.…”