The triad of erectile dysfunction, hypogonadism and the metabolic syndrome

Abstract

There has traditionally been a widely held belief that testosterone is a risk factor for cardiovascular disease in men. This belief was based on the observation that men have both a higher incidence of cardiovascular events and higher testosterone levels than women of similar ages. However, few, if any, recent observations support a causal relation between higher testosterone levels and heart disease (1-3). On the contrary, several studies suggest that higher testosterone levels are associated with a more favourable risk effect on the risk of cardiovascular disease (4,5). Studies of testosterone therapy have not demonstrated an increased incidence of cardiovascular disease or events such as myocardial infarction, stroke or angina (6,7). Evidence that testosterone therapy may be beneficial for men with cardiac disease is becoming stronger (8,9). This paper will analyse the interrelationship between the metabolic syndrome, diabetes mellitus, cardiovascular disease, (visceral) obesity, erectile dysfunction (ED) and hypogonadism in (ageing) men. Until recently, they were viewed as more or less independent entities befalling the ageing male, if necessary, treated by various medical specialties. With a more integrative approach to the health situation of middle-aged and elderly men, these conditions appear closely interrelated in their manifestations, hypothetically in their aetiology, diagnostic strategy and also their treatment. This paper takes the position that (improving) sexual health is a portal to identify health hazards and improving men's health. Appropriate diagnosis and medical work up of men presenting with sexual symptoms may have the benefit of the diagnosing and treating other important conditions, such as obesity, diabetes, hypertension and hyperlipidaemia.OnlineOpen: This article is available free online at www.blackwell-synergy.com S U M M A R YAim: To identify the relationship of erectile dysfunction, hypogonadism and the metabolic syndrome in the context of men's health. Methods: An Expert Panel Meeting was held in December 2006 in Vienna, Austria. In addition a comprehensive literature search was conducted. Results: Men have a higher incidence of cardiovascular events than women of similar ages which has led to the belief that testosterone is a risk factor for cardiovascular disease in men. The latter hypothesis is no longer tenable. On the contrary, low testosterone levels are associated with (visceral) obesity, the metabolic syndrome, diabetes mellitus, cardiovascular disease and erectile dysfunction (ED). Testosterone therapy does not lead to an increased incidence of cardiovascular disease or events such as myocardial infarction, stroke or angina. Until recently (visceral) obesity, the metabolic syndrome, diabetes mellitus, cardiovascular disease and ED were viewed as more or less independent entities affecting the ageing male. It was not recognised that hypogonadism is a common denominator. With a more integrative approach to the health situation of middle-aged and elderly men, these conditi...

Androgens and male aging: current evidence of safety and efficacy

“…OSAS is associated with an increased risk of hypertension, arrhythmia, myocardial infarction, stroke, and sudden death. Sexual dysfunction associated with OSAS may also be explained by the metabolic syndrome [175,176]. Men with OSAS have lowered plasma testosterone levels [177] but this association was largely explained by adiposity in agreement with the finding that the metabolic syndrome is associated with reduced plasma testosterone values [178,175].…”

“…Sexual dysfunction associated with OSAS may also be explained by the metabolic syndrome [175,176]. Men with OSAS have lowered plasma testosterone levels [177] but this association was largely explained by adiposity in agreement with the finding that the metabolic syndrome is associated with reduced plasma testosterone values [178,175]. In a large meta-analysis of placebo-controlled trials of testosterone administration to (elderly) men [131], the frequency of sleep apnea was not significantly different between the two groups.…”

Relationship between insulin and hypogonadism in men with metabolic syndrome

“…Testosterone supplementation was able to reduce abdominal circumference and waist-hip ratio, and to improve insulin sensitivity and glycemic control in men with hypogonadism and type 2 diabetes mellitus (6,8,53,54). Testosterone replacement was also able to decrease the levels of pro-inflammatory cytokines (TNF-alpha, IL-1 and IL-6) produced by visceral adipocytes and associated with insulin resistance (27,55).…”

“…Alternatively, there are evidences that testosterone is an important regulator of insulin sensitivity in men; low concentrations of androgens are associated with several components of metabolic syndrome, including coronary artery disease, hypertension, dyslipidemia, a prothrombotic state and visceral obesity (5)(6)(7)(8)(9).…”

“…The diagnosis and treatment of hypogonadism in males are important issues, considering that testosterone deficit is related to sexual dysfunction, depressed humor, irritability, concentration disturbance, weakness, fatigue, decrease in well-being and quality of life, osteoporosis and changes in corporal composition (6)(7)(8)(9).…”