[Hormonal etiology in erectile dysfunction]

The proper function of erection mechanisms depend on correct interrelationship between psychological, vascular, neurological and hormonal factors. Endocrine diseases affect sexual function, and sexual dysfunction may be one of the symptoms of some hormonal anomalies. Diabetes mellitus is the endocrine disease most frequently causing erectile dysfunction due to the frequent vascular and neurological complications associated. It is important to determine blood glucose in the initial evaluation of a male with erectile dysfunction, as well as to try an adequate control of blood glucose levels to avoid worsening. Diabetic male erectile dysfunction is multifactorial, more severe and has worse response to oral treatment. Hyperprolactinemia causes disorders of the sexual sphere because it produces a descent of testosterone. In these cases, sexual symptoms are treated by correcting the levels of prolactin. Routine determination of prolactin is not clear and it seems it should be determined when testosterone levels are diminished. Thyroid hormone disorders (both hyper and hypotyroidism) are associated with erectile dysfunction, which will subside in half the patients with thyroid hormone normalization. The role of adrenal hormones in erectile function is not clear and their routine determination is not considered in the diagnostic evaluation of erectile dysfunction. The role of estradiol in the regulation of the erection mechanism is not well known either, although it is known that high levels may cause erectile dysfunction. Among endocrine-metabolic disorders we point out dyslipemias, with hypercholesterolemia as an important risk factor for erectile dysfunction and, though its correction may prevent vascular system deterioration, the role of statins in erectile dysfunction is not clear.