Hormones, Age, and Erectile Dysfunction: Should Routine Testing Be Part of the Initial Evaluation?

Area of Science:

• Endocrinology
• Urology
• Andrology

Background:

• Erectile dysfunction (ED) is a common condition influenced by aging and hormonal factors.
• Understanding the interplay between age, ED severity, and hormone levels is crucial for effective management.

Purpose of the Study:

• To investigate the relationship between patient age, erectile dysfunction severity, and key hormone levels.
• To identify hormones significantly associated with erectile dysfunction for potential routine screening.

Main Methods:

• A multicenter cross-sectional study involving 411 patients.
• Assessment of age, erectile dysfunction severity (IIEF-15), and serum levels of total testosterone (TT), free testosterone (FT), FSH, LH, estradiol, prolactin (PRL), and SHBG.
• Multivariate linear regression analysis to determine significant associations.

Main Results:

• ED severity significantly correlates with increasing age.
• Both total testosterone and free testosterone levels show a positive correlation with erectile function and decrease with ED severity.
• Free testosterone levels were below the normal threshold in all ED patient groups, while total testosterone remained above the minimum threshold.
• FSH, LH, and SHBG levels increased with ED severity, but only age, TT, and FT were significant predictors of IIEF scores in regression analysis.

Conclusions:

• Age is a significant factor in ED severity and influences levels of TT, FT, LH, FSH, and SHBG.
• Total and free testosterone are significantly associated with ED severity, with FT being a critical indicator.
• Routine assessment of free testosterone alongside total testosterone is recommended for ED evaluation, while LH, estradiol, SHBG, and prolactin are not considered routine investigations for ED.