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Endocrine screening for sexual dysfunction using free testosterone determinations
F E Govier1, R D McClure, D Kramer-Levien
1Virginia Mason Medical Center, Seattle, Washington, USA.
The Journal of Urology
|August 1, 1996
Summary
Routine endocrine screening is essential for men with sexual dysfunction. Measuring free testosterone levels can reduce unnecessary tests by 50%, aiding in hypogonadism diagnosis.
Area of Science:
- Endocrinology
- Urology
- Sexual Medicine
Background:
- The necessity of routine endocrine screening in impotent men is debated.
- Optimal hormonal studies, including the role of free testosterone, are unclear.
- Predictive value of decreased libido or testicular atrophy for endocrinopathies is uncertain.
Purpose of the Study:
- To evaluate the necessity of routine endocrine screening in men with sexual dysfunction.
- To determine the most effective hormonal tests for diagnosing endocrinopathies.
- To assess the utility of free testosterone measurements and clinical signs in predicting hypogonadism.
Main Methods:
- Retrospective review of 508 men with sexual dysfunction over 22 months.
- Analysis of available testosterone and prolactin data for a subset of patients.
- Definition of hypogonadism based on two abnormal total testosterone levels.
Main Results:
- Hypogonadism was diagnosed in 15.6% of patients with available testosterone data.
- Decreased libido or testicular atrophy did not reliably predict hypogonadism.
- Normal free testosterone levels averted further evaluation in 50% of hypogonadal men.
- Hypoprolactinemia was found in 1.8% of patients.
Conclusions:
- Routine endocrine screening is necessary for evaluating sexual dysfunction.
- Clinical signs like decreased libido or testicular atrophy are poor predictors of hypogonadism.
- Measuring free testosterone levels is recommended to reduce unnecessary endocrine testing.
- Prolactin level measurement is indicated only for specific patient subgroups.