title: The relationship between testosterone levels, the metabolic syndrome (by two criteria), and insulin resistance in a population of men with organic erectile dysfunction.
abstract: BACKGROUND
  Erectile dysfunction (ED) in men increases with age, as does cardiovascular disease (CVD). Major risk factors of CVD are similar to ED, including insulin resistance (IR) and metabolic syndrome (MS). Hypogonadism has been associated with MS and IR in general populations.
  
  
  OBJECTIVE
  To determine the association between hypogonadism and MS and/or IR in men with ED, and to determine if hypogonadism is related to these cardiovascular (CV) risks.
  
  
  METHODS
  To compare the mean testosterone levels in men with and without IR and MS, and to show the difference in hypogonadism prevalence in mutually exclusive definitions of MS.
  
  
  METHODS
  Mean testosterone for the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO) criteria of MS were calculated using independent t-tests. Multiple range t-tests were used to compare and contrast four groups: (i) only NCEP-Third Adult Treatment Panel criteria; (ii) only the WHO criteria; (iii) men with no MS; and (iv) men fulfilling both MS definitions. Chi-squared analysis was employed to determine the association of hypogonadism with IR.
  
  
  RESULTS
  The prevalence of IR was 79% and of MS was 35 % by the WHO but 43% by the NCEP. Differences in point prevalences were negligible when mutually exclusive groups of MS were compared. Mean free testosterone was lower for the WHO MS or the WHO and NCEP MS (P = 0.04) but not for only the NCEP MS criteria. IR was significantly associated with low free testosterone and hypogonadism (P = 0.02 for each). If more than one criteria were present for either the WHO or NCEP MS, free testosterone was lower (P = 0.02).
  
  
  CONCLUSIONS
  MS and IR are strongly associated with lower testosterone and hypogonadism. The WHO criteria are a more sensitive indicator of MS and may predict ED better. Men with ED should not only have CV risks evaluated, but should also have testosterone levels drawn.
authors.affiliation: Department of Endocrinology/Center for Sexual Function, Lahey Clinic Northshore, One Essex Center Drive, Peabody, MA 01960, USA. andre.t.guay@lahey.org
authors.forename: Andre
authors.initials: A
authors.lastname: Guay
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000728:Androgens / Q000097:blood* / Q000172:deficiency; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000453:epidemiology; D018783:Impotence, Vasculogenic / Q000097:blood* / Q000453:epidemiology*; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013739:Testosterone / Q000097:blood* / Q000172:deficiency
chemical_list: D000728:Androgens; D013739:Testosterone