title: Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism.
abstract: BACKGROUND
  The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH).
  
  
  OBJECTIVE
  In this study, we sought to determine the correlators of ED severity amongst men with LOH.
  
  
  METHODS
  130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1-5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline.
  
  
  METHODS
  Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1-7 considered severe ED, 8-11 moderate ED and 12-16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded.
  
  
  RESULTS
  A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018).
  
  
  CONCLUSIONS
  The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.
authors.affiliation: a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany .
authors.forename: Yousef
authors.initials: Y
authors.lastname: Almehmadi
authors.affiliation: b Department of Urology , Klinikum Braunschweig , Braunschweig , Germany , and.
authors.forename: Dany-Jan
authors.initials: DJ
authors.lastname: Yassin
authors.affiliation: a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany .|c Dresden International University , Dresden , Germany.
authors.forename: Aksam A
authors.initials: AA
authors.lastname: Yassin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D007172:Erectile Dysfunction; D006801:Humans; D007006:Hypogonadism; D000067562:Late Onset Disorders; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Erectile dysfunction; hypogonadism; metabolic syndrome; testosterone