title: Is there a relationship between the severity of erectile dysfunction and the comorbidity profile in men with late onset hypogonadism?
abstract: OBJECTIVE
  To determine whether the severity of erectile dysfunction (ED) in a man diagnosed with late-onset hypogonadism (LOH) gives information about his metabolic syndrome state, as patients with LOH often have sexual symptoms and associated cardiovascular and metabolic comorbidities, but the role of ED in predicting the prevalence of comorbid disease in men with low levels of testosterone is currently unknown.
  
  
  METHODS
  Men (130) diagnosed with LOH and fulfilling the criteria of a total testosterone level of <3.5 ng/mL (<12 nmol/L), and with an erectile function domain score of <21 on the International Index of Erectile Function questionnaire (IIEF, questions 1-5), were enrolled for a subsequent trial of supplementation with testosterone undecanoate. Demographic data were recorded at baseline. The men completed three standardised questionnaires to assess sexual health, including the International Prostate Symptom Score, Ageing Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by the severity of ED, with SHIM scores of 1-7 considered severe, 8-11 moderate, and 12-16 mild to moderate. Levels of serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density and low-density lipoprotein) were assessed, along with plasma fasting glucose and glycated haemoglobin (HbA1c) levels. Body weight, body mass index and waist circumference were also recorded.
  
  
  RESULTS
  There was a significant association between the severity of ED and mean weight (P < 0.001), waist circumference (P < 0.001), triglycerides (P = 0.009), total cholesterol (P = 0.027), HbA1c (P < 0.001), fasting glucose (P = 0.003) and AMS scores (P = 0.043). There were no significant differences in testosterone fractions and SHBG levels between the ED subgroups. There was a positive correlation between the prevalence of diabetes mellitus (type 1 and type 2) and the severity of ED in these men (P = 0.018).
  
  
  CONCLUSIONS
  The descriptive data showed that a greater severity of ED in men with LOH correlated with an increased waist circumference, hyperglycaemia, hypertriglyceridaemia, hyperlipidaemia, and a history of diabetes mellitus. Severe ED is a prognostic indicator of comorbidities in men with LOH.
authors.affiliation: Institute of Urology/Andrology, Norderstedt-Hamburg, Germany ; Dresden International University, Dresden, Germany ; Gulf Medical University School of Medicine, Ajman, United Arab Emirates.
authors.forename: Aksam A
authors.initials: AA
authors.lastname: Yassin
authors.affiliation: Department of Human Metabolism, University of Sheffield, UK.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Nettleship
authors.affiliation: Institute of Urology/Andrology, Norderstedt-Hamburg, Germany.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Almehmadi
authors.affiliation: Klinikum Braunschweig, Department of Urology, Braunschweig, Germany.
authors.forename: Dany-Jan
authors.initials: DJ
authors.lastname: Yassin
authors.affiliation: Institute of Urology/Andrology, Norderstedt-Hamburg, Germany.
authors.forename: Youssef
authors.initials: Y
authors.lastname: El Douaihy
authors.affiliation: Gulf Medical University School of Medicine, Ajman, United Arab Emirates ; Global Medical Affairs Men's Healthcare, Bayer Pharma AG, Berlin, Germany.
authors.forename: Farid
authors.initials: F
authors.lastname: Saad
keywords: AMS, Ageing Males Symptoms; BMI, body mass index; CVD, cardiovascular disease; Comorbidities; DM(1,2), diabetes mellitus (type 1, type 2); ED, erectile dysfunction; Erectile dysfunction; HDL, high-density lipoprotein; HbA1c, glycated haemoglobin; Hypogonadism; IIEF, International Index of Erectile Function; LDL, low-density lipoprotein; LOH, late-onset hypogonadism; MetS, metabolic syndrome; Prediction; S, M, MM, severe, moderate, mild to moderate; SHBG, sex hormone-binding globulin; SHIM, Sexual Health Inventory for Men