Erectile Dysfunction: Back to Basics

For many years, erectile dysfunction (ED) was a condition that many men suffered with but very few were willing to discuss in public. Now, as nearly half of the baby boomer generation joins the group of people with ED, they are becoming more vocal about living with the condition and their desire to overcome it.

With the introduction of the oral phosphodiesterase type 5 inhibitors (PDE5i), many of which are promoted with direct-to-consumer advertising, interest in ED has surged. Recent studies have shown that patients are more likely now than ever before to seek help when they first notice signs of dysfunction.

Causes of ED can include smoking, or weight gain, or comorbidities such as hypertension, diabetes mellitus, or neurological disorders. Endocrine disorders can also cause or contribute to ED.

Recently, a team of Italian researchers lamented the dearth of research in endocrinopathies associated with ED in the August issue of the journal Endocrine, and provided a review of current theories.

The inverse relationship between sexual health and testosterone levels is well known and, in fact, testosterone deficiency is often used as a marker of sexual and physical frailty. Testosterone’s role in ED should not preclude a complete investigation of hormonal influence, the authors noted.

The authors recommend investigating luteinizing hormone, prolactin, thyroid-stimulating hormone, and free thyroxine in addition to testosterone. Some conditions related to these hormones may be sub-clinical. They also suggest a good basic work-up that checks blood glucose, lipid profile, and evaluation of kidney and liver functions is essential.

This article advocates a much broader diagnostic endocrine work-up for ED patients, stressing that although a PDE5i may improve the symptoms, in some patients, cure is possible.