Erectile Dysfunction, Sexual Symptoms Linked to Increased Mortality in Men

New research from the Endocrine Society (ENDO) 2020 Annual Scientific Sessions has uncovered a link between erectile dysfunction and increase mortality—regardless of an individual’s testosterone levels.

Results of the study, which examined a cohort of men from the European Male Ageing Study (EMAS), indicated the presence sexual symptoms increased risk of death by 51% in men compared to men with no sexual symptoms.

"As both vascular disease and low testosterone levels can influence erectile function, sexual symptoms can be an early sign for increased cardiovascular risk and mortality," said lead investigator Leen Antonio, MD, PhD, of KU Leuven-University Hospitals in Belgium, in a statement.

In an effort to further evaluate associations between sex steroids, gonadotrophin, and sexual symptoms with all-cause mortality, Antonio and a team of colleagues conducted an analysis of the EMAS—a prospective, observational study that included men between the age of 40-79 years old from 8 centers across Europe.

A total of 1913 men were included in the current analysis—all patients were recruited between 2003-2005 from 5 centers that recorded follow-up data through April 2018. Investigators measured an individual’s sex steroids by mass spectrometry while sexual symptoms were assessed through a validated questionnaire. Due to the wide range of age at study entry, investigators used age as a time-scale instead of years since inclusion adjusting for age.

Over a mean follow-up of 12.4±3.3 years, 483 (25.3%) of the 1913 men included in the analysis died. Results of the analysis indicated men who died had higher BMI than those who did not (P=.002).

Investigators noted total testosterone levels between men who died and did not die were similar. Conversely, men who died had lower free testosterone levels (312±86 pmol/L vs 270±84, P <.001) and higher luteinizing hormone levels (5.7±3.3 U/L vs 7.8±5.8, P <.001) than those who did not.

Results suggested men in the lowest quartile of free testosterone were at a greater mortality risk than those in the highest quartile (HR, 1.43; 95% CI, 1.06-1.95; P=.021. An increased risk was noted among those in the highest quartile of follicle-stimulating hormone (HR, 1.38; 95% CI, 1.02-1.88; P=.036).

Men reporting 3 or more sexual symptoms had a greater mortality risk than men with no sexual symptoms (HR 1.77; 95% CI, 1.28-2.41; P <.001). Results pointed to a particularly increased risk among patients reporting erectile dysfunction (HR 1.40; 95% CI, 1.15-1.73; P=.001) and poor morning erections (HR 1.30; 95% CI, 1.06-1.60; P=.012)—lower libido was not associated with an increased risk (HR 1.14; 95% CI, 0.93-1.40; P=.203). Investigators highlighted that adjustment for total testosterone and free testosterone did not impact the aforementioned risks.

Results indicated men with normal total testosterone levels but the presence of sexual symptoms was at an increased risk of mortality (HR, 1.51; 95% CI, 1.15-1.97; P=.003. Men with total testosterone less than 8 nmol/L and sexual symptoms were at a greater risk of mortality than men with normal total testosterone and no sexual symptoms (HR, 1.92; 95% CI, 1.05-3.52; P=.035).

This study, “Sexual Symptoms Predict All-Cause Mortality Independently of Sex Steroids in Ageing Men,” was accepted for presentation at ENDO 2020.