Introduction and Objectives: We have previously shown that hypogonadalsymptoms and erectile dysfunction (ED) are common in the population ofinfertile men (O’Brien et. al, J Urol 2005). We sought to examine thesefindings in a largermographic and biochemical predictors of ED.Methods: We prospectively collected demographic data and administeredthe Androgen Deficiency in the Aging Male (ADAM) and Sexual HealthInventory for Men (SHIM) questionnaires to men presenting for evaluationof infertility between July 1995 and April 2010. As part of routine work up,most infertile men underwent serum hormone evaluation for total testosterone(T), estradiol (E), luteinizing hormone (LH) and follicle-stimulatinghormone (FSH). In our analysis of 2783 men, we excluded all those underthe age of 18 and those with pre-existing significant ED (penile prosthesis,post-radical prostatectomy). We included only those that had completedthe SHIM questionnaire in entirety. All other baseline risk factors were measured,including age, smoking, marijuana use and relevant co-morbidities(diabetes mellitus, hypertension and dyslipidemia) and use of medicationswhich may affect ED (anti-hypertensives, anti-depressants, anti-androgensand anti-histamines). We defined cases (those with ED) as men having aSHIM score 22. Logistic regression modeling was conducted to determinethe significance of hormonal markers in predicting ED.Results: A total of 2466 men of mean age 36 (range 18-71) completed thequestionnaires. The prevalence of ED and those reporting low libido (question#1 of ADAM) was 28.4% and 23.9%, respectively. Hypoandrogenism(total testosterone 10 nMol/L) was found in 31.8% of the men. In ourbaseline model, age (OR 1.03; 95% CI: 1.02-1.05) and the diagnosis ofdiabetes mellitus (OR 4.38; 95% CI: 2.56-7.51) were significant predictorsof ED. While controlling for self reported low libido, T (OR 0.96; 95% CI:0.90-1.02), LH (OR 1.11; 95% CI: 0.94-1.30), and FSH (OR 1.0; 95% CI:0.93-1.07) did not significantly predict ED.Conclusions: In this relatively young group of infertile men both ED andhypoandrogenism were quite prevalent. Interestingly, ED was unrelated tohormone levels. This data shows that ED in most of these younger infertilemen is unrelated to testicular or hypothalamic-pituitary dysfunction.
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