H6 Prevalence of testosterone deficiency in patients with erectile dysfunction

Various studies have estimated the prevalence of testosterone deficiency in patients with erectile dysfunction. A systematic multidisciplinary assessment of 256 men with erectile dysfunction showed a prevalence of hypothalamic-pituitary-gonadal axis abnormalities of 17.5%. In only 12.1% did the testosterone deficiency clearly contribute to erectile dysfunction (Nickel et al. 1984). Another routine hormonal screening in 300 men presenting with a primary complaint of erectile dysfunction showed a prevalence of only 1.7% (Maatman and Montague 1986). A similar low prevalence of 2.1% was detected in 330 consecutive patients with erectile dysfunction screened for testosterone deficiency (Johnson and Jarow 1992).

More recently, endocrine screening of 1022 men with erectile dysfunction detected serum concentrations of testosterone < 3 ng/ml in 8.0% of men. However, 40% of these patients had normal serum levels at repeated determination (Buvat and Lemaire 1997). Pituitary tumors were discovered in two men with low testosterone. Determination of testosterone only in cases of low sexual desire or abnormal physical examination would have overlooked 40% of men with low testosterone, and 37% of men subsequently improving during testosterone substitution therapy (Buvat and Lemaire 1997). The largest study involving 3547 men with erectile dysfunction revealed a prevalence of testosterone deficiency (serum concentration less than 2.8 ng/ml) of 18.7% (Bodie etal. 2003).

The marked difference in the prevalence of testosterone deficiency in patients with erectile dysfunction could be explained by different patient populations, different age of men with erectile dysfunction, differences in primary, secondary or tertiary care centres, different definitions of low testosterone levels, or single versus repeated testosterone determinations. It should be noted that none of these studies really fulfils the principles of evidence-based medicine, as no study included a control group of age-matched men without erectile dysfunction. Nevertheless, recent consensus conferences on erectile dysfunction, such as the "Third International Conference on the Management of Erectile Dysfunction" (Nehra et al. 2003), or the "2nd International Consultation on Erectile and Sexual Dysfunction" held in Paris in 2003 recommend screening for testosterone deficiency in all patients with erectile dysfunction.

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