Department of Andrology, Cairo University, Cairo, Egypt.
Andrologia. 2012 Dec;44(6):373-80. doi: 10.1111/j.1439-0272.2012.01292.x. Epub 2012 Apr 4.
Diabetes mellitus is a common chronic disease, affecting 0.5-2% worldwide. The Massachusetts Male Aging Study reported that up to 75% of men with diabetes have a lifetime risk of developing ED. Type 2 diabetes is associated with low total serum testosterone (TT) identified in several cross-sectional studies and systemic analyses. There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality. In this retrospective study, we sought to evaluate the effect of associated co-morbidities on serum total testosterone (TT) level in men with type 2 diabetes DM, either with or without erectile dysfunction (ED). Three hundred and ninety-one patients were evaluated for erectile function using an abridged, five-item version of the International Index of Erectile Function-5. Measurements of TT, fasting lipid profile, blood sugar and glycated haemoglobin (HbA1c) were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Hypogonadism was found in 126 cases (33.2%), and normal TT was observed in 254 (66.8%). ED was detected in 119 cases in the hypogonadal group (94.4%) as compared to 155/254 (61.0%) in eugonadal group, P = 0.0001. TT was lower in diabetic men with ED as compared to those with normal erectile function (EF), 392.4 ± 314.9 versus 524.3 ± 140.2 ng dl(-1) , respectively, P < 0.0001. After exclusion of patients with hypertension and dyslipidaemia, 185 men were evaluated, and there was no difference in the mean TT level among men with ED 490.6 ± 498.2 ng dl(-1) versus normal EF 540.6 ± 133.4 ng dl(-1) although, HbA1c remained lower in men with normal erectile function. Receiver operating characteristic (ROC) curve of TT in men without associated co-morbidities showed that EF was compromised at TT = 403.5 ng dl(-1) or less. Sensitivity of 63.3% and a specificity of 94.0% were detected. At this level, ED was found in 33/38 (86.8%) men with TT 403.5 ng dl(-1) , whereas ED was observed in 57/147 (38.8%) men with TT ≥ 403.5 ng dl(-1) (P < 0.0001). We propose a cut-off value of 403.5 ng dl(-1) of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED. Further prospective controlled trials are recommended.
糖尿病是一种常见的慢性疾病，全球范围内发病率为 0.5-2%。马萨诸塞州男性老龄化研究报告称，高达 75%的糖尿病男性终生患有勃起功能障碍（ED）的风险。几项横断面研究和系统分析表明，2 型糖尿病与总血清睾酮（TT）水平降低有关。关于何种程度的睾酮水平属于正常范围的最低值，目前尚未达成共识。在这项回顾性研究中，我们旨在评估相关合并症对 2 型糖尿病男性血清总睾酮（TT）水平的影响，无论这些男性是否患有 ED。391 名患者使用国际勃起功能指数-5 的简化五分量表评估勃起功能。测量 TT、空腹血脂谱、血糖和糖化血红蛋白（HbA1c）。采用海绵体内注射和阴茎双功能超声检查评估阴茎血流动力学。在 126 例（33.2%）中发现低睾酮血症，254 例（66.8%）中 TT 正常。在低睾酮组中，119 例（94.4%）发现 ED，而在 TT 正常组中，155/254 例（61.0%）发现 ED，P=0.0001。与正常勃起功能（EF）的糖尿病男性相比，ED 糖尿病男性的 TT 水平较低，分别为 392.4±314.9 与 524.3±140.2 ng/dL，P<0.0001。排除高血压和血脂异常患者后，对 185 名男性进行了评估，尽管勃起功能正常的男性的 HbA1c 仍较低，但 ED 男性的平均 TT 水平无差异，分别为 490.6±498.2 ng/dL 和 540.6±133.4 ng/dL。无相关合并症的男性 TT 的受试者工作特征（ROC）曲线显示，当 TT 为 403.5 ng/dL 或更低时，EF 受损。检测到 63.3%的敏感性和 94.0%的特异性。在这一水平上，38/38（86.8%）TT 为 403.5 ng/dL 的男性发现 ED，而 TT≥403.5 ng/dL 的 147/147（38.8%）男性中发现 ED，P<0.0001。我们提出 TT 血水平 403.5 ng/dL 作为启动糖尿病男性 ED 患者睾酮替代治疗的临界值。建议进行进一步的前瞻性对照试验。
