Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China.
Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi, China.
J Sex Med. 2015 May;12(5):1165-74. doi: 10.1111/jsm.12854. Epub 2015 Mar 20.
The decline of testosterone has been known to be associated with the prevalence of erectile dysfunction (ED), but the causal relationship between sex hormones and ED is still uncertain.
To prove the association between sex hormones and ED, we carried out a prospective cohort study based on our previous cross-sectional study.
We performed a prospective cohort study of 733 Chinese men who participated in Fangchenggang Area Males Health and Examination Survey from September 2009 to December 2009 and were followed for 4 years. Erectile function was estimated by scores of the five-item International Index of Erectile Dysfunction (IIEF-5) and relative ratios (RRs) were estimated using the Cox proportional hazards regression model.
Data were collected at follow-up visit and included sex hormone measurements, IIEF-5 scores, physical examination, and health questionnaires.
Men with the highest tertile of free testosterone (FT) (RR = 0.21, 95% confidence interval [CI]: 0.09-0.46) and the lowest tertile of sex hormone-binding globulin (SHBG) (RR = 0.38, 95% CI: 0.19-0.73) had decreased risk of ED. In young men (aged 21-40), a decreased risk was observed with the increase of FT and bioavailable testosterone (BT) (adjusted RR and 95% CI: 0.78 [0.67-0.92] and 0.75 [0.62-0.95], respectively). Total testosterone (TT) (RR = 0.89, 95% CI: 0.81-0.98) was inversely associated with ED after adjusting for SHBG, while SHBG (RR = 1.04, 95% CI: 1.02-1.06) remained positively associated with ED after further adjusting for TT. Men with both low FT and high SHBG had highest ED risk (adjusted RR = 4.61, 95% CI: 1.33-16.0).
High FT and BT levels independently predicted a decreased risk of ED in young men. Further studies are urgently needed to clarify the molecular mechanisms of testosterone acting on ED.
睾酮水平下降与勃起功能障碍（ED）的普遍发生有关，但性激素与 ED 之间的因果关系仍不确定。
通过我们之前的横断面研究，我们进行了一项前瞻性队列研究，以证明性激素与 ED 之间的关联。
我们对 2009 年 9 月至 2009 年 12 月参加防城港地区男性健康与体检调查的 733 名中国男性进行了前瞻性队列研究，并随访了 4 年。通过五项国际勃起功能指数（IIEF-5）评分来评估勃起功能，使用 Cox 比例风险回归模型来估计相对比值（RR）。
随访时收集数据，包括性激素测量、IIEF-5 评分、体格检查和健康问卷。
游离睾酮（FT）最高三分位数（RR=0.21，95%置信区间[CI]：0.09-0.46）和最低三分位数（SHBG）（RR=0.38，95%CI：0.19-0.73）的男性患 ED 的风险降低。在年轻男性（21-40 岁）中，随着 FT 和生物可利用睾酮（BT）的增加，风险降低（调整 RR 和 95%CI：0.78[0.67-0.92]和 0.75[0.62-0.95]）。在调整 SHBG 后，总睾酮（TT）（RR=0.89，95%CI：0.81-0.98）与 ED 呈负相关，而在进一步调整 TT 后，SHBG（RR=1.04，95%CI：1.02-1.06）仍与 ED 呈正相关。FT 低和 SHBG 高的男性 ED 风险最高（调整 RR=4.61，95%CI：1.33-16.0）。
FT 和 BT 水平升高可独立预测年轻男性 ED 风险降低。迫切需要进一步的研究来阐明睾酮作用于 ED 的分子机制。
