Yassin Aksam A, Nettleship Joanne E, Almehmadi Yousef, Yassin Dany-Jan, El Douaihy Youssef, Saad Farid
Institute of Urology/Andrology, Norderstedt-Hamburg, Germany ; Dresden International University, Dresden, Germany ; Gulf Medical University School of Medicine, Ajman, United Arab Emirates.
Department of Human Metabolism, University of Sheffield, UK.
Arab J Urol. 2015 Sep;13(3):162-8. doi: 10.1016/j.aju.2015.06.003. Epub 2015 Jul 7.
To determine whether the severity of erectile dysfunction (ED) in a man diagnosed with late-onset hypogonadism (LOH) gives information about his metabolic syndrome state, as patients with LOH often have sexual symptoms and associated cardiovascular and metabolic comorbidities, but the role of ED in predicting the prevalence of comorbid disease in men with low levels of testosterone is currently unknown.
Men (130) diagnosed with LOH and fulfilling the criteria of a total testosterone level of <3.5 ng/mL (<12 nmol/L), and with an erectile function domain score of <21 on the International Index of Erectile Function questionnaire (IIEF, questions 1-5), were enrolled for a subsequent trial of supplementation with testosterone undecanoate. Demographic data were recorded at baseline. The men completed three standardised questionnaires to assess sexual health, including the International Prostate Symptom Score, Ageing Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by the severity of ED, with SHIM scores of 1-7 considered severe, 8-11 moderate, and 12-16 mild to moderate. Levels of serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density and low-density lipoprotein) were assessed, along with plasma fasting glucose and glycated haemoglobin (HbA1c) levels. Body weight, body mass index and waist circumference were also recorded.
There was a significant association between the severity of ED and mean weight (P < 0.001), waist circumference (P < 0.001), triglycerides (P = 0.009), total cholesterol (P = 0.027), HbA1c (P < 0.001), fasting glucose (P = 0.003) and AMS scores (P = 0.043). There were no significant differences in testosterone fractions and SHBG levels between the ED subgroups. There was a positive correlation between the prevalence of diabetes mellitus (type 1 and type 2) and the severity of ED in these men (P = 0.018).
The descriptive data showed that a greater severity of ED in men with LOH correlated with an increased waist circumference, hyperglycaemia, hypertriglyceridaemia, hyperlipidaemia, and a history of diabetes mellitus. Severe ED is a prognostic indicator of comorbidities in men with LOH.
确定被诊断为迟发性性腺功能减退（LOH）的男性勃起功能障碍（ED）的严重程度是否能反映其代谢综合征状态，因为LOH患者常伴有性症状以及相关的心血管和代谢合并症，但目前尚不清楚ED在预测睾酮水平低的男性合并疾病患病率方面所起的作用。
招募了130名被诊断为LOH且符合总睾酮水平<3.5 ng/mL（<12 nmol/L）标准、国际勃起功能指数问卷（IIEF，问题1 - 5）中勃起功能领域得分<21的男性，参与后续的十一酸睾酮补充试验。在基线时记录人口统计学数据。这些男性完成了三份评估性健康的标准化问卷，包括国际前列腺症状评分、老年男性症状（AMS）和IIEF男性性健康量表（SHIM）。根据ED的严重程度对患者进行分层，SHIM评分1 - 7分为重度，8 - 11分为中度，12 - 16分为轻度至中度。评估血清睾酮、性激素结合球蛋白（SHBG）和血脂（总胆固醇、甘油三酯、高密度和低密度脂蛋白）水平，以及空腹血糖和糖化血红蛋白（HbA1c）水平。还记录了体重、体重指数和腰围。
ED严重程度与平均体重（P < 0.001）、腰围（P < 0.001）、甘油三酯（P = 0.009）、总胆固醇（P = 0.027）、HbA1c（P < 0.001）、空腹血糖（P = 0.003）和AMS评分（P = 0.043）之间存在显著关联。ED亚组之间的睾酮组分和SHBG水平无显著差异。在这些男性中，1型和2型糖尿病的患病率与ED严重程度呈正相关（P = 0.018）。
描述性数据表明，LOH男性中ED的严重程度越高，与腰围增加、高血糖、高甘油三酯血症、高脂血症以及糖尿病病史相关。重度ED是LOH男性合并症的一个预后指标。
