Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction.

The concept that impotence is psychogenic in 95% of cases is reconsidered. Screening serum testosterone levels of 105 consecutive patients with impotence showed that 37 patients had previously unsuspected disorders of the hypothalamic-pituitary-gonadal axis. Twenty patients had hypogonadotropic-hypogonadism, seven had hypergonadotropic-hypogonadism, eight had hyperprolactinemia, and two had occult hyperthyroidism. Once the specific defect was defined, appropriate therapy was instituted, and potency was restored in 33 patients. Screening serum testosterone levels is useful in identifying hypothalamic-pituitary-gonadal dysfunction in patients with impotence.