The effect of statin therapy on testosterone levels in subjects consulting for erectile dysfunction
Giovanni Corona1,3, Valentina Boddi1, Giancarlo Balercia2, Rastrelli Giulia1, Giulia de Vita1, Alessandra Sforza3, Gianni Forti1, Edoardo Mannucci4 & Mario Maggi1
Introduction: Previous clinical studies on effect of statins treatment on testosterone levels have produced mixed results. The aim of the present study is to evaluate the association between statin therapy and hormonal parameters in a large series of subjects seeking medical care at our Unit for ED.
Methods: A consecutive series of 3484 (mean age 51.6±13.1 years) patients with ED was studied.
Several hormonal and biochemical parameters were investigated, along with ANDROTEST structured interview measuring hypogonadism-related symptoms.
Results: Among the patients studied, 244 (7%) patients were being treated with statins. After adjustment for confounding factors (including BMI and Progetto Cuore cardiovascular risk engine score) both total and calculated free testosterone levels were significantly lower in subjects taking statins, when compared to the rest of the sample (HR=0.93 (0.90; 0.96) and 0.26 (0.01; 0.18) for each decrement of total testosterone and calculated free-testosterone respectively; both P<0.0001). The use of statins was also associated with a reduced testis volume and a higher prevalence of hypogonadism-related symptoms and signs, as assessed by higher ANDROTEST score (HR=1.12 (1.03; 1.21); P<0.01 after adjustment for confounders). FSH levels were significantly higher in subjects treated with statins when compared to the rest of the sample while there was a trend toward higher LH levels, but this did not reach statistical significance. The lower levels of total and calculated free testosterone observed in subjects treated with statins were also confirmed comparing them with agewaist circumference and cardiovascular risk score matched controls. Finally, subjects being treated with statins showed lower prolactin levels when compared to the rest of the sample.
Conclusions: Our data demonstrated that statin therapy might induce an overt primary hypogonadism and should be considered as a possible confounding factor for the evaluation of testosterone levels in patients with ED.