Context: Studies suggest that 2540% of men with type 2 diabetes mellitus (T2DM) have hypogonadism. Other studies have estimated that 4050% of men with T2DM have erectile dysfunction (ED). Some guidelines suggest routine measurements of testosterone in all patients with T2DM.
Objectives: To estimate the prevalence of hypogonadism in adult male patients with type 2 diabetes mellitus and symptomatic erectile dysfunction.
Methods: Consecutive adult male patients (between 30 and 60 years) with ED and T2DM attending diabetic clinic in a tertiary hospital were recruited after informed consent. Patients with psychiatric illness, renal disease, liver disease, previous pelvic surgery and major neurological diseases were excluded. ED was graded using the International Index of Erectile Dysfunction (IIEF) questionnaire. Biochemical assessment of hypothalamic-pituitary-gonadal (HPG) axis was undertaken by collecting morning samples for serum luteinizing hormone, follicle stimulating hormone, prolactin and total testosterone. These were analyzed by electrochemiluminessense assays on an ELECSYS automated system. Patients were classified as either being eugonadal or having either hypogonadotropic hypogonadism (HH) or hypergonadotropic hypogonadism (HHG).
Results: patients consented for the study with a mean age of 50.3 years and mean duration of diabetes of 5.9 years. Of them 102 patients completed all the study related procedures and were included in the analysis. 54 (52.9%) of men with T2DM and ED were eugonadal, 38 (37.3%) had HH and 10 (9.8%) had HHG. All 25 patients with mild ED (IIEF scores 1721) were eugonadal. While of 28 patients with mild to moderate ED (IIEF scores 1216), 24 (85.7%) were eugonadal and 4 (14.3%) had HH. Of the 16 patients with moderate ED (IIEF scores 811) 4 (25%) were eugonadal, 9 (56.3%) had HH and 3 (18.8%) had HHG. Among the 33 patients with severe ED (IIEF score 17) only 1 (3%) was eugonadal, 25 (75.8%) had HH and 7 (21.2%) had HHG (P<0.0001).
Conclusions: Routine hormonal evaluations of the HPG axis is probably only required in patients with moderate to severe ED with type 2 diabetes. Over 75% of patients with moderate to severe ED have subnormal total testosterone levels.