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LINKS BETWEEN TESTOSTERONE DEFICIENCY; METABOLIC SYNDROME AND
ERECTILE DYSFUNCTION
Farid Saad
Schering AG, Strategic Business Unit, Gynaecology & Andrology, Corporate
Strategic Marketing Male Health Care, D-13342 Berlin, Germany Gulf
Medical College School of Medicine, Ajman / UAE farid.saad@schering.de
The definition of the metabolic syndrome has recently been updated
and lists 5 risk factors for cardiovascular diseases and type 2
diabetes of which 3 are considered sufficient for the diagnosis.
Several recent studies show an association between the metabolic
syndrome and erectile dysfunction and the common denominator might
well be testosterone. Epidemiological studies find negative correlations
between plasma testosterone on the one hand and central obesity,
triglycerides and blood pressure and negative correlations with
HDL cholesterol and insulin resistance on the other. Hypogonadism
may be diagnosed in up to 50 per cent of diabetic men.
These observations have been corroborated by findings in men receiving
androgen deprivation therapy for prostate cancer treatment: body
composition, lipid pattern and insulin resistance deteriorate soon
after medically or surgically induced testosterone deficiency.
When hypogonadal men receive treatment with testosterone a consistent
improvement in body composition (reduction of fat mass and increase
of muscle mass), in particular related to central obesity, lipids,
and insulin resistance (insulin, glucose, and HbA1c) has been observed.
It could be shown that testosterone has a direct and immediate effect
on insulin sensitivity which is not mediated by changes in body
composition. Testosterone also improves inflammatory cytokines profiles
towards a more favourable anti-inflammatory, anti-atherosclerotic
profile. So, studies are warranted to investigate the role of testosterone
deficiency in the metabolic syndrome to test whether testosterone
deficiency is a pivotal component of the metabolic syndrome. There
is a connection of the metabolic syndrome with erectile dysfunction,
and the common denominator might be testosterone deficiency.
In men, the effect of testosterone on sexual functioning has been
well documented. Hypogonadism is not rare in men presenting with
erectile dysfunction. Moreover, many studies reveal that comorbidities
such as hypertension, diabetes, dyslipidemia, and cardiac diseases
are common in ED patients. The more severe erectile dysfunction,
the higher the prevalence of these concomitant diseases and, vice
versa: the more severe the comorbidities, the higher the likelihood
of erectile dysfunction.
In summary, testosterone is pivotal in erectile physiology. Erectile
dysfunction and the metabolic syndrome share the same risk factors
and hypogonadism is often part of the metabolic syndrome. Testosterone
may be the common denominator. ED may be the first symptom prompting
men to seek medical advice. The time has come to view ED no longer
as an entity in itself but as an expression of multiple underlying
pathologies which require medical attention promoting general health
and therewith also sexual functioning.
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