Journal of Andrology Testis Workshop 2009
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Published-Ahead-of-Print October 15, 2009
Journal of Andrology 2009, DOI:10.2164/jandrol.109.007757

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Pablo R. Costanzo
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Erectile Dysfunction, Obesity, Insulin Resistance, and Their Relationship with Testosterone Levels in Eugonadal Patients in an Andrology Clinic Setting

Pablo Knoblovits *, Pablo R. Costanzo , Gastón J. Rey Valzacchi , Mario G. Gueglio , Alberto O. Layus , Andrea E. Kozak , Marta I. Balzaretti , and León E. Litwak

* To whom correspondence should be addressed. E-mail: pabloknoblovits{at}fibertel.com.ar.

Erectile dysfunction (ED) is associated with metabolic and endocrine diseases including obesity, metabolic syndrome (MS) and Type 2 Diabetes Mellitus (DM2). Insulin-resistance (IR), present in patients with obesity, MS and DM2, causes disturbances in the signaling pathways required for nitric oxide production with subsequent endothelial dysfunction. In addition, IR also appears to alter testosterone production. We evaluated in eugonadal ED patients: 1) the presence of obesity and IR; 2) testosterone levels and their association with obesity and IR and 3) the degree of ED according to the presence of IR. In a prospective study 78 eugonadal patients with ED (group P) where recruited and compared with 17 men without ED as a control group (group C). The erectile function was evaluated according the International Index of Erectile Function 5 (IIEF-5). IR was measured by HOMA. IR was defined as a HOMA ≥ 3. Results: patients with ED had a significant higher BMI, waist circumference (WC), HOMA values an prevalence of IR when compared to group C. Total (TT) and bioavailable testosterone (BT) levels were lower in group P compared to group C. There was a significantly negative correlation between HOMA and IIEF-5, HOMA and TT, WC and IIEF-5, WC and TT and between WC and BT. Group P patients with IR had a higher WC and lower IIEF-5 score when compared with patients in group P without IR. In conclusion: Patients with ED show a higher BMI, WC, and HOMA and lower levels of TT and BT. There is a negative correlation between erectile function and IR and abdominal obesity. The TT levels are lower in patients with increased BMI, WC and IR. However, a negative correlation was shown only between BT (biologically active fraction) and abdominal obesity.


Key words: Androgen • Erectile Dysfunction • Body Mass Index • Insulin • Waist circumference






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