Erectile Dysfunction, Obesity, Insulin Resistance, and Their Relationship With Testosterone Levels in Eugonadal Patients in an Andrology Clinic Setting

Abstract

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 appears to alter testosterone production. We evaluated in eugonadal patients with ED: 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) were recruited and compared with 17 men without ED as a control group (group C). Erectile function was evaluated according to the International Index of Erectile Function 5 (IIEF-5). IR was measured by homeostasis model assessment (HOMA). IR was defined as HOMA of 3 or greater. Patients with ED had significantly higher body mass index (BMI), waist circumference (WC), HOMA values, and prevalence of IR when compared with group C. Total (TT) and bioavailable testosterone (BT) levels were lower in group P compared with group C. There was a significant negative correlation between HOMA and IIEF-5, HOMA and TT, WC and IIEF-5, WC and TT, and WC and BT. Group P patients with IR had higher WCs and lower IIEF-5 scores when compared with patients in group P without IR. In conclusion, patients with ED showed 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.