High testosterone/estradiol ratio in men with erectile dysfunction may have a predictive value for chronic viral hepatitis

Abstract

The increased level of SHBG may suggest hepatic distress regardless of aetiology. A low T/E2 ratio was associated with increased systemic inflammation, inflammatory proteins in the plaque, and a higher risk of major CV events in future, compared to a high T/E2 ratio. This study was carried out with the purpose of evaluating the relationship between the high T/E2 ratio and the prevalence of chronic hepatitis of viral aetiology in males with ED. Twenty-six males (aged 38 ± 6.44) with ED, normal hormonal values and increased T/E2 ratio were selected. The T/E2 ratio was calculated by the formula: testosterone (ng/dL) / estradiol (pg/ml). A high T/E ratio was considered > 14.1. All men were screened for HBsAg, HBcAb and anti-HCV. Liver function tests were done for those with positive markers. Serum testosterone, SHBG and estradiol levels were assessed in all participants. Results demonstrated the mean total testosterone level to be 460 ± 40.41 ng/dL, mean total estradiol level 22 ± 6.23 pg/ml and mean SHBG level 50.32 ± 6.42 nmol/L. The T/E ratio was ranged between 23.12 the highest level and 16.45 the lowest level. The ED evaluation (IIEF-5) - 12% severe, 41% moderate, 33% mild to moderate and 14% mild. Of twenty-six screened males, 12 (46.15%) were with HBsAg positive, 2 (7.69%) with positive anti-HCV and 3 with only HBcAb. In 15 marker positive patients, liver function tests were within normal range and only 2 had slightly changed bilirubin and AST level. All 14 patients (HBsAg and anti-HCV positive) were diagnosed with liver chronic disease for the first time. The increased T/E2 ratio with normal SHBG, testosterone and estradiol values, may serve as a reason for screening for viral hepatitis in patients with erectile dysfunction as the primary symptom. Normal hormonal values in patients with erectile dysfunction should be individually interpreted and T/E ratio considered. No conflict of interest.