Predictors of erectile dysfunction and hypogonadism in men with types 2 diabetes mellitus

Abstract

ABSTRACT Background It is increasingly apparent that erectile dysfunction (ED), male hypogonadism (MHG) and type 2 diabetes mellitus (T2D) are interlinked. ED occurs in up to 75% of men with T2DM and has complex pathogenesis owing to a combination of micro vascular, macro vascular, endocrine and neuropathic disease. But its prevalence is still debated. On the other hand, hypogonadism in male is characterized by low serum testosterone (Low T) levels along with clinical symptoms and is very frequent in diabetes mellitus (DM). The association between T2D and hypogonadism is not clearly known in the Bangladeshi population. Objectives The key objective of the study was to find out the frequency of erectile dysfunction, hypogonadism predictors and serum status of newly detected male patients with T2D. Materials and Method A cross-sectional study encompassing1940 newly detected T2D male patients were carried out in the out-patient department of endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The sociodemographic and disease related data were obtained by face-to-face interview and were recorded in the pretested case record form from patients who signed the informed written consent form by knowing all the study related information. A blood sample was taken and serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicle stimulation hormone (FSH) were measured by chemiluminescent technology. Results Among hypogonadal patients, according to calculated free testosterone (cFT) and androgen deficiency in aging male (ADAM) criteria, frequency of hypogonadotropic hypogonadism was 80% which on the basis of TT and ADAM criteria was 92.5%. There was no significant difference for hypogonadism among either the glycosylated hemoglobin (HbA1c) categories (p=0.23) or age groups (p=0.9). Hypogonadal and eugonadal groups significantly differed both according to TT and ADAM (81.5% vs 43.4%; p=0.01) and cFT and ADAM (93.3% vs 47.7%, p=<0.001) criteria for ED. There was a significant difference between the groups for SHBG (21.7±11.6 vs 30.71±22; p=0.05) by TT and ADAM criteria. Similarly, cFT and ADAM criteria also revealed statistically significant difference for SHBG (38.04±19.90 vs 25.28±19.37 nmol/l; p=0.03) and Total Cholesterol (211.40±44.7 vs 191.3 ± 32.64 mg/dl p=0.04). However, in both groups, LH, FSH, HbA1c, fasting blood sugar, 2hrs after 75gm glucose, Triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) did not differ significantly. cFT significantly correlated with age (r=-0.3503, p=001) and SHBG (r=-0.37, p=<0.01) while TT with SHBG (r=0.58, p=0.01). In multiple regressions analysis, erectile dysfunction and SHBG were found to be significant predictors for hypogonadism (p=0.01, 0.03 respectively). Conclusion This study demonstrated the significant relationship between d T2DM, hypogonadism and ED presence in men. Many of newly detected male with T2D have symptoms of hypogonadism judged on the basis of TT, cFT and ADAM score. Thus, it should be considered while diagnosing T2D in men. Disclosure Work supported by industry: no, by BSMMU.