Erectile Dysfunction In Young Men Research Articles

Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey.

BackgroundExpanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise.ObjectiveThe aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED.MethodsA 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used.ResultsAccording to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED.ConclusionsThis prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC.Trial RegistrationResearch Registry researchregistry5111; https://tinyurl.com/m45mcaa2

Neurological causes of erectile dysfunction in young men

Neurological causes of erectile dysfunction in young men

MYOCARDIAL INFARCTION IN YOUNG MEN, FEATURES OF CLINICAL COURSE AND STATE OF ERECTILE FUNCTION

Aim of the study is to determine the features of the clinical course and study the state of erectile function in young men who have suffered MI.
 112 male patients of Caucasian race of the Ukrainian population under the age of 50 (mean 43.21±2.8 years) who have had MI were examined.
 Clinical and anamnestic data indicate the similarity of young men who have suffered MI with their peers. Yes, there are no significant differences in the percentage of smokers, burdened family history. Analysis of erectile dysfunction, according to the IIEF-5 questionnaire, indicates the presence of problems in young men who have suffered MI.
 All examined patients were admitted to the hospital within 12 hours from the first symptoms of MI, which allowed to perform urgent coronary angiography with subsequent endovascular intervention - stenting. According to the cardiac ventriculography, about half of the patients (50 - 44.6%) had a three-vessel disease despite the young age.
 One third of patients received as a beta-blocker the new class of drug of the 3rd generation - nebivalol (37 patients - 33.0%), which is important for young patients, as this drug has no adverse effects on erectile function in men. 44 (39.3%) received bisoprolol, a more common long-term beta-blocker. 31 patients had contraindications to beta-blockers.
 
 Conclusions.
 
 Myocardial infarction in young men was characterized by a high frequency of anginal form of the clinical course, multivessel disease of the coronary arteries, lipid profile disorders, a high proportion of patients with erectile dysfunction.
 Erectile dysfunction in young men is an early marker of coronary heart disease. All men with ED should undergo a thorough cardiac examination to determine lipid profile and testosterone levels.
 In patients with coronary heart disease, the symptoms of ED should be actively identified, initiate targeted lifestyle changes to reduce risks, as well as taken into account when choosing drugs for medical treatment.

Modern Methods of Treating Erectile Dysfunction in Young Men

Traditionally, the incidence of erectile dysfunction (ED) increases with the age of a man, evolutionarily protecting him from passing on old, defective genes to his offspring by limiting his participation in sexual activity. Nevertheless, in the modern world, only 1 % of sexual contacts are carried out for the purpose of reproduction, the rest – with a recreational and social purpose. In addition, there has been an increasing number of cases of ED in young men lately. The problem of treating ED in young patients (up to 45 years old) requires an etiological approach.
 The objective: to determine the effectiveness of etiological non-surgical (treatment of prostatitis, psychotherapy) or minimally invasive (Marmara operation, veno-occlusive surgery, PRP-therapy) treatment of young men with ED.
 Materials and methods. On the basis of the Kharkiv Regional Medical Clinical Center for Urology and Nephrology named after V.I. Shapoval and on the basis of the P. Mogila Black Sea National University (Nikolaev) during 2014–2020. a comprehensive examination and treatment of 563 patients was carried out, which were divided into three supergroups (A, B and C) according to the prevailing factor: 156 patients with venoocclusive erectile dysfunction – supergroup A, 353 patients with chronic prostatitis – supergroup B and 54 patients with predominant psychoneurological disorders and the absence of organic pathology - supergroup C.
 Results. The effectiveness of surgical treatment in supergroup A according to subjective data after 2 months was almost equal in groups and subgroups, but after 18 months it was significantly higher in subgroups 1b and 2b (65.4 % and 83.7 %) according to ICEF results, and according to objective data after 18 months – 73.4 % and 91.4 %, respectively. After 1 and 7 months, the effectiveness of treatment in supergroup B was determined by the indices of satisfaction with sexual intercourse on the IIEF scale, the number of patients satisfied with the results of treatment, the absence of prostatic complaints and the eradication of infectious agents. Convincing results were obtained when assessing the quality of life of patients in supergroup C.
 Conclusion. Chronic prostatitis is the most common cause of erectile dysfunction ED in young men. Three-week antibacterial etiological treatment demonstrates the highest rates of infection eradication and ICEF recovery in patients with prostatitis. Operation Marmara reduces venous hyperemia of the prostate, lowers the IPSS score, and improves erectile function in patients with comorbid pathology. The use of an etiological approach allows to improve the sexual function of young patients, returning them to a normal sexual life, creating an alternative to falloprosthetics.

Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms

BackgroundThe association between erectile dysfunction (ED), free testosterone (T), and androgenic genetic polymorphisms is still unclear. As most studies in the field have focused on older (>40 y.o.) men, data from young men is scarce. In addition, the clinically observed comorbidity between ED and premature ejaculation (PE) has not been explained. AimThe aim of the present study was 3-fold: to assess in a sample of young men (1) the association between ED and T; (2) the role of androgenic genetic polymorphisms in the aforementioned association; and (3) comorbidity between ED and PE symptoms. MethodsStatistical analyses were performed on a population-based sample of 2,302 Finnish men, (Mage = 26.8 years). Hormone samples were available from 317 men, and genotype information was available from a minimum of 1,144 men depending on genetic locus. For twin analyses, the sample contained 533 male individuals from opposite-sex fraternal twin pairs, 491 identical male individuals (110 complete pairs), 493 male individuals from male fraternal twin pairs (92 complete pairs), and 658 siblings of twins. OutcomesThe main outcome measure includes association between levels of salivary T and ED, main effects of the androgen-related genetic polymorphisms on ED scores. Bivariate twin models of PE and ED were fitted to elucidate possible shared etiology. ResultsWe found no significant association between T levels and ED and no significant main effects of the androgenic genetic polymorphisms on ED. We found no evidence suggesting that any of the genetic polymorphisms would moderate the association between T and ED symptoms. We found shared unique environmental influences between PE and ED (rE = .28). Clinical TranslationObtained data suggest that ED has T-independent causes and that any comorbidity between PE and ED is not explained by a set of genes affecting both phenotypes. Strengths & LimitationsFirst, the sample size for both parts of the study was relatively small, which may make some statistical analyses underpowered. Furthermore, as the sample was a population-based sample of relatively young men, the number of clinically relevant ED cases was low. Second, some concerns about T derived from saliva exist because saliva sampling comes with increased risks of error particularly because saliva samples are more vulnerable to contamination. ConclusionWe found no significant association between free T levels, androgenic genetic polymorphisms, and ED in the younger age cohort. Twin analysis suggested a common nonshared environmental component in PE and ED.Zhuravleva1 ZD, Johansson A, Jern P. Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms. J Sex Med 2021;18:265–274.

Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health Correlates.

Little is understood about physiological and psychological correlates of erectile dysfunction among younger men. We examined prevalence and correlates of erectile dysfunction in a large U.S. sample of 18 to 31-year-old men. Erectile dysfunction prevalence and severity (defined using the International Index of Erectile Function-5 scale) were examined in cross-sectional survey data from 2,660 sexually active men, age 18 to 31 years, from the 2013 Growing Up Today Study. Erectile dysfunction medication and supplement use were self-reported. Multivariable models estimated associations of moderate-to-severe erectile dysfunction with demographic (age, marital status), metabolic (body mass index, waist circumference, history of diabetes, hypertension, hypercholesterolemia) and mental health (depression, anxiety, antidepressant use, tranquilizer use) variables. Among sexually active men 11.3% reported mild erectile dysfunction and 2.9% reported moderate-to-severe erectile dysfunction. Married/partnered men had 65% lower odds of erectile dysfunction compared to single men. Adjusting for history of depression, antidepressant use was associated with more than 3 times the odds of moderate-to-severe erectile dysfunction. Anxiety was associated with greater odds of moderate-to-severe erectile dysfunction, as was tranquilizer use. Few men (2%) reported using erectile dysfunction medication or supplements. However, among them, 29.7% misused prescription erectile dysfunction medication. Limitations include reliance upon cross-sectional data and the sample's limited racial/ethnic and socioeconomic diversity. Erectile dysfunction was common in a large sample of sexually active young adult men from a U.S. cohort and was associated with relationship status and mental health. Health providers should screen for erectile dysfunction in young men, and monitor use of prescription erectile dysfunction medications and supplements for sexual functioning.

International Index of Erectile Functioning-5: A Critical Appraisal

Background: Some studies have reported methodological flaws and shortcomings in the International Index of Erectile Functioning-5 (IIEF-5) which is a self-report measure for the assessment of erectile dysfunction (ED). Aim: The aim of this research is to point out methodological flaws and shortcomings in IIEF-5 when used with Pakistani men. Settings and Design: Two independent clinical trials were run to assess the efficacy of different forms of treatment for ED in young Pakistani men. Materials and Methods: The IIEF-5 in Urdu version was employed to diagnose and assess the severity of ED in young men at 3 time points. Results and Conclusions: Several flaws and shortcomings were noted including the unidimensionality of the scale, categorization of the scale into severity categories based on cutoff points, the inability of the scale to differentiate between organic and nonorganic ED, double barrel item statement, and lack of standardized translation in local or regional languages of Pakistan. The validity of IIEF-5 can be increased if the above-mentioned flaws and shortcomings are addressed.

110 The Role of Traditional Urology Office Visits for Erectile Dysfunction in Young Men in the Era of Direct-to-Consumer Internet Platforms

Erectile dysfunction (ED) is underrecognized in young men. Direct-to-consumer (DTC) web-based companies have emerged to market prescriptions for oral phosphodiesterase-5 (PDE-5) inhibitors to young men without a thorough diagnostic workup for ED. We hypothesized that these DTC platforms may miss crucial pathology that warrants further evaluation or treatment. We aimed to evaluate clinical benefits of a traditional urology office visit in young men presenting with ED. In particular, we sought to determine underlying or concomitant conditions that would escape identification by DTC online prescribing platforms. With IRB approval, medical records of men under age 40 evaluated at an academic men’s health clinic for ED from January 2016 through March 2019 were reviewed. Demographics, exam findings, lab values, and treatments were extracted. Descriptive statistics were calculated. We identified 281 patients. Age was 29.5 ± 5.0 years. Caucasian men made up 49% of patients, followed by 24% undisclosed race, 14.5% other race, 7.5% Asian-American, and 3.9% African-American. Serum testosterone levels were tested for 265 patients, of which 49 (18.5%) were found to have levels below 300 ng/dL. BMI was calculated for all patients; 35 (13.3%) were found to have a BMI greater than 30. FSH was obtained for 254 patients; 21 (8.3%) were measured at 7.5 miU/mL or above. Of the 281 males that were encountered in clinic, 98 (37%) underwent empiric treatment with clomiphene citrate or anastrazole. Hemoglobin A1c levels were checked in 100 men; 2 (2%) were above 6.5. Total cholesterol was measured in 110 men; 35 (31.8%) were above 200 mg/dL. LDL levels were measured for 102 men; 56 (54%) were above 150 mg/dL. Triglyceride levels were measured for 107 patients; 15 (14%) were above 200 mg/dL. All patients underwent physical exams; 106 (37%) were found to have a varicocele. Twenty-eight men (27%) had a grade 3 varicocele, 41 (39.4%) grade 2, and 37 (35.6%) grade 1. Two patients elected to undergo varicocelectomy.

The global prevalence of erectile dysfunction: a review.

To evaluate the global prevalence of erectile dysfunction (ED); as well as its association with physiological and pathological ageing by examining the relationship between ED and cardiovascular disease (CVD), benign prostatic hyperplasia (BPH), and dementia. We also aimed to characterise discrepancies caused by the use of different ED screening tools. The Excerpta Medica dataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE) were searched to find population-based studies investigating the prevalence of ED and the association between ED and CVD, BPH, and dementia in the general population. The global prevalence of ED was 3-76.5%. ED was associated with increasing age. Use of the International Index of Erectile Function (IIEF) and Massachusetts Male Aging Study (MMAS)-derived questionnaire identified a high prevalence of ED in young men. ED was positively associated with CVD. Men with ED have an increased risk of all-cause mortality odds ratio (OR) 1.26 (95% confidence interval [CI] 1.01-1.57), as well as CVD mortality OR1.43 (95% CI 1.00-2.05). Men with ED are 1.33-6.24-times more likely to have BPH then men without ED, and 1.68-times more likely to develop dementia than men without ED. ED screening tools in population-based studies are a major source of discrepancy. Non-validated questionnaires may be less sensitive than the IIEF and MMAS-derived questionnaire. ED constitutes a large burden on society given its high prevalence and impact on quality of life, and is also a risk factor for CVD, dementia, and all-cause mortality.

ERECTILE DYSFUNCTION AND CAVERNOUS VENO-OCCLUSIVE DISEASE

GoalTo provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanism of vasculogenic erectile dysfunction (ED).MethodsA comprehensive systematic literature search was conducted followed by sorting, review, and summarizing.
 ResultsThe systematic review of the literature reveals a significant number of recent studies dealing with new minimally invasive methods to provide a potential solution of caverno-venous leakage. Even the long-term results reported demonstrate considerable improvement of ED caused by this condition. Furthermore, 3-D computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide high-resolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. Over 30 published studies were found in the literature with good results after caverno-venous leak treatment. Altogether, 13 comparable studies including 538 patients were found, in which a mean short-term success rate of almost 80% and a mean long-term success rate of up to 74% was achieved. None of the studies described major complications.ConclusionED is an increasingly important issue, especially in young men. Whereas the current treatment strategies are mostly focused on older men, young patients are seeking more a longer lasting or more definitive solutions, rather than a lifelong medical treatment. Various chronic disorders have been reported to be associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological disease in older men. Properly selected cases of young men may benefit from treatment of caverno-venous leak treatment. The current strategy in the treatment of ED in young men may be reconsidered.

291 Gray-scale ultrasound to assess persistent erectile dysfunction in young men

Young men exposed to 5 alpha reductase inhibitor (5ARI) finasteride for androgenic alopecia have reported persistent erectile dysfunction (PED). We are unaware of studies assessing their PED pathophysiology. Animals exposed to 5ARI have revealed both prostate smooth muscle and penile smooth muscle cell atrophy and apoptosis. High resolution gray-scale ultrasound (GSU) imaging is an efficient, non-invasive technique to assess cavernosal erectile tissue fibrosis (CETF) in men with ED. In selected men with PED from finasteride, high resolution GSU during maximal pharmacologic smooth muscle relaxation was used to better understand the pathophysiology. A renowned penile ultrasound expert (MB) blindly reviewed high resolution GSU images. Under IRB approval, charts of 27 men with PED (mean age 31) met inclusion/exclu-sion: potent prior to finasteride use; <40 years old with no obvious cardiovascular risk factors; underwent high resolution GSU/color duplex Doppler ultrasound with a high frequency probe (Aixplorer 15.4 MHz transducer) during maximal pharmacologic erection. GSU was performed in axial B-mode at multiple gains, with various dynamic ranges, in multiple penile shaft locations, to determine presence/absence of erectile tissue homogeneity or observation of heterogeneous regions. Color Doppler parameters of peak systolic velocity (PSV) and end-diastolic velocity (EDV) were also assessed. Ten control subjects with ED not exposed to finasteride who had erectile tissue homogeneity on high resolution GSU were also reviewed blindly by the ultrasound expert.

592 Erectile dysfunction in young men (up to 40 years old). What does organic or psychogenic predominate?

592 Erectile dysfunction in young men (up to 40 years old). What does organic or psychogenic predominate?

Sexual Dysfunction Among Young Men: Overview of Dietary Components Associated With Erectile Dysfunction

BackgroundSexual dysfunction is relatively common in young men, presenting in diverse manifestations, including erectile dysfunction (ED), for which dietary modifications, including increased intake of dietary antioxidants, have been suggested as promising and cost-efficient approaches. AimTo assess the consumption of selected dietary antioxidants, in particular flavonoids, in relation to ED symptoms in young men. MethodsMen 18 to 40 years old were invited to complete an anonymous web-based questionnaire for this case-control study. ED was diagnosed with the International Index of Erectile Function (IIEF) and flavonoid intake was recorded using food-frequency questionnaires, with an emphasis on flavonoid-rich foods such as coffee, fruits, etc. Participants without ED (IIEF score ≥ 26; n = 264) formed the control group and those with ED (IIEF score < 26; n = 86) formed the case group. OutcomesDietary flavonoid intake. ResultsMen with ED reported a lower median monthly intake of total flavonoids (−2.18 g, 95% CI = −3.15 to −1.21, P < .001) and all flavonoid subclasses (P < .001) compared with controls. Adjustment of intake for age and body mass index showed that consumption of flavonoids 50 mg/day lowered the risk for ED by 32% (odds ratio = 0.68, 95% CI = 0.55–0.85, P < .001). Of all recorded flavonoids, flavones appeared to contribute the most to healthy erectile function. Controls reported a greater consumption of vegetables and fruits, a lower intake of dairy and alcoholic beverages, and a less intense smoking habit compared with cases (P < .001). Clinical ImplicationsIncreased intake of fruits, vegetables, and flavonoids decreases the risk of ED in young men. Strength and LimitationsThe strength of this study stems from the innovative hypothesis, the young age of participants, and the suggested therapeutic effects of cheap dietary components against ED. Limitations include the relatively small sample and cross-sectional design. ConclusionLow flavonoid—in particular flavone—intake is associated with ED in young adult men.Mykoniatis I, Grammatikopoulou MG, Bouras E, et al. Sexual Dysfunction Among Young Men: Overview of Dietary Components Associated With Erectile Dysfunction. J Sex Med 2018;15:176–182.

Erectile dysfunction is associated with subclinical carotid vascular disease in young men lacking widely-known risk factors.

This study aimed to gain insight into the underlying pathogenesis of erectile dysfunction in young men under the age of 40 years without widely-known risk factors. Compared with normal controls, patients with erectile dysfunction had increased carotid intima–media thickness, fasting levels of blood glucose and insulin, and homeostatic model assessment index, as well as lower flow-mediated vasodilation and testosterone levels (P < 0.05), though all of these values were within their respective normal range. Multivariate logistic regression analysis identified carotid intima–media thickness, flow-mediated vasodilation, insulin level, and homeostatic model assessment index as significant predictors of erectile dysfunction. Young men with flow-mediated vasodilation <10.65% were 11.645 times more likely to have erectile dysfunction, young men with carotid intima–media thickness >0.623 mm had a 4.16-fold, and young men with homeostatic model assessment index >1.614 had a 5.993-fold greater risk of having erectile dysfunction. In conclusions, in young men with normal results from general clinical screening, an increased carotid intima–media thickness and homeostatic model assessment index and reduced flow-mediated vasodilation were associated with a higher incidence of erectile dysfunction. Erectile dysfunction may appear before the detection of traditional cardiovascular risk factors and may be the earliest clinical sign of subclinical cardiovascular disease.

Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors.

Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years. The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED. To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man. Comprehensive review of the literature pertaining to ED in young men. ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed. Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes. Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections. Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment. ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5:508-520.

365 Veno-Ooclusive Insufficiency as Reason of Erectile Dysfunction in Young Men

365 Veno-Ooclusive Insufficiency as Reason of Erectile Dysfunction in Young Men

A syndrome of erectile dysfunction in young men?

Erectile dysfunction in young men is an increasingly common chief complaint seen in urology clinics across the world (1). The international urologic community has taken an increased interest in this topic, with experts in the field of andrology and sexual dysfunction publishing multiple review articles (2,3) and an AUA Update Series Lesson (4) dedicated to this concerning issue. These articles skillfully address the epidemiology and diagnostic evaluation of ED and categorize ED into psychogenic or organic causes, addressing treatment options with specific interventions for each of the most common diagnoses.

Psychogenic cause is not the main risk factor for erectile dysfunction in young men compared to the aging group

Psychogenic cause is not the main risk factor for erectile dysfunction in young men compared to the aging group

Sex Hormones Predict the Incidence of Erectile Dysfunction: From a Population-Based Prospective Cohort Study (FAMHES).

The decline of testosterone has been known to be associated with the prevalence of erectile dysfunction (ED), but the causal relationship between sex hormones and ED is still uncertain. To prove the association between sex hormones and ED, we carried out a prospective cohort study based on our previous cross-sectional study. We performed a prospective cohort study of 733 Chinese men who participated in Fangchenggang Area Males Health and Examination Survey from September 2009 to December 2009 and were followed for 4 years. Erectile function was estimated by scores of the five-item International Index of Erectile Dysfunction (IIEF-5) and relative ratios (RRs) were estimated using the Cox proportional hazards regression model. Data were collected at follow-up visit and included sex hormone measurements, IIEF-5 scores, physical examination, and health questionnaires. Men with the highest tertile of free testosterone (FT) (RR = 0.21, 95% confidence interval [CI]: 0.09-0.46) and the lowest tertile of sex hormone-binding globulin (SHBG) (RR = 0.38, 95% CI: 0.19-0.73) had decreased risk of ED. In young men (aged 21-40), a decreased risk was observed with the increase of FT and bioavailable testosterone (BT) (adjusted RR and 95% CI: 0.78 [0.67-0.92] and 0.75 [0.62-0.95], respectively). Total testosterone (TT) (RR = 0.89, 95% CI: 0.81-0.98) was inversely associated with ED after adjusting for SHBG, while SHBG (RR = 1.04, 95% CI: 1.02-1.06) remained positively associated with ED after further adjusting for TT. Men with both low FT and high SHBG had highest ED risk (adjusted RR = 4.61, 95% CI: 1.33-16.0). High FT and BT levels independently predicted a decreased risk of ED in young men. Further studies are urgently needed to clarify the molecular mechanisms of testosterone acting on ED.

Effects of anxiety on gonadal hormone levels and erectile dysfunction in young men

Objective To explore the effects of anxiety-like behaviors on the levels of sex hormones and severity of erectile dysfunction(ED) in young men. Methods A total of 120 young men with ED, between the ages of 23 and 35 years, were prospectively studied, and all of them were the outpatients from the Affiliated Hospital of Jining Medical University from January 2012 to October 2013.Self-Rating Anxiety Scale (SAS) was used. According to the scores of SAS, the patients were divided into four groups. 26 were rated by SAS as in the normal, 36 in the mild, 32 in the moderate and 26 in the severe state of anxiety. The levels of serum sex hormone (FSH, LH, PRL, T, E2) were detected by immunochemiluminometric assays. ED was assessed using the IIEF-5. Further, the responses were divided into three diagnosing groups on the basis of cutoff scores for IIEF-5. The relationship between the SAS scores of measuring anxiety, serum sex hormone levels, and the indicators for ED, Spearman rank correlations were carried out. Results Comparing with the normal control group, the levels of serum sex hormones(FSH, LH, PRL, E2) increased in other groups, but there were no significant differences (F=0.28, P=0.08; F=2.91, P=0.06; F=0.90, P=0.44; F=0.80, P=0.15). The levels of serum testosterone and the scores of IIEF-5 in the moderate and severe anxiety group decreased.The more severe symptoms of anxiety, the more likely that the ED would occur(χ2=72.423, P=0.00), and ED was significantly positively correlated with anxiety(r=0.637, P=0.00). Testosterone played the partial intermediary role on the relationship between anxiety score and the IIEF-5 score. Conclusion Anxiety may contribute to ED through disturbing the sex hormone and lowering the level of serum testosterone. Key words: Anxiety; Young men; Serum sex hormone; Erectile dysfunction