Low levels of androgens in men with erectile dysfunction and obesity

Introduction. The relationship between obesity and erectile dysfunction (ED) has not been completely clarified. Aim. The aim of this study is to investigate the association between different obesity class (the World Health Organization definition) with several hormonal and instrumental parameters, in a large sample of patients with ED. Methods. A consecutive series of 2,435 (mean age 52.1 +/- 13.0 years) male patients with ED was investigated. Main Outcome Measures. Several hormonal and biochemical parameters were studied, along with a structured interview on erectile dysfunction (SIEDY), a psychometric questionnaire (Middle Hospital Questionnaire), and penile doppler ultrasound (PDU). Results. Among patients studied, 41.5% were normal weight, while 42.4%, 12.1% and 4.0% showed a BMI of 25-29.9, 30-34.9 and 35 kg/m(2) or higher, respectively Androgen levels (including sex hormone-binding globuline bound and unbound testosterone) decreased as a function of obesity class, while luteinising hormone levels did not show any significant change. Obesity was significantly associated with a higher organic contribution to ED (as assessed by SIEDY scale 1 score), and worse PDU parameters. At multivariate linear regression analysis, after adjustment for confounders (including metabolic syndrome), low androgens remained associated with BMI, while both basal and dynamic (after prostaglandin El [PGE1] stimulation) peak systolic velocity (PSV) at PDU resulted Significantly associated with age and elevated blood pressure (Adj. r = -0.179, -0.285 and -0.094, -0.071 for age, hypertension and for basal and dynamic PSV respectively; all P < 0.05). Conclusions. Obesity is characterized by low levels of androgens in men with ED, after adjustment for comorbidities. Obesity associated comorbidities, particularly, hypertension, are the most important determinants of arteriogenic obesity-associated ED.