By Cher Thornhillr

April 2008 | medwire-news.md

Urology 2008; 71: 693-697

MedWire News: Clinicians should consider the possibility of androgen deficiency in men who present with erectile dysfunction (ED), researchers say.

Almost half of 2794 men presenting with ED had serum testosterone levels <400 ng/dl - a cut-off used in androgen deficiency definitions - and the incidence increased with age, the team reports.

ED and androgen deficiency in aging men are two separate clinical entities that often overlap, say the investigators, led by Manoj Monga from the University of Minnesota School of Medicine in Minneapolis, USA.

However, the testosterone level that defines androgen deficiency in aging men (ADAM) remains controversial, and its prevalence in men with ED has remained uncertain.

The team analyzed testosterone measurements for 2794 men aged 25-80 years who presented with ED between 1987 and 2002.

They also analyzed how factors, including age, diabetes, cholesterol, anemia, creatinine, and prostate-specific antigen (PSA), correlated with hypogonadism, as defined by multiple cut-off points.

Previous Endocrine Society guidelines have defined ADAM [Androgen Deficiency in Aging Men] as a testosterone level below the cut-off of 200 ng/dl, or two separate testosterone tests at <400 ng/dl in conjunction with the typical symptoms, which include loss of libido, depression, lethargy, osteoporosis, and loss of muscle mass or strength.

Updated guidelines stress the use of clinical signs and symptoms, but shy away from a preset cutoff point.

Based on cut-offs of less than 200 ng/dl, less than 300, less than 346, and less than 400 ng/dl, respectively, ADAM incidence was 7%, 23%, 33%, and 47%, Monga et al report in the journal Urology.

Linear regression analysis revealed low testosterone levels were significantly associated with increasing age, the presence of uncontrolled diabetes, high total cholesterol, and anemia.

On average, men's serum testosterone level declined by 2.3 ng/ml with each increasing year of age. However, testosterone levels rose abruptly between ages 45 and 50 years, before reaching a plateau until age 80 years.

Monga and co-workers say that androgen deficiency was "quite common" in men presenting with ED, particularly in older men, and those with uncontrolled diabetes, hypercholesterolemia, or anemia.

They say that men with ED who have low testosterone levels "require additional work-up" to rule out underlying causes, including ADAM, and may benefit from testosterone supplementation.

"Our data strongly support routine testosterone screening in men older than 45 years who present with ED," they add.

© 2008 Current Medicine Group Ltd, a part of Springer Science+Business Media