Consultant Endocrinologist Golden Hospital, Jalandhar, India Jalandhar, Punjab, India
Objective: Erectile Dysfunction(ED) is quite common in male subjects with Type 2 Diabetes Mellitus and many of them have Hypogonadism (low testosterone). There are subjects having ED despite having normal testosterone levels and among them some may have Compensated hypogonadism (CH), an entity characterized by normal testosterone with an increase in LH level and is associated with a unique symptomatology. The objective was to determine the prevalence of CH in male subjects with type 2 diabetes having ED and to evaluate its correlations.
Methods: It was a cross-sectional study among the T2DM subjects attending the OPD of an Endocrinology Specialty Hospital. 500 male subjects with T2DM were screened for ED using International Index of Erectile Function-5 (IIEF-5) questionnaire, which consists of 5 items; a sum score of 21 or less indicates the presence of ED. Out of these 127 (25.4%) subjects were diagnosed as having ED. These subjects underwent clinical and biochemical evaluation including Lipid profile, HbA1c, Testosterone, LH, TSH, Prolactin. Compensated hypogonadism was defined (European Male Aging Study) as total testosterone >10.5 nmol/L and LH > 9.4 IU /L.
Results: The mean age of the participants was 56.4 ± 6.7 years and the mean duration of diabetes was 11.9 ± 7.4 years. Hypertension was present in 51.5% and CAD in 26.6% of subjects. Among the participants 44.2% had hypogonadism (low T) whereas compensated hypogonadism was present in additional 9.5%. CH was positively correlated with older age (>55yrs) (p < 0.01), the severity of ED (p-0.02), Hypertension (p-0.02), CAD (p < 0.01) and LDL (p-0.012) but not with HbA1c. There was a statistically significant negative correlation between LH level and IIEF-5 score.
Discussion/Conclusion: Hypogonadism is common in males with T2DM and is characterized by clinical and biochemical evidence of testosterone deficiency. Compensated hypogonadism (CH) is a subclinical deficiency of testosterone (normal testosterone and high LH). Symptoms of CH may include ED, low moods, decreased muscle mass, sleep disturbances, mobility issues and fatigue. Our study shows CH to be correlating with sexual dysfunction, hypertension, CAD and LDL in subjects with T2DM. Hypogonadism is treated with testosterone but in CH only limited studies have demonstrated some positive effects of testosterone therapy and the clinical meaningfulness of these findings remains debatable. The present management strategies for CH include healthy lifestyle habits, exercise, nutritious diet, reducing stress and getting good sleep. We suggest larger studies to validate our findings, to essentially include LH estimation in the workup of ED and consider formation of guidelines regarding management of CH in subjects with T2DM including the place of testosterone therapy.