Androgen deficiency, erectile dysfunction and chronic microvascular complications in male diabetic patients

Olivia Georgescu 1 , 2 , Aura Reghină 2 , 3 , Sorin Ioacără 2 , 3 , Cătălin Nica 2  and Simona Fica 2 , 3
  • 1 University Hospital, Bucharest, Romania University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
  • 2 Department of Endocrinology, Diabetes and Metabolic Diseases, Elias Emergency University Hospital, Bucharest, Romania
  • 3 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania


Background and aim: Erectile dysfunction (ED) can be present in diabetic patients not only induced by androgen deficiency, but also as a consequence of diabetes chronic complications. The aim of our study was to evaluate androgen status and chronic microvascular complications in patients with diabetes mellitus (DM), with and without ED. Material and methods: 292 patients (44 Type 1 diabetes - T1DM/ 248 Type 2 diabetes - T2DM), were evaluated for androgen status: dehydroepiandrosterone (DHEA), free testosterone (FT) and presence of chronic complications. ED was diagnosed by a score under 22 of 5-item International Index of Erectile Function (IIEF). Patients with free-testosterone < 70 pg/ml were considered hypogonadal. Results: Prevalence of ED was higher in T2DM 87.5% than in T1DM 65.9%. In patients with ED the prevalence of hypogonadism was 31.3% in T1DM, 26.7% in T2DM. In older T2DM patients IIEF-score was significantly correlated with DHEA. There was a significant correlation between ED and retinopathy in T1DM, additionally with neuropathy in T2DM. Conclusions: ED is a common comorbidity in diabetic patients, associated with other microvascular complications. Hypogonadal status might explain up to 30% of ED. In older diabetic men, severity of ED is related to lower DHEA.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RG, MC Kinley JB. Impotence and its medical and psychosocial relates: results of the Massachusetts Male Ageing Study. J Urol 151: 54-61, 1994.

  • 2. Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in man. Clin Endocrinol (Oxf) 63: 239-250, 2005.

  • 3. Kempler P. Erectile dysfunction. In: Neuropathies. Kempler P (ed). Springer Scientific Publisher, Budapest, pp. 123-128, 2002.

  • 4. Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metabol 89: 5462-5468, 2004.

  • 5. Kaplan SA, Meehan AG, Shah A. The age related decrease in testosterone is significantly exacerbated in obese men with the metabolic syndrome. What are the implications for the relatively high incidence of erectile dysfunction observed in these men? J Urol 176: 1524-1528, 2006.

  • 6. Haffner SM, Shaten J, Stern MP et al. Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Am J Epidemiol 143: 889-897, 1996.

  • 7. Stellato RK, Feldman HA, Hamdy O, Horton ES, Mc Kinlay JB. Testosterone, sex hormone-binding globulin and the development of type 2 diabetes in middleaged men: prospective results from the Massachusetts male ageing study. Diabetes Care 23: 490-494, 2000.

  • 8. Laaksonen D, Niskanen L, Punnonen K et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle age men. Diabetes Care 27: 1036-1041, 2004.

    • Crossref
  • 9. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5- item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11: 319-326, 1999.

  • 10. Kahn RC, Weir GC. Retinopathy. In: Joslin’s Diabetes Mellitus 13-th ed. Lea & Febiger Waverly Company, 1992.

  • 11. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39[2 Suppl 1]: S1- S266, 2002.

  • 12. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84: 3666-3672, 1999.

    • PubMed
  • 13. Henis O, Shahar Y, Steinvil A et al. Erectile dysfunction is associated with severe retinopathy in diabetic men. Urology 77: 1133-1136, 2011.

  • 14. Chew SK, Taouk Y, Xie J et al. Relationship between diabetic retinopathy, diabetic macular oedema and erectile dysfunction in type 2 diabetics. Clin Exp Ophthalmol 41: 683-689, 2013.

  • 15. Moţa M, Lichiardopol C, Moţa E, Pănuş C, Pănuş A. Erectile dysfunction in diabetes mellitus. Rom J Intern Med 41: 163-177, 2003.

    • PubMed
  • 16. Martin-Jabaloyas JM, Quipo-Zaragoza A, Pastor-Hermandez F, Gil-Salom M, Chuan-Nuez P. Testosterone levels in men with erectile dysfunction. BJU Int 97: 1278-1283, 2006.

  • 17. Rabijewski M, Zgliczynski W. The high prevalence of testosterone deficiency syndrome and erectile dysfunction in the aging men with diabetes mellitus type 2. Endocrine Abstracts 16: P260, 2008.

  • 18. Basar MM, Aydin G, Mert HC et al. Relationship between serum sex steroids and Aging Male Symptoms score and International Index of Erectile Function. Urology 66: 597-601, 2005.

  • 19. Rathi M, Ramachandran R. Sexual and gonadal dysfunction in chronic kidney disease. Pathophysiology. Indian J Endocrinol Metab 16: 214-219, 2012.

    • Crossref
    • PubMed
  • 20. Bellinghieri G, Santoro D, Mallamace A, Savica V. Sexual dysfunction in chronic renal failure. J Nephrol 21[Suppl. 13]: S113-S117, 2008.

  • 21. Valles-Antuna C, Fernandez-Gomez J, Fernandez-Gonzalez F. Peripheral neuropathy: an underdiagnosed cause of erectile dysfunction. BJU Int 108: 1855-1859, 2011.


Journal + Issues