SEATTLE — Low-testosterone problems are not as rare as one might think because they're associated with two common conditions: erectile dysfunction and metabolic syndrome, Dr. Richard F. Spark said at the annual meeting of the American Association of Clinical Endocrinologists.
“Some new developments indicate that there are a lot more patients with hypogonadism than we have been aware of,” said Dr. Spark, an endocrinologist at Beth Israel Deaconess Medical Center, Boston.
One of the first reports that erectile dysfunction could be associated with low testosterone was his own, published in 1980. He measured serum testosterone in 105 consecutive patients who were seen for what was then called impotence and found that 20 of them had low serum testosterone, and when they were treated for that, their erectile dysfunction went away (JAMA 1980;243:750–5).
In 2000, a meta-analysis of studies of testosterone replacement suggested that 57% of patients with erectile dysfunction treated with testosterone had resolution of their problem, including 64% of those with primary hypogonadism (J. Urol. 2000;164:371–5).
Testosterone has gotten a bad rap because of all of the press about athletes who abuse anabolic steroids, and because the controversies regarding estrogen/progesterone therapy for women have made people wary of hormone replacement, Dr. Spark said. “Until recently, the urologists had primarily insisted that there was no man [complaining of ED] in their practice who had low testosterone, and they all went on to have penile implants.”
Low testosterone has also been associated with type 2 diabetes and metabolic syndrome, Dr. Spark said. In a study of 103 men with type 2 diabetes, 33% had low testosterone levels, and low testosterone was found in all the age groups (J. Clin. Endocrinol. Metab. 2004;89:5462–8).
Individuals with metabolic syndrome have a 2.6 times higher risk of having low testosterone than does the general male population, and low testosterone has been shown to predict onset of type 2 diabetes. “One should check testosterone in metabolic syndrome patients and look for metabolic syndrome in low-testosterone patients,” he said.