Prevalence of Endocrine and Metabolic Disorders in Subjects with Erectile Dysfunction

ISSM – Abstract –April 2015

Prevalence of Endocrine and Metabolic Disorders in Subjects with Erectile Dysfunction: A Comparative Study

Elisa Maseroli, MD; Giovanni Corona, MD, PhD; Giulia Rastrelli, MD, PhD; Francesco Lotti, MD; Sarah Cipriani, MD; Gianni Forti, MD; Edoardo Mannucci, MD; and Mario Maggi, MD

ONLINE: February 16, 2015 – The Journal of Sexual Medicine

DOI: 10.1111/jsm.12832


Hormones are an integral part of sexual function and are often associated with erectile dysfunction (ED). With erectile dysfunction (ED), the relationship can be bidirectional: Hormonal problems may lead to ED, but they can also be the result of ED
Typically, endocrine disorders are simple to diagnose and treat.  it is unclear how prevalent they are in random, population-based samples.

The current study compared the prevalence of endocrine and metabolic disorders in two populations from the same geographic area (Florence, Italy).

Materials and Methods

This was a cross-sectional study involving two cohorts:

European Male Aging Study (EMAS): 202 men with a mean age of 55 years. None of the men had erectile dysfunction, low libido, or decreased morning erections. 

University of Florence (UNIFI): 3,847 men with a mean age of 60 years who were seeking first-time treatment for ED.

Clinical and Biochemical Analyses

Each participant had a complete physical exam to assess blood pressure, weight, height, and waist circumference.

Morning blood samples were taken after an overnight fast. These samples were analyzed for glucose, total testosterone, luteinizing hormone (LH), prolactin (PRL), and thyroid stimulating hormone (TSH).



• Primary and secondary hypogonadism were more prevalent in the UNIFI group.
• Compensated hypogonadism was more common in the EMAS group, even after age adjustments

Hypo / Hyperthyroidism

• No significant differences were found for overt thyroid disorders.
• Subclinical hyperthyroidism was more prevalent in the EMAS group but subclinical hypothyroidism was not.                                                                                                                                                                                                                               

Hypo / Hyperprolactinemia

• No significant differences were found for either mild or severe hyperprolactinemia.
• The prevalence of hypoprolactinemia was significantly higher in the UNIFI group, even after accounting for age, body mass index (BMI), and testosterone.

Metabolic Disorders

Central obesity, impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM) were more often detected in the UNIFI group.


“We confirm here that subjects with ED represent a population steeped in metabolic disorders, such as central obesity, IFG, and T2DM,” the authors wrote.

In their study results, thyroid disorders and hyperprolactinemia did not appear to be risk factors for ED. However, hypoprolactinemia was more prevalent among men with sexual dysfunction.

The data show that milder glucose abnormalities, in addition to diabetes, can be risk factors for ED.

Only central obesity – but not obesity or overweight assessed via BMI – was more common in the men with ED. This might be explained by central-obesity-related hypogonadism.

Secondary hypogonadism was twice as common in the men with ED, but this was not the case for primary hypogonadism.  This could be related to the increased prevalence of metabolic disorders in men with ED.

In this study, a higher prevalence of severe hyperprolactinemia was not found in the UNIFI cohort.

Reduced, not elevated, PRL levels were more common in study subjects with ED.

They concluded that T2DM, IFG, central obesity, secondary hypogonadism, and hypoprolactinemia were more prevalent in men with ED when compared to the general population in this geographic area.