Men with erectile dysfunction (ED) might have increased cardiovascular risk when their testosterone levels fall below 12 nmol/L, according to a recent Journal of Sexual Medicine study.
Dr. José M. Martínez-Jabaloyas of Hospital Clínico Universitario in Valencia, Spain authored the study on behalf of the ED-SDT study group.
The research team noted that when men with ED have low testosterone levels, their risk for cardiovascular issues increases. However, the threshold at which this occurs has not been established.
Their goals for this study were to examine possible thresholds and to determine which cardiovascular risk factors might be associated with low testosterone.
Over 1,200 men with ED participated in the study. Their mean age was 58.1 years.
The researchers assessed a number of variables for each man, including testosterone levels, overall obesity, abdominal obesity, use of tobacco and alcohol, hyperlipidemia, diabetes, hypertension, hypolipidemic therapy, and ED severity.
Almost 14% of the men were classified as hypogonadic, with total testosterone levels at or below 8 nmol/L. About 20% were considered borderline, with levels falling in the range of 8 – 12 nmol/L. Approximately two-thirds of the men had levels at or above 12 nmol/L and were classified as eugonadic. Generally, men’s ED severity worsened as their testosterone levels decreased.
Men with obesity, severe ED, hyperlipidemia, or hypertension tended to have lower total testosterone levels, as did those who were on hypolipidemic therapy. Low testosterone-related cardiovascular risk was best predicted by obesity and severe erectile dysfunction.
The prevalence of cardiovascular risk factors was similar for hypogonadic and borderline men when compared to eugonadic men. For this reason, the researchers suggested that the 12 nmol/L be considered the threshold when assessing these factors.
Dr. Martínez-Jabaloyas explained that even with these findings, it was difficult to tell whether the high prevalence of cardiovascular risk factors caused low testosterone or whether the reverse was true.
He also added that the association between low testosterone and higher cardiovascular risk “is still controversial” and that while some studies have found higher rates of cardiovascular mortality among men with low testosterone levels, “it cannot be ruled out that low [testosterone] could merely be an indicator of poor health affecting prognosis rather than a [cardiovascular] marker itself.”
His report was first published online in June in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Martínez-Jabaloyas, José M., MD, PhD
“Testosterone Deficiency in Patients with Erectile Dysfunction: When Should a Higher Cardiovascular Risk Be Considered?”
(Full-text. First published online: June 5, 2014)