Is it the ED that kills patients or their low testosterone?
This month's module of The Confident Clinician covered sexual health and libido, including a 90 minute lecture on treating erectile dysfunction.
The 90 minute webinar we shared with our community covered the nutrition and nutraceuticals that are effecacious for erectile dysfunction and how to assess ED as a marker for cardiovascular disease.
A 2022 study by Antonio (2022) stratified men by number of sexual symptoms, hormone levels and age to try and answer the age-old question about which is the chicken and which is the egg in our male patients.
Is it low testosterone that is the main issue? Or is ED an independent predictor of early death?
This podcast reviews what was found in this study and how to think about the stratification of evidence to help us understand where to place focus.
Enjoy the episode!
Erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status
Leen Antonio PMID: 35429269 DOI: 10.1093/ageing/afac094
Abstract Background: erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men.
Design: survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality.
Results: about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1 years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk.
Conclusions: sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.
