Association between serum testosterone level and erectile dysfunction among type 2 diabetes mellitus.

Thesis Report.

ABSTRACT:

BACKGROUND: Diabetes is ranked the top five non communicable disease of the world, including the Southeast Asian-countries like India and Nepal. Besides the notorious complications like renal failure and acute coronary syndrome, conditions having the psychosocial impact like erectile dysfunction is also worth looking into. Lower Serum Testosterone (LST) level and Erectile dysfunction (ED) are the distressing complications of diabetes contributed by impaired vasodilatory signalling, smooth muscle cell hypercontractility, microvascular changes, neuropathy and endothelial dysfunction due to hyperglycaemia leading to hypogonadism. OBJECTIVE: This study was intended to determine the association of Serum Total Testosterone (STT) and ED among T2DM patients and other associated risk factors like age, Body Mass Index (BMI), Waist circumference, duration of T2DM and glycated hemoglobin.

MATERIALS AND METHOD: Male patients visiting medicine department of Tribhuvan University Teaching Hospital with Type 2 Diabetes Mellitus (T2DM) were enrolled in this cross-sectional study. A pre-structured questionnaire was used for demographic data. A validated questionnaire, an abridged 5-item version of the International Index of Erectile Function (IIEF-5), was used to assess ED where ED was established when IIEF score was <22. Blood samples were taken for estimation of STT. XVII

RESULTS: A total of 160 patients were enrolled in the study with a mean age of 45 years. The prevalence of ED with varying degree of severity was found to be 76.87% and the frequency of LST was 48.75% at 95% Confidence Interval. The reduction in total testosterone (p=0.005) was significantly associated with ED among study population. STT below 300 ng/dL in this study showed statistically significant with the presence of ED (p=0.02) and reduced IIEF5 score (p=0.04). There was a significant positive correlation of IIEF5 Score with STT level (r=0.224, p=0.004) while negative correlation was found with other comorbidities like duration of T2DM (r= -0.416, p=0.000) and HbA1c (r= -0.391, p=0.000).

CONCLUSIONS: The higher prevalence of ED was associated with lower STT level among T2DM patients which were also attributed with other comorbidities like higher HbA1c level and the duration of T2DM.

KEY WORDS: Type 2 Diabetes Mellitus (T2DM), Erectile dysfunction (ED), Lower Serum Testosterone (LST), Serum Total Testosterone (STT)