Hormonal determinants of erectile dysfunction and lower urinary tract symptoms in middle-aged and elderly men with prediabetes

Figures & data

Table 1. Baseline characteristics of all patients men with PD, in the two age groups patients with PD, and in control group.

Clinical and laboratory variables	PD – 40–80 years no. 176	PD – 40–59 years no. 102	PD – 60–80 years no. 74	p*	Control group no. = 184	p**
Age, years	59 ± 6	52 ± 4	68 ± 5	NS	61 ± 5	NS
TT, nmol/l	13.5 ± 3.9	15.9 ± 3.5	11.6 ± 3.7	0.001	16.9 ± 4.3	0.02
cFT, nmol/l	0.326 ± 0.08	0.359 ± 0.09	0.313 ± 0.08	0.005	0.374 ± 0.11	0.05
DHEAS, ng/ml	541 (196–884)	675 (229–921)	238 (159–739)	0.01	698 (234–967)	NS
IGF-1, ng/ml	89.5 ± 46.3	94.6 ± 47.6	88.5 ± 41.5	NS	95.2 ± 18.3	NS
LH, IU/l	5.8 ± 1.4	5.4 ± 1.4	6.2 ± 1.5	0.05	5.1 ± 1.3	0.05
E2, pg/ml	29.7 ± 9.2	28.2 ± 12.5	32.9 ± 10.7	0.02	26.9 ± 11.7	0.02
SHBG, nmol/l	32.6 ± 4.2	31.4 ± 4.1	32.9 ± 3.8	NS	30.7 ± 5.1	NS
BMI, kg/m^2	29.3 ± 4.4	28.7 ± 4.5	30.5 ± 4.6	0.05	27.5 ± 4.2	0.05
WC, cm	102 ± 7.8	101 ± 7.5	103 ± 7.2	NS	99 ± 7.6	NS
HbA1c, %	6.0 ± 0.3	5.8 ± 0.2	6.1 ± 0.3	0.02	5.4 ± 0.2	0.02
FPG, mg/dl	115 ± 5.9	113 ± 5.2	122 ± 6.4	0.01	88 ± 7.8	0.001
Glucose in OGTT, mg/dl	140 ± 6.3	138 ± 12.3	146 ± 12.1	0.05	128 ± 13	0.05
SBP, mmHg	127 ± 15	124 ± 17	136 ± 17	NS	123 ± 16	NS
DBP, mmHg	93 ± 12	91 ± 13	95 ± 12	NS	89 ± 14	NS
Cholesterol, mg/dl	221 ± 42	219 ± 43	226 ± 38	0.05	209 ± 14	0.05
Triglicerides, mg/dl	168 ± 13	166 ± 14	173 ± 14	NS	163 ± 15	NS
HDL-cholesterol, mg/dl	36 ± 5	38 ± 6	34 ± 5	0.05	39 ± 7	NS
LDL-cholesterol, mg/dl	148 ± 23	144 ± 23	152 ± 24	NS	141 ± 21	NS
Comorbidities
Obesity, %; (no.)	68 (120)	71 (72)	65 (48)	NS	60 (1111	0.02
Current smoker, %, (no.)	26 (45)	29 (30)	20 (15)	0.05	24 (44)	NS
Hypertension, %, (no.)	51 (82)	37 (39)	58 (43)	0.01	48 (88)	NS
MetS, %, (no.)	80 (142)	79 (81)	84 (62)	NS	61 (112)	0.02
CVD, %, (no.)	18 (32)	10 (10)	30 (22)	0.001	16 (29)	NS
COPD, %, (no.)	17 (30)	13 (13)	23 (17)	0.05	14 (25)	NS
IIEF
Points	11.8 ± 6.2	13.9 ± 6.2	9.9 ± 5.5	0.001	15.5 ± 4.7	0.01
ED, %, (no.)	30 (52)	20 (24)	38 (28)	0.001	24 (45)	0.02
IPSS
Points	7.7 ± 4.2	6.9 ± 3.7	8.5 ± 3.9	0.002	6.8 ± 4.2	0.01

Data are presented as a mean ± SD of the mean, a median (with lower and upper quartiles) or number (percentage), where appropriate. *p shows differences between prediabetic men 60–80 and 40–59 years old; **p shows difference between all patients with PD and control group. ED was diagnosed when the total of the IIEF domain scores was <22 points.

BMI, body mass index; TT, total testosterone; cFT, calculated free testosterone; LH, luteinizing hormone; DHEAS, dehydroepiandrosterone sulfate; SHBG, sex hormone binding globuline; E2, estradiol; HbA1c, glycated hemoglobin; IGF-1, insulin-like growth factor 1; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; MetS, metabolic syndrome; CVD, cardiovascular disease; COPD, chronic obstructive pulmonary disease; SBP, systolic blood pressure; DBP, diastolic blood pressure; WC, waist circumference; IIEF, the International Index for Erectile Function; IPSS, the International Prostate Symptom Score.

Figure 1. Prevalence (%) of ED in men with PD (n = 176) and healthy men (n = 184). ED was diagnosed according to the IIEF [19] when the total of the IIEF domain scores was <22 points.

Figure 2. Severity (expressed as points) of ED symptoms according IIEF scale (A), and LUTS symptoms according IPSS scale (B) in men with PD aged 40–59 years (n = 102) and aged 60–80 years (n = 74), compared with healthy peers (n = 184). Higher score on the IIEF scale is associated with less severe symptoms; lower score on the IPSS scale is associated with less severe symptoms.

Table 2. Correlations between IIEF and IPSS scores and clinical characteristics in 176 men with PD.

	IIEF points		IPSS points
Variables	r	p	R	p
Age	−0.027	0.38	0.071	0.27
BMI	0.047	0.48	0.3782	0.34
HbA1c	−0.3236	0.02	0.3786	0.01

IIEF, the International Index for Erectile Function; IPSS, the International Prostate Symptom Score; BMI, body mass; HbA1c, glycated hemoglobin; Correlations were examined by Pearson’s correlation analyses.

Table 3. Parameters associated with the severity of ED (according IIEF scale) and LUTS (according IPSS scale) symptoms in men (n = 176) with PD.

	IIEF		IPSS
Variables	Univariable models	Multivariable models corrected (R^2 = 27%***)	Univariable models	Multivariable models corrected (R^2= 30%***)
Men with PD aged 40–59 years
Age, years	0.19	–	0.11	–
TT, nmol/l	−0.24**	−0.21	−0.22*	−0.31*
cFT, nmol/l	−0.32*	−0.24*	−0.29**	−0.16
DHEAS, ng/ml (In)	−0.21**	−0.20*	−0.19***	−0.12*
IGF-1, ng/ml	−0.29*	−0.27	−0.26**	−0.22*
E2, pg/ml	0.02	–	0.07	–
BMI, kg/m^2	0.15	–	0.13	–
HbA1c, %	0.20***	0.20*	0.04	–
Hypertension, yes versus no	0.09	–	0.08	–
Obesity, yes versus no	0.23*	0.32	0.22***	0.31*
MetS, yes versus no	0.19**	0.23*	0.14	–
CVD, yes versus no	0.27	–	0.20*	0.34
COPD, yes versus no	0.1	–	0.16*	0.23
Men with PD aged 60–80 years
Age, years	0.14	–	0.28	–
TT, nmol/l	−0.23**	−0.21*	−0.24	–
cFT, nmol/l	−0.29**	−0.22	−0.21**	−0.31*
DHEAS, ng/ml (In)	−0.25**	−0.28*	−0.19***	−0.24*
IGF-1, ng/ml	−0.16***	−0.31*	−0.24*	−0.19
E2, pg/ml	0.16	–	0.19	–
BMI, kg/m^2	0.11	–	0.21	–
HbA1c, %	0.31*	0.22	0.22*	0.32
Hypertension, yes versus no	0.08	–	0.06	–
Obesity, yes versus no	0.21***	0.19*	0.22	–
MetS, yes versus no	0.20***	0.31	0.19***	0.24*
CVD, yes versus no	0.32*	0.23*	0.39*	0.23
COPD, yes versus no	0.32**	0.18	0.19***	0.28

Data are presented as standardized regression coefficients β (both in univariable and multivariable models). All variables shown to be significant determinants of the severity of ED and LUTS symptoms in the univariable models (p < 0.05) were included in the multivariable models. ln, natural logarithm. IIEF, the International Index for Erectile Function, IPSS, the International Prostate Symptom Score.

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 4. Risk factors associated with the higher prevalence of ED in men with PD.

				Univarable model				Multivariable model
Variables	Men with ED	Men without ED	Unit	OR	CI	χ^2	p	OR	CI	χ^2	p
	(n = 24)	(n = 78)	Men with PD aged 40–59 years
Age, years	53 ± 3	49 ± 4	1 year	0.68	0.54–0.92	3.62	0.21	–	–	–	–
TT, nmol/l	15.3 ± 3.2	16.4 ± 3.5*	1 nmol/l	1.04	0.98–1.06	0.68	0.01	1.22	0.58–1.88	2.90	0.28
cFT, nmol/l	0.342 ± 0.09	0.367 ± 0.08*	1 nmol/l	0.88	0.68–1.06	4.56	0.03	0.61	0.45–0.74	4.59	0.05
DHEAS, ng/ml (In)	684 (221–971)	702 (236–929)	1 In ng/ml	0.72	0.38–3.12	1.12	0.02	1.26	1.07–1.38	5.35	0.05
IGF-1, ng/ml	91.8 ± 37.4	95.6 ± 32.8**	1 ng/ml	1.22	0.99–1.33	3.41	0.17	–	–	–	–
E2, pg/ml	29.6 ± 12.3	28.2 ± 11.5	1 pg/ml	1.23	0.94–2.28	0.62	0.53	–	–	–	–
BMI, kg/m^2	28.3 ± 4.9	29.4 ± 4.7	1 kg/m^2	2.23	1.78–2.74	1.21	0.15	–	–	–	–
HbA1c, %	5.9 ± 0.3	6.1 ± 0.3**	1%	2.21	1.37–4.52	7.34	0.046	–	–	–	–
Hypertension, yes	38 (9)	38 (30)	yes versus no	2.67	1.97–3.34	0.41	0.76	–	–	–	–
MetS, yes	83 (20)	78 (61)	yes versus no	2.31	1.55–5.62	0.18	0.12	–	–	–	–
CVD, yes	13 (3)	9 (7)	yes versus no	1.48	0.75–3.68	0.31	0.52	–	–	–	–
	(n = 28)	(n = 46)	Men with PD aged 60–80 years
Age, years	70 ± 4	67 ± 4	1 year	0.87	0.62–1.23	2.43	0.45	–	–	–	–
TT, nmol/l	10.3 ± 3.8	12.7 ± 3.7*	1 nmol/l	0.81	0.65–1.33	3.56	0.02	1.21	0.85–1.31	3.34	0.02
cFT, nmol/l	0.296 ± 0.08	0.324 ± 0.07**	1 nmol/l	0,73	0.58–1.23	0.41	0.94	–	–	–	–
DHEAS, ng/ml (In)	201 (159–565)	256 (171–739)	1 In ng/ml	3.45	2.23–5.78	9.563	0.01	1.89	1.21–4.56	4.78	0.21
IGF-1, ng/ml	78.74 ± 39.8	44.3 ± 38.5*	1 ng/ml	1.31	0.79–1.86	3.28	<0.001	1.66	1.23–3.11	2.88	0.03
E2, pg/ml	33.7 ± 8.9	31.2 ± 9.8	1 pg/ml	1.45	0.77–1.76	1.16	1.45	–	–	–	–
BMI, kg/m^2	34.2 ± 4.6	30.2 ± 4.3	1 kg/m^2	2.23	1.45–5.34	0.45	0.48	–	–	–	–
HbA1c, %	6.2 ± 0.3	5.9 ± 0.3**	1%	0.95	0.56–2.76	0.18	0.94	–	–	–	–
Hypertension, yes	79 (22)	78 (36)	yes versus no	1.82	1.48–2.98	0.54	0.54	–	–	–	–
MetS, yes	86 (24)	76 (35)	yes versus no	0.86	0.45–2.34	2.21	0.22	–	–	–	–
CVD, yes	29 (8)	30 (14)	yes versus no	0.88	0.67–2.21	0.34	0.45	–	–	–	–

*p < 0.05, **p < 0.01; data are presented as a mean ± SD of the mean, a median (with lower and upper quartiles) or n (with %), where appropriate. All variables shown to be significant (p < 0.05) risk factors for the presence of ED in the univariable models were included in the multivariable models. ED was diagnosed when the total of the IIEF domain scores was <22 points. CI, confidence interval; OR, odds ratio.

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