Although erectile dysfunction in young men is most frequently attributed to psychogenic causes, hypogonadism may be the underlying etiology in an appreciable proportion of these patients.
At the Sexual Medicine Society of North America scientific meeting here, the Baylor urologists presented their findings from a retrospective study based on 32 men younger than 30 years of age who had been referred to their institution for evaluation of primary ED. Serum hormone testing had been performed in 27 men. While the mean serum testosterone level for the group was within the normal range, 394 ng/dL, six men (22%) were diagnosed with hypogonadism based on Endocrine Society criteria of a testosterone level below 300 ng/dL.
"A recent article reporting on a systematic review of the population-based studies of ED found that the reported prevalence in young men under 30 years of age ranges from 2% to 7%," said David M. Fenig, MD, a fellow in male reproductive medicine at Baylor's Scott Department of Urology working with Larry Lipshultz, MD, and colleagues. "The advent of phosphodiesterase type-5 inhibitor therapy for this problem accompanied by direct-to-consumer advertising for these medications has led more patients to seek medical care. However, there are limited data on the etiology of ED in young men.
Some arterial insufficiency found
The 32 patients in the study had a mean age of 26 years. Information on medical comorbidities was also extracted from the patient records, but concomitant diseases were not common in this young group. Diagnoses of diabetes mellitus, hypertension, depression, and dyslipidemia were each present in one patient.
Fifteen men had undergone penile duplex ultrasound with intracavernosal injection of papaverine, phentolamine, and prostaglandin E1 (Trimix). None of those patients was found to have a venous leak, although four men (27%) had arterial insufficiency as diagnosed by a peak systolic velocity (PSV) <25 cm/sec and inability to attain a full erection.
"The finding of such a high proportion of men with a PSV indicative of arterial insufficiency was somewhat surprising," Dr. Fenig admitted to Urology Times. "However, we think it may be attributed at least in part to increased adrenergic tone, considering that younger men in particular can be quite anxious when undergoing this testing in the office setting."