Association of Erectile Dysfunction and Hypogonadism with Metabolic Syndrome in Men with Lower Urinary Tract Symptoms of Younger and Older Age Groups


The aim of this study was to evaluate the incidence and severity of erectile dysfunction (ED) and hypogonadism in 193 men presenting with lower urinary tract symptoms (LUTSs) in the younger (20 - 39 years old) and older (40 - 60 years old) age groups depending on the presence of metabolic syndrome (MetS). Triglycerides, glucose and high-density lipoprotein cholesterol, serum total testosterone (TT), sex hormone-binding globulin, prostate-specific antigen, pituitary hormones levels were measured in serum. Standardized criteria (2009) were used to determine the prevalence of MetS. Patients were assessed based on the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life (IPSS-QoL) for LUTSs and the International Index of Erectile Function (IIEF) for ED. Hypogonadism was determined in accordance with the ISA, ISSAM, EAU, EAA and ASA recommendations. In men with MetS in the younger age group the incidence of ED was 2.4 times higher, and that of low TT level and hypogonadism was 8.4 times higher compared to men without the syndrome. In the older age group, an increased incidence of ED and low TT level in men with MetS compared to men without the syndrome was on the trend level, but the incidence of hypogonadism was for sure higher (by 1.6 times). In conclusion, the study showed that ED and hypogonadism are associated with MetS by a high degree of certainty in young men with LUTSs. In men of the older age group with LUTSs, the presence of MetS is not so clearly associated with ED and hypogonadism due to the fact that the incidence of these urogenital diseases is also high in men without MetS.

Share and Cite:

Novikova, E. , Selyatitskaya, V. , Mitrofanov, I. , Pinkhasov, B. and Karapetyan, A. (2014) Association of Erectile Dysfunction and Hypogonadism with Metabolic Syndrome in Men with Lower Urinary Tract Symptoms of Younger and Older Age Groups. Advances in Sexual Medicine, 4, 55-64. doi: 10.4236/asm.2014.44009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] McVary, K. (2006) Lover Urinary Tract Symptoms and Sexual Dysfunction: Epidemiology and Pathophysiology. BJU International, 97, 23-28.
[2] Bozkurt, O., Bolat, D., Demir, O., Ucer, O., Sahin, A., Ozcift, B., Pektas, A., Turan, T., Gumus, B.H., Can, E., Bolukbasi, A., Erol, H. and Esen, A. (2013) Erectile Function and Late-Onset Hypogonadism Symptoms Related to Lower Urinary Tract Symptom Severity in Elderly Men. Asian Journal of Andrology, 15, 785-789.
[3] Corona, G., Lee, D.M., Forti, G., O’Connor, D.B., Maggi, M., O’Neill, T.W., Pendleton, N., Bartfai, G., Boonen, S., Casanueva, F.F., Finn, J.D., Giwercman, A., Han, T.S., Huhtaniemi, I.T., Kula, K., Lean, M.E.J., Punab, M., Siman, A.J., Vanderschueren, D., Wu, F.C.W. and Group, E.S. (2010) Age-Related Changes in General and Sexual Health in Middle-Aged and Older Men: Results from the European Male Ageing Study (EMAS). The Journal of Sexual Medicine, 7, 1362-1380.
[4] Selvin, E., Burnett, A.L. and Platz, E.A. (2007) Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine, 120, 151-157.
[5] Kubin, M., Wagner, G. and Fugl-Meyer, A.R. (2003) Epidemiology of Erectile Dysfunction. International Journal of Impotence Research, 15, 63-71.
[6] Wang, C., Nieschlag, E., Swerdloff, R., Behre, H.M., Hellstrom, W.J., Gooren, L.J., Kaufman, J.M., Legros, J.-J., Lunenfeld, B., Morales, A., Morley, J.E., Schulman, C., Thompson, I.M., Weidner, W. and Wu, F.C.W. (2009) Review ISA, ISSAM, EAU, EAA and ASA Recommendations: Investigation, Treatment and Monitoring of Late-Onset Hypogonadism in Males. International Journal of Impotence Research, 21, 1-8.
[7] Castela, A., Vendeira, P. and Costa, C. (2011) Testosterone, Endothelial Health, and Erectile Function. ISRN Endocrinology, 7.
[8] Sauver, J.L.St., Jacobson, D.J., McGree, M.E., Girman, C.J., Klee, G.G., Lieber, M.M. and Jacobsen, S.J. (2011) Associations between Longitudinal Changes in Serum Estrogen, Testosterone, and Bioavailable Testosterone and Changes in Benign Urologic Outcomes. American Journal of Epidemiology, 173, 787-796.
[9] Grossman, M. and Wu, F.C. (2014) Male Androgen Deficiency: A Multisystem Syndrome. Asian Journal of Andrology, 16, 159-160.
[10] Kelly, D.M. and Jones, T.H. (2013) Testosterone: A Metabolic Hormone in Health and Disease. Journal of Endocrinology, 217, 25-45.
[11] Kupelian, V., McVary, K.T., Kaplan, S.T., Hall, S.A., Link, C.L., Aiyer, L.P., Mollon, P., Tamimi, N., Rosen, R.C. and McKinlay, J.B. (2013) Association of Lower Urinary Tract Symptoms and the Metabolic Syndrome: Results From the Boston Area Community Health Survey. The Journal of Urology, 189, 107-116.
[12] Gorbachinsky, I., Akpinar, H. and Assimos, D.G. (2010) Metabolic Syndrome and Urologic Diseases. Reviews in Urology, 12, 157-180.
[13] Jang, M. and Berry, D. (2011) Overweight, Obesity and Metabolic Syndrome in Adults and Children in South Korea: A Review of the Literature. Clinical Nursing Research, 20, 276-291.
[14] Atabek, M.E., Eklioglu, B.S. and Akyurek, N. (2013) Reevaluation of the Prevalence of Metabolic Syndrome in an Urban Area of Turkey. Journal of Clinical Research in Pediatric Endocrinology, 5, 50-54.
[15] Heinonen, I., Helajiarvi, H., Pahkala, K., Heinonen, O.J., Hirvensalo, M., Palve, K., Tammelin, T., Yang, X., Joonala, M., Mikkila, V., Kahonen, M., Lehtimaki, T., Viikari, J. and Raitakari, O.T. (2013) Sedentary Behaviors and Obesity in Adults: The Cardiovascular Risk in Young Finns Study. BMJ Open, 3.
[16] Alberti, K.G.M.M., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., Fruchart, J.-Ch., James, W.P.T., Loria, C.M. and Smith, S.C. (2009) Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society and International Association for the Study of Obesity. Circulation, 120, 1640-1645.
[17] Barry, M.J., Fowler Jr., F.J., O’Leary, M.P., Bruskewitz, R.C., Holtgrewe, H.L., Mebust, W.K. and Cockett, A.T. (1992) The American Urological Association Symptom Index for Benign Prostatic Hyperplasia. The Measurement Committee of the American Urological Association. The Journal of Urology, 148, 1549-1557.
[18] Rosen, R.C., Riley, A., Wagner, G., Osterloh, I.H., Kirkpatrick, J. and Mishra, A. (1997) The International Index of Erectile Function (IIEF): A Multidimensional Scale for Assessment of Erectile Dysfunction. Urology, 6, 822-830.
[19] Mirzaei, M.R., Amini, M. and Aminorroaya, A. (2012) The Prevalence of Hypogonadism in Diabetic Men in Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran. Journal of Research in Medical Sciences, 17, 602-606.
[20] Heinemann, L.A. (2005) Aging Males’ Symptoms Scale: A Standardized Instrument for the Practice. Journal of Endocrinological Investigation, 28, 34-38.
[21] Cheserek, M.J., Wu, G.-R., Shen, L.-Y., Shi, Y.-H. and Le, G.-W. (2014) Disparities in the Prevalence of Metabolic Syndrome (MS) and Its Components among University Employees by Age, Gender and Occupation. Journal of Clinical and Diagnostic Research, 8, 65-69.
[22] Bal, K., Oder, M., Sahin, A.S., Karatas, C.T., Demir, O., Can, E., Gumus, B.H., Ozer, K., Sahin, O. and Esen, A.A. (2007) Prevalence of Metabolic Syndrome and Its Association with Erectile Dysfunction among Urologic Patients: Metabolic Backgrounds of Erectile Dysfunction. Urology, 69, 356-360.
[23] Pinkhasov, B.B., Selyatitskaya, V.G., Karapetyan, A.R. and Astrakhantseva, E.L. (2012) Metabolic Syndrome in Men and Women with Upper or Lower Types of Body Fat Distribution. Health, 4, 1381-1389.
[24] Matsuzawa, Y. (2008) The Role of Fat Topology in the Risk of Disease. International Journal of Obesity, 32, 83-92.
[25] Loprinzi, P.D., Smit, E. and Mahoney, S. (2014) Physical Activity and Dietary Behavior in US Adults and Their Combined Influence on Health. Mayo Clinic Proceedings, 89, 190-198.
[26] Pan, Y. and Pratt, C.A. (2008) Metabolic Syndrome and Its Association with Diet and Physical Activity in US Adolescents. Journal of the American Dietetic Association, 108, 276-286.
[27] Li, C., Ford, E.S., Li, B., Giles, W.H. and Liu, S. (2010) Association of Testosterone and Sex Hormone-Binding Globulin with Metabolic Syndrome and Insulin Resistance in Men. Diabetes Care, 33, 1618-1624.
[28] Hackett, G., Kirby, M. and Sinclair, A.J. (2014) Testosterone Deficiency, Cardiac Health and Older Men. International Journal of Endocrinology, 10, 1-10.
[29] Chen, I.H., Tsai, Y.S. and Tong, Y.C. (2012) Correlations among Cardiovascular Risk Factors, Prostate Blood Flow and Prostate Volume in Patients with Clinical Benign Prostatic Hyperplasia. Urology, 79, 409-414.
[30] Rao, D.P., Dai, S., Lagace, C. and Krewski, D. (2014) Metabolic Syndrome and Chronic Disease. Chronic Diseases and Injuries in Canada, 34, 36-45.
[31] Albersen, M., Orabi, H. and Lue, T.F. (2012) Evaluation and Treatment of Erectile Dysfunction in the Aging Male: A Mini-Review. Gerontology, 58, 3-14.
[32] Corona, G., Rastrelli, G., Monami, M., Saad, F., Luconi, M., Lucchese, M., Facchiano, E., Sforza, A., Forti, G., Mannucci, E. and Maggi, M. (2013) Body Weight Loss Reverts Obesity-Associated Hypogonadotropic Hypogonadism: A Systematic Review and Meta-Analysis. European Journal of Endocrinology, 168, 829-843.
[33] Fui, M.N.T., Dupuis, P. and Grossmann, M. (2014) Lowered Testosterone in Male Obesity: Mechanisms, Morbidity and Management. Asian Journal of Andrology, 16, 223-231.
[34] Corona, G., Mannucci, E., Forti, G. and Maggi, M. (2009) Hypogonadism, ED, Metabolic Syndrome and Obesity: A Pathological Link Supporting Cardiovascular Diseases. International Journal of Andrology, 32, 587-598.
[35] Huhtaniemi, I. (2014) Late-Onset Hypogonadism: Current Concepts and Controversies of Pathogenesis, Diagnosis and Treatment. Asian Journal of Andrology, 16, 192-202.
[36] Guay, A.T. (2009) The Emerging Link between Hypogonadism and Metabolic Syndrome. Journal of Andrology, 30, 370-376.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.