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Figure 1. Тhe E2/T ratio and IEFI result.
Abstract
Aim
This study investigated the relationship between erectile dysfunction and the estradiol-to-testosterone ratio in men aged 35 to 45.
Materials and methods
Screening procedures were designed to select eugonadal men between 35 and 45 years of age to evaluate the impact of the estradiol-to-testosterone ratio on the development of erectile dysfunction. Out of 1,521 patients examined in the andrology office for erectile dysfunction between January 2013 and December 2019, a total of 73 men were included for evaluation. Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF). Twenty age-matched men without erectile dysfunction were randomly selected to form the control group. We measured the total serum testosterone level three times, every 45 days, for three months, and measured estradiol once at the third blood collection.
Results
Among the patients with erectile dysfunction, we observed the estradiol-to-testosterone ratio values ranging from 0.0042 to 0.0110. These values were significantly higher than those of the control group (0.0015–0.0020) (p<0.001). There were significant differences in the questionnaire score between the patients and the control group (p<0.001). We did not observe fluctuations in the blood flow to the artery profunda of the penis bilaterally during color Doppler ultrasound.
Conclusion
Our study suggests that erectile dysfunction in men aged 35 to 45 years may be associated with an estradiol-to-testosterone ratio of 0.0041–0.0110. In the clinical examination of these patients, it is necessary to test for estradiol in addition to testosterone.
Erectile dysfunction (ED) and low sexual desire are multifactorial diseases that affect 5% to 10% of men under the age of 40.[1] Many authors have reported that the majority of these patients were diagnosed with psychogenic ED.[2,3] Along with the psychological origin of ED in young patients, other causes should be considered, including metabolic, endocrine, vasculogenic, neurological, and psychiatric diseases.[1] Androgens have long been thought to play an important role in male erections as serum total testosterone (TT) levels decline with age and the incidence of ED increases.[4] The decrease in TT levels is one cause, but the effect of estradiol (E2) remains unclear. Previous studies have found that an elevated E2/T ratio negatively affects penile erection, yet the relationship between the two still remains unclear.[5] Furthermore, studies have shown that the E2/T ratio is a more significant factor in assessing sexuality than E2 alone.[5] Some authors have not found a relationship between E2/T imbalance and changes in erectile function and sexual desire. They conclude that, in the clinical examination of these patients, it is unnecessary to include E2 in laboratory tests.[6] Neto et al. have found that low testosterone levels and low T/E2 ratios are significantly associated with decreased perceived libido in men seeking treatment for sexual dysfunction. They recommend further studies to confirm these data and understand how treatment affects these parameters.[7]
Limitations
1. The E2/T ratio values were only observed once, so we cannot say how ED would develop in the future. Based on our preliminary data, we can conclude that if these values remain above 0.041 for an extended period of time, ED will occur in this group of young men.
2. The number of patients included in this pilot study is relatively small, and we are considering expanding it.
Conclusion
Our findings suggest that erectile dysfunction in men aged 35 to 45 years may be associated with estradiol-to-testosterone ratio values ranging from 0.0041 to 0.0110, and that estradiol should be tested alongside testosterone during clinical examinations of these patients.
Estradiol-to-testosterone ratio and erectile dysfunction in men aged 35-45
Aim: This study investigated the relationship between erectile dysfunction and the estradiol-to-testosterone ratio in men aged 35 to 45. Materials and methods: Screening procedures were designed to select eugonadal men between 35 and 45 years of age to evaluate the impact of the...
foliamedica.bg
Abstract
Aim
This study investigated the relationship between erectile dysfunction and the estradiol-to-testosterone ratio in men aged 35 to 45.
Materials and methods
Screening procedures were designed to select eugonadal men between 35 and 45 years of age to evaluate the impact of the estradiol-to-testosterone ratio on the development of erectile dysfunction. Out of 1,521 patients examined in the andrology office for erectile dysfunction between January 2013 and December 2019, a total of 73 men were included for evaluation. Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF). Twenty age-matched men without erectile dysfunction were randomly selected to form the control group. We measured the total serum testosterone level three times, every 45 days, for three months, and measured estradiol once at the third blood collection.
Results
Among the patients with erectile dysfunction, we observed the estradiol-to-testosterone ratio values ranging from 0.0042 to 0.0110. These values were significantly higher than those of the control group (0.0015–0.0020) (p<0.001). There were significant differences in the questionnaire score between the patients and the control group (p<0.001). We did not observe fluctuations in the blood flow to the artery profunda of the penis bilaterally during color Doppler ultrasound.
Conclusion
Our study suggests that erectile dysfunction in men aged 35 to 45 years may be associated with an estradiol-to-testosterone ratio of 0.0041–0.0110. In the clinical examination of these patients, it is necessary to test for estradiol in addition to testosterone.
IntroductionErectile dysfunction (ED) and low sexual desire are multifactorial diseases that affect 5% to 10% of men under the age of 40.[1] Many authors have reported that the majority of these patients were diagnosed with psychogenic ED.[2,3] Along with the psychological origin of ED in young patients, other causes should be considered, including metabolic, endocrine, vasculogenic, neurological, and psychiatric diseases.[1] Androgens have long been thought to play an important role in male erections as serum total testosterone (TT) levels decline with age and the incidence of ED increases.[4] The decrease in TT levels is one cause, but the effect of estradiol (E2) remains unclear. Previous studies have found that an elevated E2/T ratio negatively affects penile erection, yet the relationship between the two still remains unclear.[5] Furthermore, studies have shown that the E2/T ratio is a more significant factor in assessing sexuality than E2 alone.[5] Some authors have not found a relationship between E2/T imbalance and changes in erectile function and sexual desire. They conclude that, in the clinical examination of these patients, it is unnecessary to include E2 in laboratory tests.[6] Neto et al. have found that low testosterone levels and low T/E2 ratios are significantly associated with decreased perceived libido in men seeking treatment for sexual dysfunction. They recommend further studies to confirm these data and understand how treatment affects these parameters.[7]
Limitations
1. The E2/T ratio values were only observed once, so we cannot say how ED would develop in the future. Based on our preliminary data, we can conclude that if these values remain above 0.041 for an extended period of time, ED will occur in this group of young men.
2. The number of patients included in this pilot study is relatively small, and we are considering expanding it.
Conclusion
Our findings suggest that erectile dysfunction in men aged 35 to 45 years may be associated with estradiol-to-testosterone ratio values ranging from 0.0041 to 0.0110, and that estradiol should be tested alongside testosterone during clinical examinations of these patients.
