© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
Address correspondence to Dr. Michael Greenspan, 414
Victoria Avenue North, Suite M11, Hamilton, Ontario L8L
5
G8 Canada
Erectile dysfunction and testosterone
deficiency syndrome: the “portal to men’s
health”
Michael B. Greenspan, MD,
1
Jack Barkin, MD
2
1
Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada
2
Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
GREENSPAN MB, BARKIN J. Erectile dysfunction
and testosterone deficiency syndrome: the “portal
to men’s health”.
Can J Urol
2012;19(
Suppl 1):18-27.
Erectile dysfunction (ED) and testosterone deficiency
syndrome (TDS) are closely related. In addition to affecting
men’s sexual health, both conditions also affect other male
health issues. Screening for ED, especially in younger men,
should become standard clinical practice for the primary care
physician. Possible systemic effects and associated effects of
TDS are now well documented. Testosterone replacement
therapy (TRT) is very safe and effective in the right man.
Key Words:
erectile dysfunction, testosterone
deficiency syndrome, testosterone replacement
therapy
Erectile dysfunction
Risk factors and link to coronary artery disease
An erection is a complex event that requires an intact
arterial and venous system, normal innervation,
normal hormonal factors, and functioning erectile
tissue (endothelium). Abnormalities in one or more
of these factors can lead to ED.
Well-established risk factors for ED include
hypertension, hyperlipidemia, diabetes, smoking, low
testosterone, alcohol and drug abuse, anemia, trauma
to/surgery of the pelvis or spine, coronary artery
disease (CAD), peripheral vascular disease, Peyronie’s
disease, and depression.
It is well-established that ED is linked to
cardiovascular disease. According to a landmark study
published in 2009, ED, especially in younger men, can
be an early warning sign for imminent cardiovascular
disease.
5
Compared to men with no ED, men with ED
whowere age 40 to 49 at baseline had a 50-fold increase
of CAD, including death from cardiovascular disease
18
Introduction
Men’s sexual health is an important part of their overall
health and quality of life, and it also affects their
partners. In 1994, theMassachusettsMaleAging Study
(
MMAS) reported that 52% of men between the ages
of 40 and 70 had some degree of erectile dysfunction
(
ED).
1
In 2000, a study estimated that the worldwide
incidence of EDwill increase from 152 million cases in
1995
to 322 million cases by the year 2025.
2
ED and testosterone deficiency syndrome (TDS)
commonly occur along with other comorbidities,
and may be markers for other comorbidities. A
study published in 2000 estimated that in Canada,
25%
of men aged 40 to 82 had TDS.
3
Similarly, the
Hypogonadism in Males Study (HIM) reported that
38.7%
of men over age 45 had TDS.
4
