Endocrine and other non-endocrine organic factors often simultaneously and mutually interact with other intrapsychic and relational determinants in the pathogenesis of erectile dysfunction (ED). Among endocrine factors, testosterone (T) is one of the best studied, although its role in ED is still questioned. In a consecutive series of almost 2000 subjects with sexual dysfunction, we identified an overt Hypo (T <8 nM) in 5.2% of the sample. In this sample, obesity and type 2 diabetes mellitus (DM) were the most important determinants of Hypo. Because type 2 DM, obesity and Hypo are considered components (or are often associated with) metabolic syndrome (MS), we now reports their interrelationships and psycho-biological correlates in patients with sexual dysfunction. Metabolic syndrome was defined by Adult Treatment Panel III (ATP III) criteria. Patients with ATP-III MS showed a higher cardiovascular risk (as assessed by PROCAM and Framingham risk scores) and worst subjective (SIEDY structured interview) and objective (PDU) erectile parameters than the rest of the sample. The relative risk for Hypo (T <8 nM) was significantly higher in patients reporting 3 or more factors for MS (6.3[1.4-28.7], p<0.001). At logistic regression, considering ATP-III criteria as putative predictors of Hypo, waist circumference and hyperglycaemia were the best predictors of T <8 nM. Among patients with MS, those with Hypo showed higher LH and FSH and lower free T levels, suggesting a primitive origin of the problem. Hypo patients with MS reported a higher prevalence of Hypo-related symptoms, such as higher depression and hypoactive sexual desire and lower frequency of sexual intercourses. In conclusion our data suggest that the prevalence of Hypo is higher in patients with MS. The presence of Hypo can further exacerbate the already MS-compromised penile blood flow, adding the typical Hypo-related symptoms, which, however, can potentially be ameliorated by T replacement therapy.
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