erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men.
survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality.
about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1 years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk.
sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.
Age and ageing. 2022 Apr 01 [Epub]
Leen Antonio, Frederick C W Wu, Hannes Moors, Cathy Matheï, Ilpo T Huhtaniemi, Giulia Rastrelli, Marian Dejaeger, Terence W O'Neill, Stephen R Pye, Gianni Forti, Mario Maggi, Felipe F Casanueva, Jolanta Slowikowska-Hilczer, Margus Punab, Jos Tournoy, Dirk Vanderschueren, EMAS Study Group
Department of Chronic Diseases and Metabolism, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium., Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK., Department of Public Health and Primary Care, KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium., Department of Public Health and Primary Care, KU Leuven, Academic Center for General Practice, Leuven, Belgium., Institute of Reproductive and Developmental, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK., Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy., Centre for Epidemiology Versus Arthritis, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK., Endocrinology Unit, University of Florence, Florence, Italy., Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS); CIBER de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain., Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland., Andrology Centre, Tartu University Hospital, Tartu, Estonia.