The Graham Jackson Memorial Lecture ISSM 2016-"The Man Who Knew Too Much": Time to Recognize Erectile Dysfunction and Low Testosterone as Independent Risk Factors for Cardiovascular Disease: Beyond the Abstract
Understandably there was a reluctance to take up the burden of asking about sexual difficulties for fear that consultations might morph into unfamiliar areas. As a result, both conditions were termed “markers” or “harbingers” for CV events and type 2 diabetes, effectively meaning that there would be minimal impact on every day practice. The intellectual argument was that associated co-morbidities meant that including ED, and more controversially, low testosterone, would add little if included in diagnostic tools. These decisions overlooked the high predictive value of ED in younger men, where conventional risk factors underestimate the degree of risk. Because testosterone measurement is mandatory in all men with ED, hypogonadism is also a particularly relevant marker of risk of all causes mortality through mechanisms associated with metabolic syndrome, sarcopenia and frailty. Above all, rather than endless patronising lectures about weight and lifestyle, often from an equally unfit doctor, ED and hypogonadism are highly bothersome, symptomatic conditions that motive patients to be highly co-operative.
In this paper, I explore the recent evidence, many from urological and sexual medicine publications, that suggests that ED and low testosterone need to be elevated to the level of, at the very least, predisposing risk factors. Only then will they be included in routine health consultations and diagnostic tools that will have much better outcomes for our patients.
Written By: Geoff Hackett, MD, FRCPI, MRCGP, FECSM, Fellowship of the European Academy of Sexual Medicine
Read the Abstract