Disorders of Sexual Function in Male Diabetics

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Abstract
Among 314 male diabetic patients who developed diabetes before age sixty, 160 (51 per cent) complained of erectile impotence. Mean known duration of diabetes was 9.3 yrs. in the impotent group and 4.3 yrs. in the group without this complaint. Wives of the diabetics in the former group had had fewer conceptions and more miscarriages than wives of patients in the latter group. Endocrine studies of patients with impotence revealed that two thirds had decreased urinary excretion of pituitary gonadotropin. On the other hand, urinary excretion of 17-ketosteroids was increased. Chromatographic fractionation of 17-ketosteroids revealed that the augmented excretion reflected an increase in metabolites of adrenal steroids of low androgenic potency, while metabolites of testosterone were decreased. One third of the impotent patients studied had low sperm counts, and one half had low concentrations of fructose in the semen, indicative of androgen deficiency. Testicular biopsy in 24 patients revealed thickening of the basement membrane of the tubules and abnormal spermatogenesis. In most of the patients under 40 years of age impotence was corrected by combined therapy with chorionlc gonadotropin and testosterone. Wives of 4 of these patients became pregnant after prolonged periods without conception. Patients over 40 were usually treated with testosterone alone, with improvement of sexual potency and general well-being. Results of the endocrine studies, and response to treatment, suggest that impotence and infertility in male diabetics are frequently due to hypogonadotroplc hypogonadism.

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