Endocrine Dysfunction in Impotence: Incidence, Significance and Cost-Effective Screening

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Abstract
A comprehensive evaluation of impotence includes assessment of the functional integrity of the hypothalamic-pituitary-gonadal axis. Little is known about the incidence or significance of hormonal abnormalities in an unselected group of men with erectile failure. A systematic multidisciplinary, multidimensional assessment of 256 impotent men showed clearly an organic etiology in 35.9%, psychogenic in 38.3% and mixed or uncertain in 25.8%. The incidence of hypothalamic-pituitary-gonadal axis abnormalities in the entire group was 17.5% but in only 12.1% did they contribute clearly to erectile dysfunction. A cost-effective screening of the endocrine system in impotent men includes a thorough history and physical examination, and a serum testosterone determination. More sophisticated and expensive investigations should be reserved for patients with a history of drug use known to induce hormonal abnormalities or with somatic evidence of hypogonadism and a depressed serum testosterone level.