Men who can keep ‘it’ up may live longer

Men with erectile dysfunction (ED) run a higher risk of death, suggested data presented at ENDO 2020.

“As both vascular disease and low testosterone can influence erectile function, sexual symptoms [such as ED] can be an early sign for increased cardiovascular risk and mortality,” said lead researcher Dr Leen Antonio from the University Hospitals Leuven in Leuven, Belgium.

Antonio and colleagues used data from the large prospective European Male Ageing Study designed to explore age-related hormonal changes and a broad range of health outcomes in community-dwelling elderly men aged 40–79 years (n=1,913). The associations between hormone measurements and sexual function at the beginning of the study were assessed. [ENDO 2020, abstract OR02-06]

A quarter (25.3 percent) of men died during a mean follow up of 12.4 years. Despite the similar level of total testosterone (TT) between men who lived and died, those who died had a lower level of free testosterone* (FT; mean, 270 vs 312 pmol/L; p<0.001) and a higher level of luteinizing hormone (7.8 vs 5.7 U/L; p<0.001).

Men in the lowest FT quartile had a higher risk of death than those in the highest FT quartile (hazard ratio [HR], 1.43, 95 percent confidence interval [CI], 1.06–1.95; p=0.021), as did men in the highest vs lowest follicle-stimulating hormone quartile (HR, 1.38, 95 percent CI, 1.02–1.88; p=0.036).

The impact of total testosterone

In men with normal TT (>12 nmol/L) levels, the presence of sexual symptoms, particularly ED, increased the risk of death by 51 percent compared with those without sexual symptoms (HR, 1.51, 95 percent CI, 1.15–1.97; p=0.003).

For men with low TT (<8 nmol/L) levels and fewer sexual symptoms, the risk of death was higher compared with men with normal TT levels and no sexual symptoms. (HR, 1.92, 95 percent CI, 1.05–3.52; p=0.035).

These findings imply that the presence of sexual symptoms was a common predictor of mortality risk regardless of TT level, noted the researchers.

Stratification by sexual symptoms showed that a high mortality rate was associated with ED and poor morning erections (HR, 1.40, 95 percent CI, 1.15–1.73; p=0.001 and HR, 1.30, 95 percent CI, 1.06–1.60; p=0.012, respectively) but not with low sexual drive (HR, 1.14, 95 percent CI, 0.93–1.40; p=0.203). Men with all three symptoms had a significantly higher mortality risk than those who did not report any of these symptoms (HR, 1.77, 95 percent CI, 1.28–2.41; p<0.001).

Taken together, the findings highlighted ED as a particular predictor of all-cause mortality in elderly men independent of testosterone levels, said Antonio.