Testosterone levels are directly related with erectile function and endothelial function in men with intermediate risk according to the Framingham score

Background. The value of testosterone levels and erectile dysfunction (ED) as early markers of atherosclerosis is not well understood. Objectives. To analyze the relationship between plasma testosterone levels in men with both endothelial function (F) and ED. Methods. We enrolled 802 asymptomatic, intermediate cardiovascular risk patients, according to the Framingham Risk Score, aged 40 to 80 years, who underwent the study of EF, evaluation of ED and dosage of plasma testosterone. Results. At linear regression, EF (t=9.40; 95% CI from 0.9318 to 1.4234; p<0.0001) and erectile function (t=8.96; 95% CI from 0.7642 to 1.1932; p<0.0001) statistically increased with increasing levels of testosterone. At multivariable logistic regression analysis, lower serum testosterone were strongly associated (p<0.001) with severe (OR 0,78; CI 0,62-0,86), and moderate ED (OR 0,85; CI 0,72-0,97), while worse EF was strongly associated (p<0.001) with severe (OR 0,68; CI 0,59-0,79), moderate (OR 0,76; CI 0,63 to 0,83) and mild to moderate ED (OR 0,8; CI 0,69 to 0,94). Even mild ED resulted statistically associated worse EF (OR 0.94; CI 0.82 - 1.07; p=0.03) but not with testosterone levels. These relations were substantially affected by adjustments for further potential confounders including smoking status, hyperthension, diabetes mellitus and body mass index. Conclusions. We demonstrated a significant correlation between ED, worse EF and testosterone plasma levels in a primary prevention population, therefore low testosterone levels may be considered as early markers of atheroslerosis.