Differential Diagnosis for Erectile Dysfunction (ED) and Low Libido with High SHBG

Single Most Likely Diagnosis

• Hypogonadism: High SHBG can be associated with hypogonadism, which is a common cause of ED and low libido. Hypogonadism can lead to decreased testosterone production, which in turn can cause an increase in SHBG.

Other Likely Diagnoses

• Obesity or Metabolic Syndrome: Often associated with high SHBG, insulin resistance, and low testosterone, which can contribute to ED and low libido.
• Thyroid Disorders: Both hyperthyroidism and hypothyroidism can affect libido and erectile function, and thyroid disorders can also impact SHBG levels.
• Depression or Anxiety: Psychological factors can significantly contribute to ED and low libido, and some antidepressants can also affect libido and erectile function.

Do Not Miss Diagnoses

• Pituitary Tumors: Although rare, pituitary tumors (such as prolactinomas) can cause hypogonadism, leading to high SHBG, ED, and low libido. Missing this diagnosis could have significant health implications.
• Testicular Cancer: Though less common, testicular cancer can lead to hormonal imbalances, including changes in SHBG and testosterone levels, affecting libido and erectile function.

Rare Diagnoses

• Klinefelter Syndrome: A genetic condition that affects male physical and cognitive development, leading to hypogonadism, which could explain high SHBG, ED, and low libido. However, it's typically diagnosed earlier in life.
• Androgen Insensitivity Syndrome: A rare genetic condition where the body is unable to respond to androgens, leading to a variety of physical and hormonal abnormalities, including potential impacts on libido and erectile function.
• Congenital Adrenal Hyperplasia: A group of inherited disorders that affect the adrenal glands, potentially leading to hormonal imbalances that could influence SHBG, libido, and erectile function.