From the Guidelines
The most likely cause of erectile dysfunction (ED) in a 34-year-old male with normal testosterone levels is psychological factors or underlying cardiovascular disease (CVD).
Possible Causes of ED
- Psychological factors: such as depression, anxiety, and relationship conflict, which can be primary or secondary contributors to ED 1
- Underlying cardiovascular disease (CVD): ED can be a risk marker for underlying CVD and other health conditions that may warrant evaluation and treatment 1
Evaluation and Management
- A comprehensive evaluation, including a thorough medical, sexual, and psychosocial history, physical examination, and selective laboratory testing, is recommended for men presenting with ED symptoms 1
- Validated questionnaires, such as the Erection Hardness Score and the Sexual Health Inventory for Men, can be used to assess the severity of ED and guide treatment 1
- Lifestyle changes, such as smoking cessation, regular dynamic exercise, weight loss, and a healthy diet, can help reduce cardiovascular risk and improve erectile function 1
Importance of Testosterone Levels
- While normal testosterone levels are present in this case, it is essential to note that low testosterone levels can be associated with increased all-cause and cardiovascular mortality 1
- Testosterone levels should be measured in all men with ED, especially in those for whom PDE5 inhibitor therapy failed 1
From the Research
Causes of Erectile Dysfunction
The causes of erectile dysfunction (ED) in a 34-year-old male with normal testosterone levels can be attributed to various factors.
- Physical organic causes, such as atherosclerotic disease, vascular disease, and diabetes, are estimated to account for a significant percentage of ED cases 2.
- Psychological conditions, including anxiety and depression, can also contribute to ED 2.
- Neurological conditions, such as Parkinson's disease, and pelvic surgery with nerve damage, are additional risk factors 2.
- Endocrine disorders and interactions from prescribed drugs, including antihypertensives, antidepressants, and antipsychotics, can also lead to ED 2.
- Anatomical features and conditions, such as Peyronie's disease, are less common causes of ED 2.
Role of Testosterone in Erectile Dysfunction
While testosterone plays a role in enhancing libido, its exact contribution to erections in men remains unclear 3, 4, 5, 6.
- Testosterone may facilitate erection by acting as a vasodilator of the penile arterioles and cavernous sinusoids 3.
- Hypogonadism is not a common finding in ED, occurring in about 5% of cases, and there is a lack of association between serum testosterone levels and erectile function when testosterone levels are normal or moderately low 3.
- Testosterone treatment may ameliorate the response to phosphodiesterase 5 (PDE5) inhibitors in hypogonadal men and men with low-normal serum testosterone 3, 4, 5, 6.