Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study

Luca Boeri, Paolo Capogrosso, Eugenio Ventimiglia, Walter Cazzaniga, Filippo Pederzoli, Donatella Moretti, Federico Dehò, Emanuele Montanari, Francesco Montorsi, Andrea Salonia

Research output: Contribution to journalArticle

Abstract

Background Although erectile dysfunction (ED) has been associated with low circulating total testosterone (TT) levels, the utility of free testosterone (FT) over TT is debatable. Aim To assess the relative impact of low TT and low calculated FT (cFT) on androgen-related sexual symptoms in men with ED. Methods Data from 485 men were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) and the Beck Inventory for Depression (BDI). Descriptive statistics tested differences between patients with normal TT levels (>3 ng/mL) and normal cFT levels (>65 pg/mL; group 1) and men with normal TT and low cFT (group 2), low TT and normal cFT (group 3), and low TT and low cFT (group 4). Linear regression models tested the association between clinical predictors and sexual function impairment. Outcomes We assessed the impact of different hormonal categories on androgen-related symptoms and the clinical utility of measuring cFT in men with ED. Results Groups 1, 2, 3, and 4 were composed of 338 (69.6%), 44 (9.1%), 34 (7.0%), and 69 (14.3%) patients, respectively. Compared with group 1, patients in group 2 were older (P <.001), had a higher body mass index (P <.01), and had a larger proportion with CCI scores of at least 1 (P =.006). Likewise, group 2 presented lower scores for the IIEF erectile function (P =.07), sexual desire (P =.04), and orgasmic function (P =.007) domains and lower BDI scores (P =.02) than group 1. Similar findings were found for group 4 vs 1. Conversely, patients in group 3 had similar scores on the questionnaires to those in group 1. Low cFT and normal or low TT achieved independent predictor status for pathologic IIEF domains and BDI scores after accounting for age, CCI, and body mass index. Conversely, low TT and normal cFT status was not associated with pathologic scores on the questionnaires. Clinical Implications The inclusion of cFT in the first-line assessment of hypogonadal symptoms in men with ED has major clinical utility. Strengths and Limitations This is the first study evaluating the concomitant impact of TT and cFT on men with ED using well-validated instruments to assess patients’ sexuality and depressive symptoms. Limitations are the retrospective nature of the study and lack of physical function data and bone ultrasound measurements. Conclusions Although normal cFT was not associated with signs and symptoms suggestive of testosterone deficiency, even when concomitant with low TT or low cFT irrespective of TT values, it was indicative of poorer clinical profiles and impaired sexual and depressive parameters compared with normal TT and normal cFT in a cohort of patients with ED. Boeri L, Capogrosso P, Ventimiglia E, et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med 2017;14:1549–1557.

Original languageEnglish
Pages (from-to)1549-1557
Number of pages9
JournalJournal of Sexual Medicine
Volume14
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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Testosterone
Cross-Sectional Studies
Erectile Dysfunction
Comorbidity
Depression
Equipment and Supplies
Androgens
Linear Models
Body Mass Index
Symptom Assessment
Sexuality
Signs and Symptoms

Keywords

  • Androgen Related Symptoms
  • Calculated Free Testosterone
  • Depressive Symptoms
  • Erectile Dysfunction
  • Testosterone

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Urology

Cite this

Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. / Boeri, Luca; Capogrosso, Paolo; Ventimiglia, Eugenio; Cazzaniga, Walter; Pederzoli, Filippo; Moretti, Donatella; Dehò, Federico; Montanari, Emanuele; Montorsi, Francesco; Salonia, Andrea.

In: Journal of Sexual Medicine, Vol. 14, No. 12, 01.12.2017, p. 1549-1557.

Research output: Contribution to journalArticle

Boeri, Luca ; Capogrosso, Paolo ; Ventimiglia, Eugenio ; Cazzaniga, Walter ; Pederzoli, Filippo ; Moretti, Donatella ; Dehò, Federico ; Montanari, Emanuele ; Montorsi, Francesco ; Salonia, Andrea. / Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. In: Journal of Sexual Medicine. 2017 ; Vol. 14, No. 12. pp. 1549-1557.
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T1 - Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study

AU - Boeri, Luca

AU - Capogrosso, Paolo

AU - Ventimiglia, Eugenio

AU - Cazzaniga, Walter

AU - Pederzoli, Filippo

AU - Moretti, Donatella

AU - Dehò, Federico

AU - Montanari, Emanuele

AU - Montorsi, Francesco

AU - Salonia, Andrea

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N2 - Background Although erectile dysfunction (ED) has been associated with low circulating total testosterone (TT) levels, the utility of free testosterone (FT) over TT is debatable. Aim To assess the relative impact of low TT and low calculated FT (cFT) on androgen-related sexual symptoms in men with ED. Methods Data from 485 men were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) and the Beck Inventory for Depression (BDI). Descriptive statistics tested differences between patients with normal TT levels (>3 ng/mL) and normal cFT levels (>65 pg/mL; group 1) and men with normal TT and low cFT (group 2), low TT and normal cFT (group 3), and low TT and low cFT (group 4). Linear regression models tested the association between clinical predictors and sexual function impairment. Outcomes We assessed the impact of different hormonal categories on androgen-related symptoms and the clinical utility of measuring cFT in men with ED. Results Groups 1, 2, 3, and 4 were composed of 338 (69.6%), 44 (9.1%), 34 (7.0%), and 69 (14.3%) patients, respectively. Compared with group 1, patients in group 2 were older (P <.001), had a higher body mass index (P <.01), and had a larger proportion with CCI scores of at least 1 (P =.006). Likewise, group 2 presented lower scores for the IIEF erectile function (P =.07), sexual desire (P =.04), and orgasmic function (P =.007) domains and lower BDI scores (P =.02) than group 1. Similar findings were found for group 4 vs 1. Conversely, patients in group 3 had similar scores on the questionnaires to those in group 1. Low cFT and normal or low TT achieved independent predictor status for pathologic IIEF domains and BDI scores after accounting for age, CCI, and body mass index. Conversely, low TT and normal cFT status was not associated with pathologic scores on the questionnaires. Clinical Implications The inclusion of cFT in the first-line assessment of hypogonadal symptoms in men with ED has major clinical utility. Strengths and Limitations This is the first study evaluating the concomitant impact of TT and cFT on men with ED using well-validated instruments to assess patients’ sexuality and depressive symptoms. Limitations are the retrospective nature of the study and lack of physical function data and bone ultrasound measurements. Conclusions Although normal cFT was not associated with signs and symptoms suggestive of testosterone deficiency, even when concomitant with low TT or low cFT irrespective of TT values, it was indicative of poorer clinical profiles and impaired sexual and depressive parameters compared with normal TT and normal cFT in a cohort of patients with ED. Boeri L, Capogrosso P, Ventimiglia E, et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med 2017;14:1549–1557.

AB - Background Although erectile dysfunction (ED) has been associated with low circulating total testosterone (TT) levels, the utility of free testosterone (FT) over TT is debatable. Aim To assess the relative impact of low TT and low calculated FT (cFT) on androgen-related sexual symptoms in men with ED. Methods Data from 485 men were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) and the Beck Inventory for Depression (BDI). Descriptive statistics tested differences between patients with normal TT levels (>3 ng/mL) and normal cFT levels (>65 pg/mL; group 1) and men with normal TT and low cFT (group 2), low TT and normal cFT (group 3), and low TT and low cFT (group 4). Linear regression models tested the association between clinical predictors and sexual function impairment. Outcomes We assessed the impact of different hormonal categories on androgen-related symptoms and the clinical utility of measuring cFT in men with ED. Results Groups 1, 2, 3, and 4 were composed of 338 (69.6%), 44 (9.1%), 34 (7.0%), and 69 (14.3%) patients, respectively. Compared with group 1, patients in group 2 were older (P <.001), had a higher body mass index (P <.01), and had a larger proportion with CCI scores of at least 1 (P =.006). Likewise, group 2 presented lower scores for the IIEF erectile function (P =.07), sexual desire (P =.04), and orgasmic function (P =.007) domains and lower BDI scores (P =.02) than group 1. Similar findings were found for group 4 vs 1. Conversely, patients in group 3 had similar scores on the questionnaires to those in group 1. Low cFT and normal or low TT achieved independent predictor status for pathologic IIEF domains and BDI scores after accounting for age, CCI, and body mass index. Conversely, low TT and normal cFT status was not associated with pathologic scores on the questionnaires. Clinical Implications The inclusion of cFT in the first-line assessment of hypogonadal symptoms in men with ED has major clinical utility. Strengths and Limitations This is the first study evaluating the concomitant impact of TT and cFT on men with ED using well-validated instruments to assess patients’ sexuality and depressive symptoms. Limitations are the retrospective nature of the study and lack of physical function data and bone ultrasound measurements. Conclusions Although normal cFT was not associated with signs and symptoms suggestive of testosterone deficiency, even when concomitant with low TT or low cFT irrespective of TT values, it was indicative of poorer clinical profiles and impaired sexual and depressive parameters compared with normal TT and normal cFT in a cohort of patients with ED. Boeri L, Capogrosso P, Ventimiglia E, et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med 2017;14:1549–1557.

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KW - Erectile Dysfunction

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