Does He have an Endocrinological Cause to His ED

Androgen and prolactin levels are of particular concern. Hyperprolactinaemia occurs secondary to stress, drugs (such as neuroleptics and infertility treatments), cirrhosis, breast manipulation, or pituitary adenoma tumour. A high level of circulating prolactin causes inhibition of gonadotrophin releasing hormone which lowers levels of testosterone. Men with low testosterone levels may exhibit a decrease in sexual interest. Causes of low testosterone include renal failure, hypogonadism, bilateral cryptorchidism, other hypothalamic-pituitary-gonadal axis dysfunctions, Addison's disease, adrenalectomy, Kleinfelter's syndrome, cytotoxic therapies, mumps orchitis, and age related testicular degeneration as well as antiandrogen medications (e.g., cyproterone acetate, spironolactone, etc.). Androgens have also been shown to influence the activity of NOS in the corporal smooth muscle, which suggests a more direct effect of low levels of testosterone on erectile function. Approximately 52% of circulating testosterone is bound to albumin, 46% is bound to sex hormone binding globulin (SHBG), and 2% is unbound. Determination of free testosterone is preferred as it represents the most accurate parameter to reflect a real testosterone deficiency in the respective target cells. However, because the methods used most widely for determination of these parameters (e.g., equilibrium dialysis method) have shown poor reliability and high cost, the standard for evaluating testosterone deficiency remains determination of total testosterone, the free androgen index (free T/SHBG x 100%), LH level, and clinical symptoms.

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