II. Causes: Endocrine
-
Diabetes Mellitus (most common)
- Impotence occurs in 50% of men with Diabetes Mellitus
- Abnormal Glucose tolerance in 15% men with Impotence (ED may be an indicator sign for undiagnosed DM)
- Confers 3 fold increased Erectile Dysfunction (esp. with longer duration of Diabetes Mellitus)
-
Metabolic Syndrome and Obesity
- Low Serum Testosterone
- Excessive aromatase (in adipose) converts Testosterone to Estradiol
- Confers 2.6 fold increased Erectile Dysfunction (esp. with higher Fasting Glucose)
- Hypogonadism (5% of Impotence cases)
- Hyperprolactinemia (Prolactinoma)
- Hypothyroidism (6% of Impotence cases)
- Hyperthyroidism
- Cushing's Syndrome
III. Causes: Vascular
-
Coronary Artery Disease
- Shares similar risks for Erectile Dysfunction
-
Erectile Dysfunction is diagnosed 2-5 years before Coronary Artery Disease
- Potential for lifestyle intervention to prevent progression to symptomatic CAD (esp. ages 40-49 yo)
- Also associated with a 75% increased risk of Peripheral Vascular Disease
- Peripheral Vascular Disease
- Chronic Renal Failure
- Hypertension
- Hyperlipidemia
IV. Causes: Neurologic disease
- Multiple Sclerosis
- Alzheimer Disease
- Parkinson Disease
- Cerebrovascular Accident
- Spinal Cord Injury (50% Impotence risk)
- Pelvic irradiation
- Pelvic Surgery
- Simple Prostatectomy: 10% Impotence risk
- Radical Prostatectomy: 40% Impotence risk
V. Causes: Medications
VI. Causes: Habit Related
-
Substance Abuse
- Alcoholism (associated with Hypogonadism)
- Anabolic Steroids
- Heroin
- Marijuana
- Methamphetamine
- Cocaine
-
Tobacco Abuse
- Penile artery clot in 72% of men with 20 pack years
- Erectile Dysfunction risk increased 51% in current smokers and 20% of ex-smokers compared with non-smokers
VII. Causes: Miscellaneous
- Advanced age
- Obesity
- Peyronie Disease
- Psychogenic causes (20% of Impotence cases)
- Anxiety Disorder
- Major Depression
- Relationship problems