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BoxBaghdad, Iraq. Diabetic men with erectile dysfunction have not been widely studied. They have low testosterone levels, causing low sex drive and erectile dysfunction. To assess the erectile dysfunction and sex drive in relation to testosterone serum levels in type 2 Diabetes Mellitus DM patients. A total of 64 patients with type 2 DM were enrolled in this cross-sectional study, according to the treatment types they were divided into three groups, group A : 34 patients dgive with metformin, group B : 30 patients treated with sulfonylurea and frive C : 27 healthy normal non-diabetic men are taken as control.

On other hand Bioavailable testosterone BT was low in metformin drive patients 2. SHIM was low in metformin treated patients Metformin leads to significant reduction in testosterone levels, sex drive and induction of low testosterone-induced erectile dysfunction, whereas; sulfonylurea leads to significant elevation in testosterone levels, sex drive and erectile drivr. Erectile dysfunction is a well-recognized complication ddive diabetes mellitus and it is common in older men.

Also, decrease libido and orgasmic dysfunction are commonly associated with erectile ses in patients with type 2 Diabetes Mellitus DM aj 12 ]. Sex drive and desire are regulated by sex hormones and affected by psychological factors and metabolic diseases like DM [ 3 ]. The role of insulin is essential for sex homeostasis via induction of peripheral tissue glucose uptake, inhibiting hepatic glucose output and regulating lipid metabolism drivf cooperation with other hormones like catecholamine, cortisol, growth hormone and glucagon [ 5 ].

Recently, higher endogenous testosterone secretion has been correlated with beneficial effect on cardiometabolic profile through induction of Rdive Density Lipoproteins HDL and reduction in serum levels of cholesterol and triglyceride, whereas exogenous testosterone leads to harmful effects causing dyslipidemia and various hepatic dysfunctions [ 6 ]. Likewise, low testosterone is associated with the pathogenesis of type 2 DM. Recent studies demonstrated that men with type 2 DM have low testosterone levels that cause low sex drive and erectile dysfunction [ 78 ].

Moreover, low testosterone serum levels are more linked with type 2 DM coupled with obesity causing sexual dysfunction, physical fatigue and mood changes [ 9 ]. Furthermore, other factors like increasing age, impaired penile blood flow and peripheral neuropathy with low testosterone are often responsible for type 2 DM-induced erectile dysfunction [ 10 ].

Indeed, patients with diabetic-induced erectile dysfunction with low testosterone respond weakly to sildenafil and respond better to the testosterone replacement therapy that also causes improvement in insulin sensitivity, glucose and lipid sex [ 11 ].

Many longitudinal studies demonstrated that men with low testosterone levels are at higher risk for development of type 2 DM due to induction of insulin resistance, since free testosterone levels are inversely corelated with insulin resistance [ 1415 ]. Metformin is an insulin sensitizing agent that increases insulin sensitivity and reduced androgen serum levels through inhibition of ovarian gluconeogenesis in women with polycystic ovary syndrome [ 16 ]. Furthermore, metformin therapy leads to significant reduction in testosterone serum levels in diabetic and non-diabetic patients [ 17 ]; while, sulfonylurea glimepiride restore testosterone serum ao in type 2 DM patients [ 18 ].

The study procedures were done in respect to the Declaration of Helsinki [ 19 ]. A total number of 64 patients with well diagnosed type 2 DM the range of disease duration was 7 years associated with erectile dysfunction on either metformin or glibenclamide therapy were recruited from the Iraqi Endocrinology Drive involved in this study.

The duration of treatment for those patients ranged from years. All patients were followed-up for one month duration during the study protocol for final findings regarding sex drive and full medical history like the response to sildenafil, drug allergy, pelvic trauma and psychological disorders.

Inclusion criteria: Male patients with type 2 DM without complications, with age range of years and on treatment with either metformin or glibenclamide that are associated with erectile dysfunction. Furthermore, blood pressure measurement was done sexx mercury sphygmomanometer.

The unpaired student t-test was used to compare the significance of differences between the diabetic patients and non-diabetic drive control, whereas one-way ANOVA test was used to detect the significance of differences between treated groups as compared to the control.

A total number of 70 patients with type 2 DM were screened for enrollment in this study, 6 patients were excluded, so 64 men patients were enrolled and randomized into two treated groups, metformin and sulfonylurea Glibenclamide groups seex to 27 normal healthy men regarded as drive.

Age of the patients was ranged from years with 6. The results of the present study also revealed that There was no significant difference in age of patients between the three groups. Effects of metformin and glibenclamide on anthropometric and blood pressure profile on men patients with type 2 DM compared to normal sex subjects.

Effects of metformin and glibenclamide on glucose levels and lipid profile, on men patients with type 2 DM compared to normal healthy subjects.

SHBG levels were significantly higher in glibenclamide treated patients compared to metformin treated patients. FAI and FT was significantly higher in glibenclamide treated patients compared to metformin treated patients. Effects of metformin and glibenclamide on testosterone serum levels and Sexual Health Inventory in men patients with type 2 DM compared to normal healthy subjects. The drive study demonstrated that men patients dex type 2 DM are associated with low testosterone serum levels compared to normal healthy men, this finding is compatible with Cheung et al.

Low testosterone serum levels is linked with the occurrence of type 2 DM, since testosterone lead to increments in the muscle mass and decrement in the fat mass that causes a significant reduction in insulin resistance and prevention of type 2 DM. Additionally, testosterone inhibits lipoprotein lipase activity and augment triglyceride uptake that prevents insulin resistance [ 2930 ].

In present study, all enrolled patients were of the middle age group. This was done to exclude the effect of aging on testosterone serum levels since; aging leads to reduction in the androgen serum levels due to defects in testicular-pituitary-hypothalamic axis [ 31 ]. Indeed, most of our patients were overweight and obese.

Zhao et al. In addition peripheral conversion of testosterone to estrogen is augmented causing negative feedback inhibition on luteinizing hormone production and then inhibition of testicular androgen production [ 32 ]. This leads to sexual dysfunction and low sex sex as demonstrated in the present study. Moreover, testosterone therapy is more effective in reducing BP than exercise and diet alone in metabolic syndrome [ 34 ].

A study indicated sez androgen deprivation therapy in treatment of prostatic cancer leads to hyperlipidemia and increases the risk of cardiovascular complications [ 35 ], whereas another study showed that androgen deprivation therapy causes an early elevation in total cholesterol and TG levels [ 36 ]. Furthermore, the present study showed that fasting blood glucose and HbA1c were higher in diabetic men patients with low testosterone serum levels compared to the control men, since testosterone inhibits gluconeogenic and glycogenolytic pathways, decreases corticosterone effects on glucose metabolism, improves skeletal muscle glucose uptake and inhibits hepatic insulin resistance [ 37 ].

Thus, reduction in testosterone levels in type 2 DM may elevate fasting blood glucose and subsequently HbA1c as observed in our study. This finding was incompatible with Lotti et sex. The possible explanation for low testosterone in the present study compared to Lotti et al. Regarding the effect of diabetic pharmacotherapy on testosterone serum levels, metformin significantly reduces TT; through inhibition of Cytochrome PC17a which is a key enzyme in Drivf synthesis and reduction of LH hormone secretion [ 39 ].

All of these findings are compatible with the results of the present study. On the other hand, TT, FT, BT levels and FAI were significantly higher in patients treated with sulfonylurea compared to metformin treated patients, that corresponding with a study by Wong et al.

They found that treatment with sulfonylurea in type 2 DM led to significant elevation in TT and FT due to inhibition of prob-hydroxysteroid dehydrogenase type 1 leading to reduction sex glucocorticoid biosynthesis and stimulation of testosterone synthesis since; thus glucocorticoid reduces testosterone levels [ 42 ].

Moreover, it is well-known that sulfonylureas stimulate insulin secretion which plays an important role in the regulation of testicular function and hypothalamic-pituitary-testicular qk, thus insulin improves testosterone levels and testosterone secretion index in type 2 DM [ 43 ]. In the present study, sulfonylurea showed an insignificant effect on SHBG levels compared to metformin, this finding is supported by previous studies that demonstrated non-significant effect of sulfonylurea on SHBG in type 2 DM compared to the baseline data, since SHBG reduces testosterone bioavailability and because insulin inhibits hepatic SHBG production so BT is augmented [ 4445 ].

Additionally, scores of the SHIM were significantly higher in sulfonylurea treated patients compared to metformin treated patients; rdive indicated that sex drive was superior in sulfonylurea treated patients compared to metformin treated patients, since testosterone improves sex sex in hypogonadal men [ 46 ].

Furthermore, insulin improves testosterone serum levels, causing increasing sex drive and reduction of erectile dysfunction as well. Tight glycemic driv by sulfonylurea plus 5-phosphodiestrase inhibitor improved sexual function more than 5-phosphodiestrase inhibitor alone in experimental animals due to the synergistic effects on penile nitric oxide [ 47 ]. In contrast, Rey-Valzacchi et al. Consequently, low sex drive and erectile dysfunction in type 2 DM are multifactorial with and without low testosterone levels [ 7 ], also; metformin improves erectile function zk insulin resistance and diabetic-induced erectile dysfunction inspite of low testosterone levels [ 49 ], but the reverse is documented in the present study.

Firstly, patients could not be followed-up for a longer time period for evaluating the effect of metformin or sulfonylurea on testosterone levels. Secondly, the sample size of diabetic patients was small. Thirdly, serum insulin srx insulin resistance were not evaluated and correlated with TT, since they are well and extensively studied in previous researches. But, regardless of these limitations, to our knowledge this study may be the first one that implicated metformin in low sex drive and erectile dysfunction in type 2 DM.

Metformin in type 2 DM drive to significant reduction in testosterone levels, sex drive and induction of low testosterone-induced erectile dysfunction, whereas; sulfonylurea in type 2 DM leads to significant rise in testosterone levels, sex drive and erectile function.

National Center for Biotechnology InformationU. J Clin Diagn Res. Published online Dec 1. Hayder M. Al-Kuraishy 1 and Ali I.

Al-Gareeb 2. Find articles by Hayder M. Ali I. Find articles by Ali I. Author information Article notes Copyright and License information Disclaimer. Corresponding author.

E-mail: moc. This article has been cited by other articles in PMC. Abstract Introduction Diabetic men with erectile dysfunction have not been widely studied. Aim To assess the erectile dysfunction and sex drive in relation to testosterone serum levels in type 2 Diabetes Mellitus DM patients.

Materials drive Methods A total of 64 patients with type 2 DM were enrolled in this cross-sectional study, according to the treatment types they were divided into three groups, group A : 34 patients treated with metformin, group B : 30 patients treated with sulfonylurea and group C : 27 healthy normal non-diabetic men are taken as control.

Conclusion Metformin leads to significant reduction in testosterone levels, sex drive and induction of low testosterone-induced erectile dysfunction, whereas; sulfonylurea leads to significant elevation in testosterone levels, sex drive and erectile function.

Keywords: Diabetic, Metformin, Sulfonylurea. Introduction Erectile dysfunction is a well-recognized complication in diabetes mellitus and it is common in older men. Free androgenic index was estimated as. Open in a separate window. Results A total number of 70 patients with type 2 DM were screened for enrollment in this study, 6 patients were excluded, so 64 men patients were enrolled and drive into dex treated groups, metformin and sulfonylurea Glibenclamide groups compared to 27 normal healthy men regarded as control.

Changes in the Anthropometric profile There drivve no significant difference in age of patients between the three groups. Correlation between total testosterone and sexual health inventory for men.

Discussion The present study demonstrated that men patients with al 2 DM are associated with low testosterone serum levels compared to normal healthy men, this finding is compatible with Cheung et al. Limitation Firstly, patients could not be followed-up for a longer time period for evaluating the effect of metformin or sulfonylurea on testosterone levels.

Conclusion Metformin in type 2 DM leads to significant reduction in testosterone levels, sex drive and induction of low testosterone-induced erectile dysfunction, sex sulfonylurea in type 2 DM leads to significant rise in testosterone levels, sex drive and erectile function. Erectile dysfunction is predictive of endothelial dysfunction in a well visit population. J Urol. J Sex Med. Sexual function of the ageing male.

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Give today. Request Appointment. Testosterone therapy in women: Does it boost sex drive? Products and services. Free E-newsletter Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Sign up now. Does testosterone therapy help increase sex drive in women? What are the pros and cons? Show references Korkidakis AK, et al. Testosterone in women: Measurement and therapeutic use. Johansen N, et al.

Hormone levels and sexual functioning after risk-reducing salpingo-oophorectomy. Sexual Medicine. Shifren JL. Overview of sexual dysfunction in women: Management. Accessed March 20, Krakowsky Y, et al. A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada.

Canadian Urological Association Journal. Jayasena CN, et al. A systematic review of randomized controlled trials investigating the efficacy and safety of testosterone therapy for female sexual dysfunction in postmenopausal women.

Clinical Endrocrinology. Reaffirmed IBM Micromedex 2. Accessed April 4, Davis SR, et al. Androgens and female sexual function and dysfunction—Findings from the Fourth International Consultation of Sexual Medicine.

Journal of Sexual Medicine. Wein AJ, et al. Sexual function and dysfunction in the female. In: Campbell-Walsh Urology. Philadelphia, Pa. Clayton AH, et al. Mayo Clinic Proceedings. Goldstein I, et al.