(243) Normalization of Prolactin and Erectile Function in Hyperprolactinemic Men: A Retrospective Cohort Study

Introduction Hyperprolactinemia is an uncommon but clinically meaningful endocrine cause of erectile dysfunction (ED). We evaluated whether biochemical normalization of prolactin (PRL) is associated with improvement in erectile function measured by the International Index of Erectile Function-5 (IIEF-5). Objective To assess changes in IIEF-5 following PRL reduction/normalization across routine treatment pathways in hyperprolactinemic men with ED. Methods We performed a retrospective cohort analysis of adult men with ED and hyperprolactinemia (N = 20) managed in routine care. All patients completed pituitary MRI and received phosphodiesterase-5 inhibitors (PDE5i) for ED. Patients were allocated by etiology/severity to: conservative management (drug-induced hyperprolactinemia; n = 4), medical therapy with cabergoline (n = 11), or transsphenoidal surgery for macroadenoma (n = 5). Primary endpoint: within-group change in IIEF-5; key secondary endpoints: PRL change and PRL normalization (< 300 ng/mL). Non-parametric tests (Wilcoxon signed-rank; Kruskal-Wallis; χ2) were used with α = 0.05. Results Median age was 50.5 years. Baseline PRL was highest in the surgery group. PRL decreased in all arms with group-specific patterns: conservative 513.0→138.2 ng/mL (ns), cabergoline 657.5→215.8 ng/mL (p = 0.001), surgery 3801.9→356.6 ng/mL (p = 0.031). PRL percent-change differed across groups (Kruskal-Wallis p = 0.01). PRL normalization rates were 100% (4/4), 63.6% (7/11), and 20.0% (1/5) for conservative, cabergoline, and surgery, respectively (trend p = 0.058). Erectile function improved in every arm: conservative IIEF-5 16.5→20.5 (ns), cabergoline 15.0→23.0 (p = 0.001), surgery 18.0→22.0 (p = 0.031). Between-group differences in IIEF-5 change were not significant (p = 0.79), consistent with universal PDE5i co-treatment. Conclusions In hyperprolactinemic men with ED, addressing the endocrine driver is associated with meaningful gains in erectile function alongside PRL reduction. Cabergoline produced consistent improvements in both PRL and IIEF-5, while surgery achieved the largest absolute PRL drop from very high baselines but lower normalization rates. Concurrent PDE5i likely optimizes short-term sexual outcomes and reflects real-world practice. Comprehensive hormonal assessment-including PRL-in men presenting with ED is justified, as treating hyperprolactinemia can yield clinically relevant improvements in sexual function. Disclosure No