(878) Luteinizing Hormone Versus Total Testosterone for Identifying Moderate-To-Severe Erectile Dysfunction: A Gonadotropin-Based Diagnostic Approach

Introduction Total testosterone (T) is routinely requested in the work-up of erectile dysfunction (ED), yet its ability to identify clinically relevant, moderate-to-severe ED is modest. Gonadotropins may better capture primary or compensated testicular failure. We aimed to compare the accuracy of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), the T/E2 ratio, and total T for identifying moderate-to-severe ED defined by the Erection Hardness Score (EHS). Objective To compare the diagnostic performance of LH, FSH, estradiol (E2), the T/E2 ratio and total T for identifying moderate-to-severe ED defined by the Erection Hardness Score (EHS). Methods We conducted a cross-sectional analysis of 601 men attending an outpatient urology clinic (median age 63 years; interquartile range [IQR] 54–71) who underwent standardized evaluation for erectile dysfunction. All included participants had complete hormonal profiling with luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), the T/E2 ratio, and total testosterone (T), together with Erection Hardness Score (EHS) assessment. Moderate-to-severe ED was defined a priori as EHS 0–2 and compared with EHS 3–4. Hormonal levels were summarized across EHS strata and described comparatively between groups. To quantify the discriminative ability of each hormone for moderate-to-severe ED, receiver-operating characteristic (ROC) curves were constructed and areas under the curve (AUCs) with 95% confidence intervals (CI) were calculated for LH, FSH, E2, T/E2, and total T.underwent complete hormonal profiling, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), the T/E2 ratio, and total testosterone (T), along with an Results Moderate-to-severe ED was present in 186/601 men (30.9%), representing a substantially older subgroup (median age 74 [67–80] vs 59 [52–65] years in those with EHS 3–4). Compared with men without clinically relevant ED, these patients had clearly higher gonadotropin levels, with median LH 6.5 vs 4.3 IU/L and FSH 9.8 vs 5.5 IU/L. In contrast, total T values largely overlapped between groups (452 vs 495 ng/dL), suggesting preserved or “eugonadal” T in many men with severe symptoms. In ROC analysis, gonadotropins showed the best discrimination for moderate-to-severe ED. AUCs (95% confidence interval) were: FSH 0.716 (0.678–0.751) and LH 0.664 (0.624–0.701), followed by T/E2 0.593 (0.552–0.632), total T 0.562 (0.521–0.602), and E2 0.530 (0.489–0.571). Thus, FSH and LH performed clearly better than chance and outperformed all T-based or E2-based indices, which showed only modest, near-borderline accuracy. Conclusions In men evaluated with the EHS in an outpatient urology setting, LH and FSH showed substantially higher diagnostic accuracy than total T, E2, and the T/E2 ratio for identifying moderate-to-severe ED. These findings support incorporating gonadotropins-especially LH as a marker of compensated Leydig cell failure-into the hormonal work-up of men with suspected clinically relevant ED, rather than relying solely on total testosterone.demonstrated substantially higher diagnostic accuracy than total T, E2, and the T/E2 ratio for identifying moderate to severe erectile dysfunction Disclosure No