(432) The Value of Routine Testosterone and HbA1c Testing in Men Presenting with Erectile Dysfunction

Introduction Testosterone deficiency and diabetes is commonly associated with erectile dysfunction (ED) and should be considered in clinical practice. Objective This study aimed to evaluate the clinical utility of systematic upfront testing of total testosterone and hemoglobin A1c (HbA1c) in men with ED. Methods We retrospectively extracted data from medical records for all men with organic ED referred to the outpatient clinic between June 1, 2019, and June 1, 2024. All underwent upfront blood testing including serum total testosterone and HbA1c. Men receiving ongoing testosterone treatment at the time of referral were excluded from the analysis. Collected variables included age, BMI, Charlson Comorbidity Index (CCI), diabetes status, total testosterone, and HbA1c. Potential hypogonadism was defined as a total testosterone level below 12 nmol/L. Elevated HbA1c was defined as >48 mmol/mol. We performed descriptive analyses, with the main outcomes being the proportions of patients with potential hypogonadism and elevated HbA1c. Independent predictors of these outcomes were identified using multivariable logistic regression. Results Of 312 men, 13 were excluded due to ongoing testosterone therapy, leaving 299 men for analysis. The median age was 60 years (IQR: 46 - 71), BMI was 26.9 (IQR: 24.0 – 30.4), and CCI 0 (IQR: 0 – 1). Overall, 69 (23.1%) men had a known diagnosis of diabetes upon referral. The median total testosterone level was 14.6 nmol/L (IQR: 11 – 20). Testosterone levels were below 12 nmol/l in 80 men corresponding to a prevalence of 26.8% (95% CI: 21.7 – 31.8%). Higher BMI (OR 1.19; 95% CI 1.11–1.27; p < 0.0001) and higher CCI (OR 1.42; 95% CI 1.03–1.95; p = 0.030) were independently associated with greater odds of hypogonadism. Age (OR 1.01; 95% CI 0.99–1.03; p = 0.46) and diabetes (OR 0.83; 95% CI 0.38–1.82; p = 0.65) were not significant. The median HbA1c was 38 mmol/mol (IQR: 34.0 – 48), and 71 of 299 men (23.7%; 95% CI: 18.9–28.6%) had HbA1c levels above 48 mmol/mol. Of these, 54 had a known diagnosis of diabetes. Among men without known diabetes, 17 of 230 (7.4%; 95% CI: 4.0–10.8%) had elevated HbA1c values. In the multivariable logistic model, higher BMI (OR 1.09; 95% CI 1.01–1.17; p = 0.019) and CCI (OR 2.02; 95% CI 1.47–2.78; p < 0.0001) were associated with elevated HbA1c. Age showed a borderline association (OR 1.02; 95% CI 0.999–1.043; p = 0.06), while low testosterone was not significant (OR 1.67; 95% CI 0.84–3.32; p = 0.14). Conclusions Routine blood testing in men with ED revealed a notable proportion of men with potential hypogonadism and elevated HbA1c. A subset of men without a prior diabetes diagnosis showed HbA1c levels suggestive of undiagnosed diabetes. These findings support the value of measuring testosterone and HbA1c as part of the initial evaluation for ED. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Viatris