II. Causes: Endocrine

  1. Diabetes Mellitus (most common)
    1. Impotence occurs in 50% of men with Diabetes Mellitus
    2. Abnormal Glucose tolerance in 15% men with Impotence (ED may be an indicator sign for undiagnosed DM)
    3. Confers 3 fold increased Erectile Dysfunction (esp. with longer duration of Diabetes Mellitus)
  2. Metabolic Syndrome and Obesity
    1. Low Serum Testosterone
    2. Excessive aromatase (in adipose) converts testosterone to estradiol
    3. Confers 2.6 fold increased Erectile Dysfunction (esp. with higher Fasting Glucose)
  3. Hypogonadism (5% of Impotence cases)
  4. Hyperprolactinemia (Prolactinoma)
  5. Hypothyroidism (6% of Impotence cases)
  6. Hyperthyroidism
  7. Cushing's Syndrome

III. Causes: Vascular

  1. Coronary Artery Disease
    1. Shares similar risks for Erectile Dysfunction
    2. Erectile Dysfunction is diagnosed 2-5 years before Coronary Artery Disease
      1. Potential for lifestyle intervention to prevent progression to symptomatic CAD (esp. ages 40-49 yo)
      2. Also associated with a 75% increased risk of Peripheral Vascular Disease
  2. Peripheral Vascular Disease
  3. Chronic Renal Failure
  4. Hypertension
  5. Hyperlipidemia

IV. Causes: Neurologic disease

  1. Multiple Sclerosis
  2. Alzheimer Disease
  3. Parkinson Disease
  4. Cerebrovascular Accident
  5. Spinal Cord Injury (50% Impotence risk)
    1. Paraplegia
    2. Quadriplegia
  6. Pelvic irradiation
  7. Pelvic Surgery
    1. Simple Prostatectomy: 10% Impotence risk
    2. Radical Prostatectomy: 40% Impotence risk

V. Causes: Medications

VI. Causes: Habit Related

  1. Substance Abuse
    1. Alcoholism (associated with Hypogonadism)
    2. Anabolic Steroids
    3. Heroin
    4. Marijuana
    5. Methamphetamine
    6. Cocaine
  2. Tobacco Abuse
    1. Penile artery clot in 72% of men with 20 pack years
    2. Erectile Dysfunction risk increased 51% in current smokers and 20% of ex-smokers compared with non-smokers
      1. Cao (2013) PLoS One 8(4): e60443 [PubMed]

VII. Causes: Miscellaneous

  1. Advanced age
  2. Obesity
  3. Peyronie Disease
  4. Psychogenic causes (20% of Impotence cases)
    1. Anxiety Disorder
    2. Major Depression
    3. Relationship problems

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