Erectile dysfunction is associated with low total serum testosterone levels and impaired flow-mediated vasodilation in intermediate risk men according to the Framingham risk score

Atherosclerosis. 2015 Feb;238(2):415-9. doi: 10.1016/j.atherosclerosis.2014.12.007. Epub 2014 Dec 9.


Background: The role erectile dysfunction (ED) coupled with low testosterone levels as early markers of atherosclerosis is not well understood.

Objectives: To analyze the relationship between serum testosterone levels with both ED and brachial artery flow-mediated vasodilation (FMD), in a primary prevention sample of men.

Methods: We enrolled 802 asymptomatic, intermediate CV risk patients, according to the Framingham Risk Score, aged 40-80 years, who underwent the ultrasound examination of FMD, the evaluation of ED and the assessment of total serum testosterone levels.

Results: Testosterone levels correlated both with FMD (r = 0.85; p < 0.0001) and IIEF-5 score (rs = 0.65; p < 0.0001). Multivariable logistic regression analyses revealed that lower serum testosterone levels were strongly associated (p < 0.001) with severe (OR 0.78; 95% CI: 0.62-0.86), and moderate ED (OR 0.85; 95% CI: 0.72-0.97), while impaired FMD percentages were strongly associated (p < 0.001) with severe (OR 0.68; 95% CI: 0.59-0.79), moderate (OR 0.76; 95% CI: 0.63-0.83) and mild to moderate ED (OR 0.8; 95% CI: 0.69-0.94). Mild ED resulted statistically associated with lower FMD (OR 0.94; 95% CI: 0.82 - 1.07; p = 0.03) but not with serum testosterone levels. These relations were not substantially affected by adjustments for further potential confounders including smoking status, hypertension, diabetes mellitus and body mass index.

Conclusions: lower total serum testosterone levels are associated with impaired FMD and ED in this sample of intermediate CV risk men according to the Framingham Risk Score.

Keywords: Endothelial function; Erectile dysfunction; Flow mediated vasodilation; Serum testosterone levels.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Brachial Artery / physiopathology*
  • Chi-Square Distribution
  • Erectile Dysfunction / blood
  • Erectile Dysfunction / diagnosis*
  • Erectile Dysfunction / physiopathology
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Peripheral Arterial Disease / blood
  • Peripheral Arterial Disease / diagnosis*
  • Peripheral Arterial Disease / physiopathology
  • Regional Blood Flow
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Testosterone / blood*
  • Testosterone / deficiency
  • Vasodilation*


  • Biomarkers
  • Testosterone