ENDOCRINE SCREENING FOR SEXUAL DYSFUNCTION USING FREE TESTOSTERONE DETERMINATIONS

Purpose: Controversy exists concerning the need for routine endocrine screening in impotent men. Debate also continues as to what hormonal s tudies are necessary, the role of the free fraction of testosterone an d whether a history of decreased Libido or testicular atrophy can pred ict these endocrinopathies. Materials and Methods: We reviewed 508 con secutive men who presented with sexual dysfunction within a 22-month p eriod. Testosterone data were available for 268 patients (53%) and pro lactin data were available for 170 (33%). Results: Hypogonadism, defin ed as 2 abnormal total testosterone levels, was found in 42 of our 268 patients (15.6%). A history of decreased libido by patient questionna ire and/or testicular atrophy on physical examination could not predic t these cases. A normal free fraction of testosterone saved further un necessary endocrine evaluation in 50% of patients with hypogonadism. H ypoprolactinemia was noted in 3 of 170 patients (1.8%). Conclusions: R outine endocrine screening remains a necessary part of the evaluation for sexual dysfunction. A history of decreased libido and/or testicula r atrophy on physical examination cannot predict hypogonadism. Measure ment of free fraction of testosterone will further lessen unnecessary endocrine evaluations by 50% and should become standard practice in sc reening for hypogonadism. Prolactin levels are necessary only in patie nts with hypogonadism and/or a history of decreased libido.