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A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie's disease.
Erectile dysfunction, also known as impotence, has many causes and a growing body of treatments. According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), erectile dysfunction "can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections." The condition affects as many as 30 million American men at some point in their lives.
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Patients who express a loss of libido, depression, or any signs of diminished secondary sexual characteristics should have an endocrine evaluation that consists of at least measuring morning serum testosterone levels. The relative merits of measuring total, free, and bioavailable testosterone levels and serum hormone–binding globulin are controversial. At this time, measuring total and free testosterone levels is recommended and should be performed when screening for hypogonadism. These hormone levels are generally higher in the morning than later in the day; therefore, a morning level should be checked whenever possible. Free or bioavailable testosterone is an important component because this is the testosterone that is usable. That portion attached to other proteins, the serum hormone–binding globulins, store testosterone.
Horwitz and lead author Mark Buyyounouski, also at Fox Chase, were expected to present their team's findings at the annual meeting of the American Society for Therapeutic Radiology and Oncology, in Los Angeles.
AW Jowdy Professor of Pharmacy Care, College of Pharmacy, University of Georgia, Athens, GA
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