Background Systemic lupus erythematosus (SLE) in men is uncommon. Gonad and sexual function in these patients have rarely been studied.
Objectives The aim of this study was to determine the prevalence of hypogonadism and erectile dysfunction (ED) in Thai men with SLE. The association of SLE disease-parameters and the treatment in these patients was also examined.
Methods This was a cross-sectional study that included all men with SLE who presented to the Rheumatology clinic, Chiang Mai University Hospital, performed between January 2013 and December 2013. The demographic data, clinical features, modified-SLE disease activity index (mSLEDAI), systemic lupus erythematosus collaborating clinic (SLICC) damage score, chromosome study, and sex hormones (FSH, LH and morning testosterone level) were evaluated. Testicular size was measured by ultrasonography. Symptoms of hypoandrogenism were determined by Androgen Deficiency in the Aging Male (ADAM) screening questionnaires and ED severity was determined by the 5-item International Index for Erectile Function (IIEF-5) questionnaires.
Results There were 26 male SLE patients. Their mean ± SD age and disease duration were 37.5±15.4 and 4.2±4.5 years. The mean ± SD of mSLEDAI and SLICC score were 3.4±5.5 and 0.7±1.0, respectively. Five patients had co-morbidities; 2 diabetes mellitus (DM), 1 chronic renal failure (CRF), 1 cirrhosis and CRF and 1 long segment bowel dissection. All patients had XY chromosome. Seventeen patients (65%) were married and 15 of 17 patients (88%) fathered children before disease onset. Seven patients (27%) had biochemical hypoandrogenism (testosterone ≤3 ng/ ml). Two of 7 patients (28.5%) had high FSH level (FSH ≥15 mIU/ ml). The prevalence of symptomatic hypoandrogenism (ADAM ≥3) and ED (IIEF-5 score ≤20) was 62% and 76%, respectively. The testicular volume was 9.7±3.2 ml per side. Two patients (8.7%) had shrinking testes (testicular volume <5 ml). Both of them had co-morbidities, 1 DM and 1 cirrhosis and CRF. Testicular volume showed a positive correlation with testosterone level (r=0.525, p=0.010) and IIEF-5 score (r=0.476 and p=0.046) but negative correlation with SLICC damage score (r=-0.435, p=0.038). Patients with biochemical hypoandrogenism had significantly higher prevalence of neuropsychiatric-SLE (NPSLE) than the others (57% vs. 5%, p=0.010). Patients with ED had significantly lower testicular volume than the patients without ED (9.4±2.4 vs. 12.4±2.4 ml, p=0.018) and 19% of patients with ED had hypogonadism. ED was not associated with SLE disease-parameters or treatments.
Conclusions Hypogonadism in SLE can be both primary and secondary hypogonadism. A substantial proportion of male SLE patients had symptoms of hypoandrogenism and ED but only small number of them showed biochemical hypoandrogenism. Testicular volume correlated with symptomatic hypoandrogenism and ED, while biochemical hypoandrogenism did not. Therefore, the volume of testes may be more sensitive to predict sexual dysfunction than testosterone level.
Disclosure of Interest None declared