Skip to main content

Advertisement

Log in

Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Diabetes is an established risk factor for erectile dysfunction (ED). The pathophysiology of ED in diabetic men is multifactorial, but it mainly involves a vascular disorder related to a reduction of endothelial function. Recently, several studies have correlated ED risk factors with vitamin D deficiency. In this study, we evaluate the relationship between 25-hydroxyvitamin D [25(OH)D] levels, erectile dysfunction, and vascular disease, in type 2 diabetes mellitus men (T2DM). In this observational study, 92 T2DM males (58.83 ± 9.73 years) underwent medical history collection, International Index of Erectile Function (IIEF-5) questionnaire, that allows the identification and grading of DE, physical examination, biochemical/hormonal blood tests, and penile echo-color Doppler ultrasonography. T2DM patients with lower 25(OH)D levels (<25 nmol/l) showed higher penile IMT (p < 0.05), waist circonference (p < 0.05), glucose concentrations (p < 0.05), and lower IIEF-5 score (p < 0.005), testosterone concentrations (p < 0.05), and cavernous peak systolic velocity (PSV) (p < 0.05), compared to patients with 25(OH)D >50 nmol/l. 25(OH)D levels were directly correlated with IIEF-5 (R = 0.39; p = 0.0001), testosterone (R = 0.24; p = 0.02), and PSV (R = 0.24; p = 0.04) and inversely with waist (R = −0.33; p = 0.002), HbA1c (R = −0.22; p = 0.03), triglyceride (R = −0.21; p = 0.06), and penile IMT (R = −0.30; p = 0.009). At multivariate analysis, 25(OH)D deficiency remained an independent predictor of DE. We demonstrate a significant association between 25(OH)D deficiency and erectile dysfunction in T2DM men. This association may be due to the influence of 25(OH)D deficiency on cardiovascular risk factor (glycaemia, HDL cholesterol, and triglycerides), testosterone plasma levels and endothelial dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. E. Selvi, A.L. Burnett, E.A. Platz, Prevalence and risk factors fer erectile dysfunction in the US. Am. J. Med. 120, 151–157 (2007)

    Article  Google Scholar 

  2. L.S. Malavige, J.C. Levy, Erectile dysfunction in diabetes mellitus. J Sex Med 6, 1232–1247 (2009)

    Article  PubMed  Google Scholar 

  3. H.A. Feldman, I. Goldstein, D.G. Hatzichristou, R.J. Krane, J.B. McKinlay, Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J. Urol. 151, 54–61 (1994)

    CAS  PubMed  Google Scholar 

  4. C. Gazzaruso, A. Coppola, T. Montalcini et al., Erectile dysfunction can improve the effectiveness of the current guidelines for the screening for asymptomatic coronary artery disease in diabetes. Endocrine 40, 273–279 (2011)

    Article  CAS  PubMed  Google Scholar 

  5. M.E. Sullivan, C.S. Thompson, M.R. Dashwood et al., Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? Cardiovasc. Res. 43, 658–665 (1999)

    Article  CAS  PubMed  Google Scholar 

  6. K.L. Billups, A.J. Bank, H. Padma-Nathan, S.D. Katz, R.A. Williams, Erectile dysfunction as a harbinger for increased cardiometabolic risk. Int. J. Impot. Res. 20, 236–242 (2008)

    Article  CAS  PubMed  Google Scholar 

  7. H. Solomon, J.W. Man, G. Jackson, Erectile dysfunction and the cardiovascular patient: endothelial dysfuntion is the common denominator. Heart 89, 251–253 (2003)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. I.M. Bird, Endothelial nitric oxide synthase activation and nitric oxide funtion: new light throught old windows. J. Endocrinol. 210, 239–241 (2011)

    Article  CAS  PubMed  Google Scholar 

  9. L. Ghiadoni, S. Taddei, A. Virdis, Hypertension and endothelial dysfunction: therapeutic approach. Curr. Vasc. Pharmacol. 10, 42–60 (2012)

    Article  CAS  PubMed  Google Scholar 

  10. C. Vlachopoulos, K. Rokkas, N. Ioakeimidis, C. Stefanadis, Inflammation, metabolic syndrom, erectile dysfunction, and coronary artery disease: common links. Eur. Urol. 52(6), 1590–1600 (2007)

    Article  CAS  PubMed  Google Scholar 

  11. C. Foresta, P.F. Palego, M. Schipilliti et al., Asymmetric development of pheriferal atherosclerosis in patients with erectile dysfunction: an ultrasonographic study. Atherosclerosis 197, 889–895 (2008)

    Article  CAS  PubMed  Google Scholar 

  12. J.P. Reis, D. von Muhlen, E.D. Michos et al., Serum vitamin D, parathyroid hormone levels and carotid atherosclerosis. Atherosclerosis 207, 585–590 (2009)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. A.C. Borges, T. Feres, L.M. Vianna, T.B. Paiva, Effect of cholecalciferol treatment on the relaxant responses of spontaneously hypertensive rat arteries to acetylcholine. Hypertension 34, 897–901 (1999)

    Article  CAS  PubMed  Google Scholar 

  14. S. Vigili de Kreutzenberg, A. Coracina, A. Volpi et al., Microangiopathy is independently associated with presence, severity and composition of carotid atherosclerosis in type 2 diabetes. NMCD 21, 286–293 (2011)

    PubMed  Google Scholar 

  15. L. Polidoro, G. Properzi, F. Marampon et al., Vitamin D protects human endothelial cells from H(2)O(2) oxidant injury through the Mek/Erk-Sirt1 axis activation. J. Cardiovasc. Transl. Res. 6, 221–231 (2013)

    Article  PubMed  Google Scholar 

  16. A. Barassi, R. Pezzilli, G.M. Colpi, M.M. Corsi Romanelli, G.V. Melzi d’Eril, Vitamin D and erectile dysfunction. J. Sex Med. 11, 2792–2800 (2014)

    Article  CAS  PubMed  Google Scholar 

  17. W.B. Grant, M. Sorenson, B.J. Boucher, Vitamin D deficiency may contribute to the explanation of the link between chronic periodontitis and edectile dysfunction. J. Sex Med. 10, 2353–2354 (2013)

    Article  PubMed  Google Scholar 

  18. M. Sorenson, W.B. Grant, Does vitamin D deficiency contribute to erectile dysfunction? Dermatoendocrinology 4, 128–136 (2012)

    Article  CAS  Google Scholar 

  19. Y. Song, L. Wang, A.G. Pittas et al., Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 36(5), 1422–1428 (2013)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. D.J. Al-Tamini, A.F. Ali, Serum 25(OH) D in diabetes mellitus type 2: relation to glycaemic control. J. Clin. Diagn. Res. 7, 2686–2688 (2013)

    Google Scholar 

  21. B.J. Boucher, W.G. John, K. Noonan, Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am. J. Clin. Nutr. 80, 1666–1667 (2004)

    PubMed  Google Scholar 

  22. V. Hirani, Relationship between vitamin D and hyperglycemia in older people from a nationally representative population survey. J. Am. Geriatr. Soc. 59, 1786–1792 (2011)

    Article  PubMed  Google Scholar 

  23. R. Scragg, M. Sowers, C. Bell, Serum 25-hydroxyvitamin D, diabetes and ethnicity in the third national health and nutrition examination survey. Diabetes Care 27, 2813–2818 (2004)

    Article  CAS  PubMed  Google Scholar 

  24. C. Foresta, N. Caretta, G. Corona et al., Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart. Int. J. Androl. 32, 198–211 (2009)

    Article  CAS  PubMed  Google Scholar 

  25. N. Caretta, P. Palego, Schipilliti et al., Cavernous artery intima media thickness: a new parameter in the diagnosis of vascular erectile dysfunction. J. Sex Med. 6, 1117–1126 (2009)

    Article  PubMed  Google Scholar 

  26. F.A. Giuliano, A. Leriche, E.O. Jaudinot, A.S. de Gendre, Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 64, 1196–1201 (2004)

    Article  PubMed  Google Scholar 

  27. D. Liu, B.O. Fernandez, A. Hamilton et al., UVA irradiation of human skin vasodilates arterial vasculature and lowers blood pressure independently of nitric oxide synthase. J. Invest. Dermatol. 134, 1839–1846 (2014)

    Article  CAS  PubMed  Google Scholar 

  28. C. Oplander, C.M. Volkmar, A. Paune-Gorgulu et al., Whole body UVA irradiation lowers systemic blood pressure by releae of nitric oxide from intracutaneous photolabile nitric oxide derivates. Circ. Res. 105, 1031–1040 (2009)

    Article  PubMed  Google Scholar 

  29. G. Corona, G. Rastrelli, S. Filippi et al., Erectile dysfunction and central obesity: an Italian perspective. Asian J. Androl. 16, 581–591 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  30. A.T. Drincic, L.A. Armas, E.E. Van Diest, R.P. Heaney, Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity 20(7), 1444–1448 (2012)

    Article  CAS  PubMed  Google Scholar 

  31. E. Wehr, S. Pilz, B.O. Boehm, W. Marz, B. Obermayer-Pietsch, Association of vitamin D status with serum androgen levels in men. Clin. Endocrinol. 73, 243–248 (2010)

    Article  CAS  Google Scholar 

  32. S. Pilz, S. Frisch, H. Koertke et al., Effect of vitamin D supplementation on testosterone levels in men. Horm. Metab. Res. 43(3), 223–225 (2011)

    Article  CAS  PubMed  Google Scholar 

  33. J.M. Blomberg, J.E. Nielsen, A. Jorgensen et al., Vitamin D receptor and vitamin D metabolizing enzymes are expressed in the human male reproductive tract. Hum. Reprod. 25, 1303–1311 (2010)

    Article  Google Scholar 

  34. D.W. Eyles, S. Smith, R. Kinobe, M. Hewison, J.J. McGrath, Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J. Chem. Neuroanat. 29, 21–30 (2005)

    Article  CAS  PubMed  Google Scholar 

  35. R. Perez-Fernandez, M. Alonso, C. Segura et al., Vitamin D receptor gene expression in human pituitary gland. Life Sci. 60, 35–42 (1997)

    Article  CAS  PubMed  Google Scholar 

  36. L.S.F. Carvalho, A.C. Sposito, Vitamin D for the prevention of cardiovascular disease: are we ready for that? Atherosclerosis 241, 729–740 (2015)

    Article  CAS  PubMed  Google Scholar 

  37. M.I. Ullah, G.I. Uwaifo, W.C. Nicholas, C.A. Koch, Does vitamin D deficiency cause hypertension? Current evidence from clinical studies and potential mechanisms. Int. J. Endocrinol. 2010, 579–640 (2010)

    Article  Google Scholar 

  38. O. Andrukhova, S. Slavic, U. Zeitz et al., Vitamin D is a regulator of endothelial nitric oxide synthase and arterial stiffness in mice. Mol. Endocrinol. 28, 53–64 (2014)

    Article  PubMed  Google Scholar 

  39. M.S. Wong, R. Delansorne, R.Y. Man, P. Svenningsen, P.M. Vanhoutte, Chronic treatment with vitamin D lowers arterial blood pressure and reduces endothelium-dependent contractions in the aorta of the spontaneously hypertensive rat. Am. J. Physiol. Heart Circ. Physiol. 299, 1226–1234 (2010)

    Article  Google Scholar 

  40. M. Hirata, K. Serizawa, K. Aizawa et al., 22-Oxacalcitriol prevents progression of endothelial dysfunction through antioxidative effects in rats with type 2 diabetes and early-stage nephropathy. Nephrol. Dial. Transpl. 28, 1166–1174 (2013)

    Article  CAS  Google Scholar 

  41. J.J. Cannell, W.B. Grant, M.F. Holick, Vitamin D and inflammation. Dermatoendocrinology 6(1), e983401 (2015)

    Article  Google Scholar 

  42. Y. Talmor, J. Bernheim, O. Klein, J. Green, G. Rashid, Calcitriol blunts proatherosclerotic parameters through NFkappaB and p38 in vitro. Eur. J. Clin. Invest. 38, 548–554 (2008)

    Article  CAS  PubMed  Google Scholar 

  43. K. Kudo, S. Hasegawa, Y. Suzuki et al., 1alpha,25-dihydroxyvitamin D(3) inhibits vascular cellular adhesion molecule-1 expression and interleukin-8 production in human coronary arterial endothelial cells. J. Steroid Biochem. Mol. Biol. 132, 290–294 (2012)

    Article  CAS  PubMed  Google Scholar 

  44. M.P. Ponda, X. Huang, M.A. Odeh, J.L. Breslow, H.W. Kaufman, Vitamin D may not improve lipid levels: a serial clinical laboratory data study. Circulation 126, 270–277 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicola Caretta.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caretta, N., de Kreutzenberg, S.V., Valente, U. et al. Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes. Endocrine 53, 831–838 (2016). https://doi.org/10.1007/s12020-015-0851-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-015-0851-z

Keywords

Navigation