ED may occur in males with deficient testicular function and low circulating levels of the male sex hormone, testosterone. These cases may be due to congenital abnormalities or testicular disease but in the case of metabolic syndrome the abdominal fat binds the testosterone and releases proinflammtory cytokines which in return may damage the endothelium even more.
Therefore it is necessary to check for testosterone deficiency if the ED patient presents with the following additional and indicative symptoms:
Testosterone Levels and Symptom Thresholds1
1. Zitzmann M et al. J Clin Endocrinol Metab 91(11): 4335-4343 (2006)