Adolescent Erectile Dysfunction: Presenting Characteristics and Comorbidities
Amelia Pantazis, B.S.1, Israel Franco, MD2, Spencer Shain, B.S.1, Alexander Fang, B.S.1, Steven Friedmen, MD3, Ronnie Fine, MD1, Mark Horowitz, MD1, Richard Schlussel, MD4, Lori Dyer, MD5, Paul Zelkovic, MD5, Jaime Freyle, MD3, Richard Shoor, MD6, Jordan Gitlin, MD1.
1NYU Langone Health, North New Hyde Park, NY, USA, 2Yale School of Medicine, New Haven, CT, USA, 3Maimonides Hospital, Brooklyn, NY, USA, 4Hackensack University Medical Cente, Hackensack, NJ, USA, 5Westchester Medical Center, Valhalla, NY, USA, 6NYU Langone Urology Associates, Smithtown, NY, USA.
BACKGROUND: Traditionally, erectile dysfunction (ED) has been considered a disease affecting older men. Recently, pediatric urologists have seen an increase in adolescent male patients presenting with ED. An extensive literature review reveals a paucity of publications, making management a significant challenge. Our aim was to better understand this population and collate presenting characteristics.
Methods: A retrospective, single practice chart review from 2014-2022 was conducted in adolescent males aged 14 - 21 presenting with a primary complaint of ED. We evaluated mental health status, medications, laboratory values, setting and severity of ED, seasonal timing, age of presentation, referral to other providers, medical history, surgical history, testicular size, problem resolution, BMI, and the number of visits. Statistics were performed using SPSS, including descriptives of the cohort.
Results: 129 males with a mean age of 16.89 ± 1.41 years were identified with a mean number of visits of 1.2 ± 0.53 and a mean BMI of 23.5 ± 3.90 kg/m2. New patients increased from 1 in 2014 to 32 in 2020, with an increase during winter months (61%) compared to summer (38%). Quality of erections was as delayed onset in 9 (9%), difficulty of maintenance in 26 (26%), partial in 50 (50%), and failure to achieve in 15 (15%). Erection problems were present during intercourse in 33 (39%), masturbation in 29 (35%), and both in 22 (26%). 56% of patients that had a psychiatric problem reported an issue with intercourse. In 25 of 33 patients asked about mental health (77%), a diagnosis of neuropsychiatric conditions included anxiety in 10 (40%), depression in 8 (32%), psychosis in 1(4%), and combination in 6 (24%). 33 of the 129 patients had an evaluation of total testosterone and prolactin levels. Among those with labs, normal age-range of total testosterone and prolactin was observed in 94% and 76%, respectively. 14 (37%) of patients with elevated prolactin levels were on psychiatric medications. There was a statistically significant association between testicular hypotrophy and ED severity by chi-square analysis (p=0.048), however, we do not have the laboratory data to potentially link the presence of hypotrophy to an endocrine or organic cause of ED. Major of patients were counseled that their ED is likely self-limited. Low-dose Viagra or Cialis was prescribed in 10% of patients. 50% of patients were referred to another specialist. CONCLUSIONS: There has been a recent increase in adolescent patients presenting with ED with a high incidence of psychogenic ED ranging from 18-77%. ED presentations increased in winter months, peaking during the start of the COVID-19 pandemic. Organic causes do exist and blood work should be ordered on all adolescent males presenting with ED which includes Testosterone, LH, FSH, Prolactin, and TSH.
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