What are the American College of Physicians (ACP) guideline for lab testing in the diagnosis and management of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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According to an American College of Physicians (ACP) guideline, the evidence for the utility of hormonal blood tests in identifying and affecting therapeutic outcomes for treatable causes of ED is inconclusive. The ACP makes no recommendations either for or against routine use of hormonal blood tests or hormonal treatment in the management of patients with ED. Clinicians should make decisions to measure hormone levels on a case-by-case basis, in accordance with the patient’s clinical presentation.

Patients who express a loss of libido, depression, or any signs of diminished secondary sexual characteristics should undergo an endocrine evaluation. At a minimum, this should consist of measuring morning serum testosterone levels.

The relative merits of measuring total, free, and bioavailable testosterone levels and serum hormone–binding globulin are controversial. In screening for hypogonadism, total and free testosterone levels should be measured to investigate the hypothalamic-pituitary-gonadal axis. Testosterone levels peak at about 8 AM; thus, a morning level should be checked whenever possible. Free or bioavailable testosterone is important because it is the testosterone that is usable; the rest is attached mainly to serum hormone–binding globulin.

Measurement of luteinizing hormone (LH) may be helpful. LH levels vary according to the body’s need for testosterone. The hypothalamus regulates testosterone levels by releasing or inhibiting LH-releasing hormone (LHRH), which acts in the pituitary to produce LH. A high LH level associated with a low testosterone level implies primary testicular (Leydig cell) failure. Conversely, a low LH level associated with a low testosterone level suggests a central defect.

In some instances, prolactin levels may be helpful as well. A serum prolactin level is obtained if the patient has evidence of pituitary hyperfunction (eg, from a pituitary tumor) or if low serum testosterone levels have been documented.

A serum thyroid-stimulating hormone (TSH) evaluation is appropriate in selected patients.

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