Sexual health in men with COPD: testosterone deficiency, erectile dysfunction and prediction using routine clinical indices

Sexual health impairment, including erectile dysfunction (ED) and testosterone deficiency syndrome (TDS), is common in men and particularly prevalent in chronic obstructive pulmonary disease (COPD). The aim of this study was to assess their prevalence and clinical correlates in COPD. Cross-sectional, multicentre study, including men aged 40–75 years with stable moderate-to-severe COPD. ED was measured by the International Index of Erectile Function (IIEF-5). Biochemical and symptomatic TDS were evaluated through serum testosterone levels and the Aging Males’ Symptom Scale (AMSS). Associations and predictors of severe ED were analysed. Forty-four men were included (mean age of 65.9 years and FEV1% 50.4%. ED was present in 81.8%, 54.5% severe ED. Biochemical TDS was identified in 70.5%, 54.5% reported severe symptoms. ED affected all IIEF-5 domains, with greater involvement of subjective domains. ED severity correlated strongly with COPD Assesment Test (CAT), comorbidities, psychological distress and systemic inflammation, but not with lung function or testosterone levels. Higher CAT, comorbidity burden and psychological distress independently predicted severe ED. ED and TDS are highly prevalent in COPD. ED relates more to symptom burden, comorbidities and psychological distress than to lung function or testosterone. Routine clinical indices, such as CAT, may help identify high risk patients, supporting routine sexual health assessment into COPD care.