Serum Homocysteine Level as A Marker of Erectile Dysfunction

Background: The Fourth International Consultation on Sexual Medicine defined erectile dysfunction (ED) as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction homocysteine (Hcy) is a toxic, nonproteogenic sulfur-containing amino acid synthesized from dietary methionine in the liver and is metabolized either via trans-sulfuration or remethylation pathway.
Objective: To investigate serum Hcy levels in ED patients as compared to those in healthy controls, and to explore its correlation with severity of ED.
Patients and methods: This study consisted of 30 ED-affected men and 50 age-matched controls who were free from ED. All participants were recruited from the Andrology Outpatient Clinic of Mansoura University Hospital, between October 2019 and September 2020.
Results: Serum Hcy was significantly higher in ED cases compared to controls (P < 0.001). The mean of serum Hcy in cases was 24.17 ± 11.502 µmol/L versus 8.43 ± 9.076 µmol /L in controls. 23 out of 30 ED cases (76.66 %) had hyperhomocysteinemia (> 15 μmol/L). On the other hand, 6 out of 50 controls (12 %) had elevated level of Hcy. Elevation of Hcy levels was associated with an increased risk of ED, and that a cut-off value of 8.28 µmol/L was able to detect ED patients with a corresponding sensitivity and specificity of 90.0% and 78% respectively.
Conclusion: Elevated Hcy is associated with ED and may represent an important risk factor and play a pathophysiologic role in ED. Hence, Hcy-lowering agents, such as folic acid and vitamin B12, seem reasonable choices for the prevention and management of this condition.