Improved erectile function after bariatric surgery: role of testosterone and other factors—a cohort prospective study

Abstract

Background

The prevalence of obesity has risen dramatically worldwide. Beyond its metabolic implications, obesity profoundly impacts sexual health, particularly in males, with erectile dysfunction (ED) emerging as a prevalent and distressing co-morbidity. Studies show that bariatric surgery alleviates ED. Patients suffering from obesity have lower testosterone levels, which increase after weight loss surgery.

Objectives

This study aims to investigate the relationship between ED improvement, weight loss, and hormonal changes after surgery.

Setting

University Hospital, Poland.

Methods

This prospective study included 108 patients who underwent sleeve gastrectomy from 2022 to 2023. All patients completed a section of International Index of Erectile Function questionnaire before surgery and 1 year postoperatively. Patients with a score <25 were included in the analysis. Linear regression models were created to evaluate the impact of weight loss and hormonal changes on ED remission.

Results

Sixty patients with ED underwent analysis. The mean age was 41.9 and mean body mass index was 46.67. The average excess weight loss of the analyzed group was 59%. Significant improvements in erectile functioning were observed postsurgery: 40% of patients experienced full remission, and another 40% showed symptom alleviation. Multiple regression model identified preoperative severity of ED, weight loss, and diabetes as independent factors influencing ED remission Although testosterone levels increased significantly after the surgery, it was not an independent factor. Loss to follow-up was 20%.

Conclusions

Bariatric surgery improves erectile function, with weight loss and diabetes mellitus being key factors influencing ED. ED should be considered as an obesity-related co-morbidity similarly as hypertension.