Sexual Dysfunction and Hypogonadism in Men with Diabetes 2018 Clinical Practice Guidelines Sexual Dysfunction and Hypogonadism in Men with Diabetes Chapter 33 Richard Bebb MD ABIM FRCPC, Adam Millar MD MScCH FRCPC, Gerald Brock MD FRCSC

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Key Changes Reinforcement of 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Key Changes 2018 Reinforcement of The importance of regular screening for erectile dysfunction in adult men with diabetes Timing of testosterone measurements (before 11 AM) New section on hypogonadism including a diagnostic workup algorithm

Erectile Dysfunction (ED) Checklist 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Erectile Dysfunction (ED) Checklist SCREEN all adult men with diabetes regularly with sexual function history TREAT erectile dysfunction with PDE-5 inhibitor as first-line therapy (if no contraindication) INVESTIGATE for hypogonadism if men with ED do not respond to PDE-5 inhibitor therapy PDE-5, phosphodiesterase type 5 4

Screen for ED Common + Important 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Screen for ED ED affects 34-45% of men with diabetes 40% of men >60 years with diabetes have complete ED ED negatively impacts quality of life Common + Important Screen all adult men with diabetes regularly as part of sexual function history ED, erectile dysfunction 5

Management of erectile dysfunction in men with diabetes 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes 2018 Management of erectile dysfunction in men with diabetes ED, erectile dysfunction; PDE5, phosphodiesterase type 5

2018 opioid use

2018 Diabetes Canada CPG – Chapter 33 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Recommendations 1-2 All adult men with diabetes should be regularly screened for ED with a sexual function history [Grade D, Consensus] A PDE5 inhibitor should be offered as first-line therapy to men with diabetes and ED in either an on-demand [Grade A, Level 1A] or daily-use [Grade B, Level 2] dosing regimen ED, erectile dysfunction; PDE5, phosphodiesterase type 5

2018 Diabetes Canada CPG – Chapter 33 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Recommendation 3 2018 3. Men with diabetes and ED who do not respond to PDE5 inhibitors should be investigated for hypogonadism with measurement of a morning serum total testosterone level drawn before 11 am [Grade D, Level 4] 2 ED, erectile dysfunction; PDE5, phosphodiesterase type 5

2018 Diabetes Canada CPG – Chapter 33 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Recommendations 4-5 Referral to a specialist in ED should be considered for eugonadal men who do not respond to PDE5 inhibitors or for whom the use of PDE5 inhibitors is contraindicated [Grade D, Consensus] Men with diabetes and ejaculatory dysfunction who are interested in fertility should be referred to a healthcare professional experienced in the treatment of ejaculatory dysfunction [Grade D, Consensus] ED, erectile dysfunction; PDE5, phosphodiesterase type 5

Key Messages Regarding Sexual Dysfunction in Men with Diabetes 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Key Messages Regarding Sexual Dysfunction in Men with Diabetes Erectile dysfunction affects approximately 34 to 45% of adult men with diabetes. It has been demonstrated to negatively impact quality of life among those affected across all age strata and may be an early clinical indication of CVD All adult men with diabetes should be regularly screened for ED with a sexual function history ED, erectile dysfunction; CVD, cardiovascular disease

Key Messages Regarding Sexual Dysfunction in Men with Diabetes 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Key Messages Regarding Sexual Dysfunction in Men with Diabetes The current mainstay of therapy for ED is PDE5 inhibitors . They have been shown to have major impacts on erectile function and quality of life, with a low reported side effect profile, and should be offered as first-line therapy to men with diabetes wishing treatment for ED ED, erectile dysfunction; PDE5, phosphodiesterase type 5

Key Messages Regarding Hypogonadism in Men with Diabetes 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Key Messages Regarding Hypogonadism in Men with Diabetes Hypogonadotropic hypogonadism is common in men with type 2 diabetes, with a prevalence of up to 40% Hypogonadal men with diabetes have a higher risk for CV mortality than eugonadal men with diabetes Screening for symptomatic hypogonadism in men with type 2 diabetes is recommended CV, cardiovascular

Key Messages for People with Diabetes 2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Key Messages for People with Diabetes Low testosterone is common in men with type 2 diabetes Symptoms of low testosterone can include: diminished interest in sex, erectile dysfunction, reduced lean body mass, depressed mood and lack of energy A decrease in sexual function may indicate your risk of cardiovascular disease is increasing If you are experiencing symptoms of low testosterone, you should talk with your health-care provider

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