1. 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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3. 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

4. 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

5. 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

6. 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

7. 2018
opioid use

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Visit guidelines.diabetes.ca

16. Or download the App

17. Diabetes Canada Clinical Practice Guidelines
– for health-care providers
1-800-BANTING ( )
– for people with diabetes 17