Aim of this study is the assessment of clinical features associated with hyperprolactinemia in male patients consulting for sexual dysfunction.

A consecutive series of 2146 (mean age 52.2±12.8 years) male patients with sexual dysfunction was studied. Several hormonal and biochemical parameters were studied along with validated structured interviews (ANDROTEST and SIEDY). Mild hyperprolactinemia (MHPRL; PRL levels 420-735 mU/l or 20-35 ng/ml) and severe hyperprolactinemia (SHPRL, PRL levels >735 mU/l, 35 ng/ml) were considered.

MHPRL and SHPRL were found in 69 (3.3%) and in 32 (1.5%) patients respectively. Mean age and the prevalence of gynecomastia were similar in the two groups and in subjects with normal prolactin values. MHPRL was not confirmed in almost one half of the patients, after repetitive venous sampling. Hyperprolactinemia was associated with the current use of antidepressants, antipsychotic drugs and benzamides. SHPRL was also associated with hypoactive sexual desire (HSD), elevated TSH, and hypogonadism. The association between HSD and SHPRL was confirmed after adjustment for testosterone, TSH levels and use of psychotropic drugs (HR=8.60[3.85-19.23]; p<0.0001). In a 6-months follow up of patients with SHPRL testosterone levels and sexual desire were significantly improved by the treatment.

Our data indicate that SHPRL, but not MHPRL, is a relevant determinant of HSD. Gynecomastia does not help in recognising hyperprolactinemic subjects, while the use of psychotropic medications and HSD are possible markers of disease. In case of MHPRL, repetitive venous sampling is strongly encouraged.