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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 4  |  Page : 1263-1267

Quantification of serum melatonin level and its association with erectile dysfunction


1 Department of Dermatology, Andrology and STIs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission04-Jan-2021
Date of Decision28-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Mohamed H. A. Ghoniem
MBBCh, Salah Salem Street, El-Bagour, El-Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_2_21

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  Abstract 


Objectives
The work aimed to evaluate the role of melatonin in erectile dysfunction (ED) by measuring its level in the serum of these patients and correlating its level with the clinical data.
Background
One common issue is ED. It is the persistent inability to obtain or maintain a sufficient penile erection for satisfactory sexual performance. One of the hormones secreted from the pineal gland is melatonin. It has antioxidative and antiinflammatory effects. It plays a role in erectile function. In the etiology of ED, oxidative stress is an essential factor, and promising results have been obtained with melatonin treatment in many experimental models.
Patients and methods
This case–control study included 60 patients with ED and 30 age-matched healthy controls. The serum melatonin level was measured in all participants by enzyme-linked immunosorbent assay.
Results
The study results revealed a significant difference between patients with ED and normal persons regarding mean serum melatonin level. It was lower in cases than controls (2.11 ± 1.73 vs. 5.69 ± 4.33 ng/l), with P value of 0.001. There was no significant difference among the three ED classes in the levels of serum melatonin. There was no significant relation between melatonin level and diabetes, hypertension, hepatitis C virus, and smoking (P > 0.05).
Conclusion
There has been a significant association between ED and low levels of serum melatonin. This relationship indicates that in the etiology of ED, melatonin deficiency may be of significance.

Keywords: erectile dysfunction, etiology, melatonin, oxidative stress


How to cite this article:
Gaber MA, Ghoniem MH, Bayomy NR, Abdelaziz Hassan RA. Quantification of serum melatonin level and its association with erectile dysfunction. Menoufia Med J 2021;34:1263-7

How to cite this URL:
Gaber MA, Ghoniem MH, Bayomy NR, Abdelaziz Hassan RA. Quantification of serum melatonin level and its association with erectile dysfunction. Menoufia Med J [serial online] 2021 [cited 2024 Mar 29];34:1263-7. Available from: http://www.mmj.eg.net/text.asp?2021/34/4/1263/333230




  Introduction Top


Erectile dysfunction (ED) is the consistent and recurring inability to obtain or maintain an erection of sufficient rigidity and length to engage in satisfactory sexual intercourse, as described by the International Consultation on Sexual Medicine [1]. More than 150 million men are expected to experience ED worldwide. Its prevalence depends on age and varies from 2% in younger men (<40 years) to 86% in older men (>80 years) [2]. Age, diabetes, hypertension, obesity, lack of exercise, dyslipidemia, smoking, depression, lower urinary tract symptoms, and pelvic surgery are all risk factors for ED [3]. Treatment choices include lifestyle improvements, oral medications, penile injections, and penile prostheses that are surgically implantable. More experimental approaches are being investigated, such as penile shockwave treatment and stem cell intracorporeal injection, or platelet-rich plasma [4].

Melatonin is an indole hormone synthesized enzymatically in the pineal gland from the amino acid tryptophan. Melatonin is often referred to as 'the hormone of darkness' because its synthesis and secretion are enhanced by darkness and inhibited by light [5]. Melatonin can affect erectile function positively. Erection is a neurovascular occurrence in the corpus cavernosum that requires intact and functional endothelium and smooth muscle (CC). Atherosclerosis is an inflammatory mechanism that includes several proinflammatory cytokines, representing a high oxidative stress condition [6]. Melatonin protects the tissues from the oxidative damage caused by the different processes that create free radicals [7]. Besides, melatonin functions as an indirect antioxidant by activating the antioxidant enzymes, mainly superoxide dismutase. Treatment with melatonin has also been recorded in reducing/prevention of the functional and morphological alterations in penile structure and function induced by chronic ischemia [8]. Our work aimed to evaluate the role of melatonin in ED and correlate its level with clinical data.


  Patients and methods Top


This case–control study included 60 patients with ED and 30 age-matched healthy controls. The patients were randomly selected from the outpatient clinic of Dermatology, Andrology, and STDs Departments, Menoufia University Hospital, during the study period from August 2019 to April 2020. The biochemical investigations were performed in the Medical Biochemistry and Molecular Biology Department and the central laboratory of Menoufia Medical University. The study was started after approval of the protocol by the Ethical Committee of Menoufia University. Each participant received a complete explanation of the study's purpose, and written consent was taken from each participant according to the human rights and ethical committee. The inclusion criteria included patients with ED more than 6-month duration. Simultaneously, the exclusion criteria were the presence of neurological disorders, major psychiatric diseases, history of pelvic trauma, patients with cerebral disease or trauma that may affect the pineal gland, thyroid disease, acute or chronic urinary tract disease, end-stage renal disease, medication that would affect their sex hormones within the last 3 months, and being under treatment for ED. The control group included 30 healthy participants and their age ranged between 32 and 65 years. For all participants, careful sexual, medical, and psychological history was taken. Full clinical general and local examinations were performed to exclude any systemic disease associated with melatonin serum level.

The International Index of Erectile Function, which is a validated questionnaire that consists of 15 items, was performed. All items are scored in five domains: ED, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Items that reflect the erectile function domain (International Index of Erectile Function-EF) include items number 1, 2, 3, 4, 5, and 15. Each item ranges from 0 to 5, except the last question, which ranges from 1 to 5. The maximum score is 30. The score interpretations were as follows: 1–10, severe ED; 11–16, moderate ED; 17–21, mild to moderate ED; 22–25, mild ED, and 26–30, no ED [9]. Blood samples were taken at 9 a.m. from all participants after sleeping for 8 h at night. Biochemical investigations were complete blood count (using Swelab Alfa Plus, blood cell counter(, alanine transaminase (ALT), aspartate transaminase (AST) (using colorimetric kits supplied from Human (Stegelitzer Straße 3 39126 Magdeburg Germany) Diagnostics, on Chem-7 analyzer, Grenzacherstr. 124:4070 Basel, Switzerland), HbA1c (by a nephelometric kit supplied from AGAPPE Diagnostics, Switzerland, on MISPA-i2 analyzer), serum prolactin, prostatic-specific antigen (PSA), total testosterone (TT), and free testosterone (FT) (by electrochemiluminescence immunoassays on Cobas E601 analyzer; Roche Diagnostics, F. Hoffmann-La Roche Ltd, Grenzacherstr. 124:4070 Basel, Switzerland). According to the manufacturer's instructions on a microplate enzyme-linked immunosorbent assay Reader, Infinity 50, assessment of the serum melatonin level in the two studied groups was performed using an enzyme-linked immunosorbent assay kit supplied by Sun Red Biotechnology Company (catalog No. 201-12-1014; Shanghai, China).

Analysis of data was done using the Statistical Program for Social Science, version 20 (SPSS Inc., Chicago, Illinois, USA). Descriptive and inferential statistics were done. The χ2 test was conducted to determine the associations between the categorical variables. The Fisher exact test was used to compare two groups of qualitative data with the expected value of one cell less than 5, and the Student t test was used to compare the means of two groups of continuous parametric data. All P values less than 0.05 were considered statistically significant.


  Results Top


The patients were 60 males. Their age varied from 26.0 to 78.0 years (mean ± SD 51.9 ± 11.5). The controls were 30 males. Their age varied from 32.0 to 65.0 years (mean ± SD 48.8 ± 8.32). In terms of age, there was no statistically significant difference between patients and controls (P = 0.136).

The mean duration of ED between studied cases was 2.70 ± 2.15 years. A total of 17 (28.3%) patients had diabetes, two (3.30%) patients had hypertension, eight (13.3%) patients had diabetes and hypertension together, and five (8.30%) cases had hepatitis C virus (HCV). Overall, 17 (28.3%) patients were smokers, 32 (53.3%) patients were nonsmokers, and 11 (18.4%) cases were ex-smokers [Table 1].
Table 1: Clinical data of studied cases

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Distribution of the studied patients according to the degree of ED showed that 18 (30.0%) were mild ED, 10 (16.7%) were mild to moderate ED, 22 (36.6%) were moderate ED, and 10 (16.7%) were severe ED [Figure 1].
Figure 1: Percentage distribution of erectile dysfunction among studied cases.

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There was a highly significant difference between cases and controls regarding the mean level of serum melatonin. It was lower in patients than controls (2.11 ± 1.73 vs. 5.69 ± 4.33; P = 0.001) [Table 2].
Table 2: Comparison between cases and controls regarding their serum melatonin level (n=90)

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There was no significant relationship between the degree of ED and serum melatonin levels among the studied cases. There was a significant relationship between the degree of ED and FT, and there was no significant relationship between the degree of ED and TT [Table 3].
Table 3: Relation between degree of erectile dysfunction and serum melatonin level among the studied cases (n=60)

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There was no significant relation between serum melatonin level and age, ED duration, diabetes, hypertension, diabetes with hypertension, HCV, and smoking [Table 4].
Table 4: Relation between serum melatonin level and clinical data of studied cases (n=60)

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There was a negative correlation between serum melatonin level and white blood cells, ALT, AST, TT, and FT, and a positive correlation between serum melatonin level and hemoglobin (Hb), platelets, prolactin, HbA1C, and PSA of the studied cases but was not statistically significant [Table 5].
Table 5: Correlation between serum melatonin level and laboratory investigations among the studied cases (n=60)

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  Discussion Top


Melatonin can affect erectile function positively. The acute administration of melatonin was also shown to restore full sexual activity in selected impotent male rats [10]. Treatment with melatonin has also been recorded in reducing/prevention of the functional and morphological alterations in penile structure and function induced by chronic ischemia [8]. This study aimed to evaluate the serum melatonin's role in patients with ED to correlate its level with the clinical data. The age of patients with ED ranged from 26.0 to 78.0 years, with a mean ± SD of 51.9 ± 11.5. The age of controls ranged from 32.0 to 65.0 years, with a mean ± SD of 48.8 ± 8.32 years. Patients and controls showed a nonsignificant difference regarding age. A study by Nisahan et al. [11], was in the same line with our research regarding the patients' age, where the mean age of patients with ED was 49 ± 7.5 years. Moreover, our results agreed with Bozkurt et al. [6].

We found that the ED degree was mild in 30%, mild to moderate in 16.7%, moderate in 36.6%, and severe in 16.7% of patients. Similarly, Rhoden et al. [12] found that the ED degree was mild in 21.5%, mild to moderate in 14.3%, moderate in 6.3%, and severe in 11.9%.

Overall, 28.3% of patients with ED had diabetes. Nearly similar results were reported by Zamorano-Leon et al. [13], who found that diabetes was present in 28.57% of patients with ED. Overall, 3.3% of patients with ED had hypertension. However, Zedan et al. [14] found that 17.3% of patients with ED had hypertension. 13.3% of patients with ED had diabetes with hypertension. Nearly similar results were detected by Roth et al. [15], who found that 25% of patients with ED had diabetes with hypertension. 28.3% of patients with ED were smokers, 53.3% of patients with ED were nonsmokers, and 18.4% of patients with ED were ex-smokers. Similar results were noticed by Zedan et al. [14], who found that 40.1% of ED patients were smokers. We found a significant relationship between the degree of ED and the age of studied cases. This agrees with Tan et al. [16], who found that the ED severity is associated with increasing patients' age. We also found that there was a significant relationship between the degree of ED and diabetes. Goyal et al. [17], found similar results.

There was a significant difference between patients with ED and normal persons regarding the mean level of serum melatonin in our study. It was lower in cases than controls (2.11 ± 1.73 vs. 5.69 ± 4.33 ng/l; P = 0.001), and the serum melatonin level was found to be 2.18 ± 2.23 ng/l in the mild ED group, 1.98 ± 1.16 ng/l in the moderate ED group, and 2.64 ± 1.82 ng/l in the severe ED group. There was no significant relationship between the degree of ED and the serum melatonin level among the studied cases.

In agreement with our results, the results of Bozkurt et al. [6], showed that serum melatonin levels were significantly lower in all the ED groups than the control group (P = 0.019). There was no significant difference among the three ED classes in the levels of serum melatonin.

There was no significant relationship between serum melatonin level and age, duration of ED, diabetes, hypertension, and diabetes with hypertension, HCV, and smoking in our study. There was a negative correlation between serum melatonin level and ALT, AST, TT, and FT and a positive correlation between serum melatonin level and serum prolactin, HbA1C, and PSA of the studied cases but not statistically significant.

Zhang et al. [18] found that treatment with melatonin partially but substantially enhanced erectile function and reduced neuropathy in the major pelvic ganglion, decreased collagen deposition, and oxidative stress, and p-p38 levels in diabetic rats. Tang et al. [19], found that treatment with melatonin increases erectile function in rats with hyperhomocysteinemia, maybe by the possible action of antioxidative stress.

Sahan et al. [20], found that in type 1 diabetic rats, melatonin therapy substantially protects the cavernosal tissue against hyperglycemia-induced oxidative injury. The key protective effect seemed to be owing to sirtuin-1 protein expression activation, which facilitated the inhibition of apoptosis and provided resistance to oxidative stress.

By causing lower antioxidant capacity, a low serum level of melatonin can lead to an inadequate erection. Additional studies to determine the exact function of melatonin deficiency in patients with ED are required.


  Conclusion Top


We found an important association between the presence of ED and low levels of serum melatonin in the present study. This relationship indicates that in the etiology of ED, melatonin deficiency may be of significance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Zamorano-Leon J, Segura A, Lahera V, Rodriguez-Pardo J, Prieto R, Puigvert A, et al. Relationship between erectile dysfunction, diabetes and dyslipidemia in hypertensive-treated men. Urol J 2018; 15:370–375.  Back to cited text no. 13
    
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Zedan H, Hareadei A, Abd-Elsayed A, Abdel-Maguid E. Cigarette smoking, hypertension, and diabetes mellitus as risk factors for erectile dysfunction in upper Egypt. East Mediterr Health J 2010; 16:281–285.  Back to cited text no. 14
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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