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Fang-I Hsieh,^1,2 Ti-Sheng Hwang,³ Yi-Chen Hsieh,¹ Hsiu-Chiung Lo,¹ Chien-Tien Su,^1,4 Hui-Shing Hsu,⁵ Hung-Yi Chiou,^1,2 and Chien-Jen Chen⁶

¹School of Public Health, and ²Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan; ³Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; ⁴Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; ⁵Department of Urology, Lotung Poh-Ai Hospital, Lotung, Taiwan; ⁶Genomics Research Center, Academia Sinica, Taipei, Taiwan

Abstract
Background: Erectile dysfunction (ED) has a profound impact on the quality of life of many men. Many risk factors are associated with ED, such as aging, sex hormone levels, hypertension, cardiovascular diseases, and diabetes mellitus. Arsenic exposure could damage peripheral vessels and increase the risk of cardiovascular disease. However, the relationship between arsenic exposure and ED has seldom been evaluated.

Objectives: In this study we aimed to investigate whether exposure to arsenic enhances the risk of ED.

Methods: We recruited 177 males ≥ 50 years of age through health examinations conducted in three hospitals in Taiwan. We used a questionnaire (International Index of Erectile Function-5) to measure the level of erectile function. Sex hormones, including total testosterone and sex hormone–binding globulin, were determined by radioimmunoassay. We used another standardized questionnaire to collect background and behavioral information (e.g., cigarette smoking ; alcohol, tea, or coffee drinking ; and physical activity) .

Results: The prevalence of ED was greater in the arsenic-endemic area (83.3%) than in the non–arsenic-endemic area (66.7%) . Subjects with arsenic exposure > 50 ppb had a significantly higher risk of developing ED than those with exposure ≤ 50 ppb, after adjusting for age, cigarette smoking, diabetes mellitus, hypertension, and cardiovascular disease [odds ratio (OR) = 3.4]. Results also showed that the risk of developing severe ED was drastically enhanced by arsenic exposure (OR = 7.5) , after adjusting for free testosterone and traditional risk factors of ED.

Conclusions: Results suggested that chronic arsenic exposure has a negative impact on erectile function.

Key words: arsenic exposure, calculated free testosterone, erectile dysfunction, sex hormone, total testosterone. Environ Health Perspect 116:532–536 (2008) . doi:10.1289/ehp.10930 available via http://dx.doi.org/ [Online 16 January 2008]

Address correspondence to H.-Y. Chiou, School of Public Health, Topnotch Stroke Research Center, Taipei Medical University, No. 250, Wu-Hsing St., Taipei 110, Taiwan. Telephone: 886-2-23779188. Fax: 886-2-23779189. E-mail: hychiou@tmu.edu.tw

This work was supported by grants NSC92-2321-B-038-005 and NSC93-2321-B-038-008 from the National Science Council of Taiwan ; the Topnotch Stroke Research Center, Ministry of Education ; and the center of Excellence for Clinical Trial and Research in Stroke and TBI (DOH-TD-B-111-002) .

The authors declare they have no competing financial interests.

Received 28 September 2007 ; accepted 15 January 2008.