International ward roundsHypogonadism and erectile dysfunction associated with soy product consumption
Introduction
During the past two decades, accumulating evidence has linked soy consumption to beneficial health effects. Most of these health effects are related to the presence of isoflavones in soybeans [1]. The isoflavones genistein and daidzein are structurally and functionally similar to 17-β-estradiol, but with weaker bioactivity than estradiol [2]. Genistein and daidzein bind to the estrogen receptor-α and are therefore also known as phytoestrogens [3], [4]. Animal studies have shown that these isoflavones possess mixed estrogen receptor agonist/antagonist properties [5]. Isoflavones have been reported to lower cholesterol blood concentration in men [6], [7]. Furthermore, isoflavones are assumed to inhibit bone loss and to alleviate vasomotor symptoms, also referred to as hot flashes, in postmenopausal women [7], [8]. Some clinical evidence has linked isoflavones to a decreased risk of coronary heart disease [1], [9]. Furthermore, there are epidemiologic studies showing that isoflavone intake can lower the risk of breast cancer [10], [11]. However, some studies on the positive health effects of soy bean consumption are equivocal and reports of adverse effects of isoflavones related to their estrogenlike properties have been published [1], [12], [13]. Furthermore, the recent finding of reproductive toxicity of isoflavones in rats has amplified the discussion of estrogenic effects of isoflavones [14]. There are only infrequent reports of symptoms of feminizing such as gynecomastia related to soy product consumption [15]. Some investigators have concluded that isoflavones do not exert feminizing effects on men even at high intake levels [16]. The objective of this study is to document a case of hypogonadism and erectile dysfunction related to soy product ingestion and to review the current literature.
Section snippets
Case report
A 19-y-old male pre-med student with a history of type 1 diabetes mellitus presented to our clinic with complete loss of libido and erectile dysfunction that had begun suddenly 12 mo previously. Previously, he had been in good health. He stated a heterosexual preference and he had been sexually active and had sufficient libido. The patient denied any testicular trauma, history of orchitis, or undescended testicles. He had no history of androgen abuse or any hormonal medication. He denied any
Discussion
The symptoms of hypogonadism and erectile dysfunction and the hormonal findings of decreased free and percentage of free testosterone and increased DHEA levels in the present patient are related to the intake of 360 mg of isoflavones per day over 1 y. In comparison, the average dietary isoflavone intake in Western countries is as low as 2 mg/d [18]. The constellation of decreased free testosterone and increased DHEA indicates that isoflavones may cause an insufficient production of
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Neither soy nor isoflavone intake affects male reproductive hormones: An expanded and updated meta-analysis of clinical studies
2021, Reproductive ToxicologyCitation Excerpt :Nevertheless, reports of soy exerting estrogenic or feminizing effects subsequent to the 2010 meta-analysis [47] and narrative review [48] have been published. For example, a case-report by Siepman et al. [49] described a 19-year-old vegan who developed hypogonadism and erectile dysfunction allegedly as a result of his soy consumption. It is notable that the man described in this case-report and in the previously cited one [45], consumed an estimated 360 mg/d isoflavones, which is approximately 9 times the typical intake of older native Japanese men [11].
Vasculogenic Erectile Dysfunction: The Impact of Diet and Lifestyle
2021, American Journal of MedicineCitation Excerpt :Finally, the effect of soy foods on libido and erectile function has received attention because of the potential feminizing effects of soy isoflavones. Although a case report in which consuming large quantities of soy (containing up to 360 mg of isoflavones per day) as part of a vegan diet was temporarily associated with decreased libido and worsened erectile function,32 a review of 9 studies of soy isoflavone intake in men concluded that dietary isoflavones from soy of up to 139 mg/d (about 440-610 grams of tofu) had no “feminizing effect.”33,34 The effects of dietary patterns and components on vascular health and disease are mediated through numerous biologic pathways.35
Diet and sexual health
2019, Effects of Lifestyle on Men’s HealthErectile Dysfunction in Young Men—A Review of the Prevalence and Risk Factors
2017, Sexual Medicine ReviewsCitation Excerpt :When juvenile rats were exposed to daidzein in relatively large amounts, they were found to have impaired erectile function in a dose-related manner in adulthood.51 Apart from the animal models, there has been one case report of a 19-year-old man who developed sudden onset of loss of libido and ED after ingestion of large quantities of soy-based products; he eventually regained full sexual function 1 year after cessation of soy consumption.52 Normal erectile function is largely dependent on the neurologic system.
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