Choi was deeply distressed. His performance in bed was not what it used to be, and his wife was worried, too. When, after a few agonising months, the 54-year-old professional finally decided to see a doctor, he was in for a surprise. Rather than just prescribing a 'magic pill', the doctor ordered a series of tests. The results came a few days later: Choi not only had erectile dysfunction (ED), but also high blood pressure and mild diabetes.
Although Choi isn't the patient's real name, there's nothing phoney about his problem which is all too common. 'ED, or sexual impotence, is not just about sex,' says Choi's physician, Andrew Yip Wai-chun, a specialist in urology. 'It is often a harbinger of serious underlying conditions, such as diabetes, hypertension and high cholesterol.'
These related conditions, when coupled with abdominal obesity, are often referred to as metabolic syndrome - a cluster of risk factors predisposing people to cardiovascular disease. An estimated 20-25 per cent of the world's adult population have metabolic syndrome, making them three times as likely to have a heart attack or stroke as people without it.
ED affects an estimated 152 million men worldwide, or 16 per cent of all men aged 20-75, and Yip says about one-third of Hong Kong's adult males may have the problem.
Yip, who runs the Men's Clinic at Kwong Wah Hospital, says 50 per cent of his ED patients - most of them in their 50s and 60s - have diabetes, and many are treated for hypertension.
Many ED patients also share risk factors with testosterone-deficient patients. 'Testosterone - the principal male hormone - plays a key role not only in sexual desire and function but also in body shape, muscle mass and strength, self-confidence, mood and general well-being. A man without testosterone is not a man. Testosterone deficiency, or male hypogonadism, also has been linked to symptoms of metabolic syndrome,' says Ronald Tan, a specialist in internal medicine and healthy ageing.