{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:13:22Z","timestamp":1793121202748,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vasculogenic erectile dysfunction (ED) is an important subtype of organic ED, and its development and progression are closely related to endocrine, metabolic, and psychological factors. Identifying risk factors for vasculogenic ED may facilitate early recognition and targeted intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 519 patients diagnosed with ED using penile color Doppler duplex ultrasonography (CDDU) as the gold standard. Clinical and laboratory indicators were collected. Feature selection was strictly performed within the training set using univariate logistic regression, the Boruta algorithm, and least absolute shrinkage and selection operator (LASSO) regression. Based on the selected key variables, five machine learning models\u2014logistic regression, random forest, support vector machine, light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost)\u2014were constructed and compared. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve (AUC), and the SHapley Additive exPlanations (SHAP) method was employed to interpret the optimal model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 519 patients, 235 were diagnosed with vasculogenic ED. Feature selection identified seven key risk factors: age, hypertension, smoking, diabetes, Hamilton Anxiety Scale (HAMA) score, total testosterone (T), and estradiol (E2). The random forest model performed best in the validation set, but its discriminative ability was only moderate (AUC\u00a0=\u00a00.682, 95% confidence interval [CI]: 0.598\u20130.768). SHAP analysis revealed that age contributed most to the model predictions, followed by hypertension, T, and smoking; the HAMA score also ranked highly. Testosterone levels exhibited a nonlinear U\u2212shaped association with vasculogenic ED risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on routine clinical indicators, this study identified seven key factors associated with vasculogenic ED. Among them, anxiety as measured by the HAMA score was recognized as a non\u2212traditional factor, suggesting a complex interplay between psychological factors and vascular pathology; however, the specific direction of this relationship remains to be elucidated by prospective studies. The machine learning model constructed in this study showed moderate discriminative ability and is currently insufficient to support independent clinical decision\u2212making. Future research should collect multicenter, large\u2212sample data and adjust model parameters for further validation and optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1849563","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:36:03Z","timestamp":1779338163000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying risk factors for vasculogenic etiology in patients with erectile dysfunction based on clinical features and machine learning"],"prefix":"10.3389","volume":"17","author":[{"given":"Jian","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Andrology, Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Andrology, The First Clinical Medical College of Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yancheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Andrology, Huai\u2019an Hospital of Traditional Chinese Medicine","place":["Huai\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medicine, Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Andrology, Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Andrology, The First Clinical Medical College of Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenrong","family":"Piao","sequence":"additional","affiliation":[{"name":"Department of Andrology, Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Andrology, The First Clinical Medical College of Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Urology, Yangzhou Hospital of Traditional Chinese Medicine","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maosen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Andrology, Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"Department of Andrology, The First Clinical Medical College of Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.1096741","article-title":"Advances in physical diagnosis and treatment of male erectile dysfunction","volume":"13","author":"Pang","year":"2023","journal-title":"Front Physiol"},{"key":"B2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1001\/jama.1993.03510010089036","article-title":"Impotence","volume":"270","year":"1993","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2021.06.007","article-title":"European association of urology guidelines on sexual and reproductive health-2021 update: male sexual dysfunction","volume":"80","author":"Salonia","year":"2021","journal-title":"Eur Urol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1002\/smrj.35","article-title":"Intracavernosal injection for the diagnosis, evaluation, and treatment of erectile dysfunction: a review","volume":"3","author":"Belew","year":"2015","journal-title":"Sex Med Rev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02902-1","article-title":"Causal machine learning for predicting treatment outcomes","volume":"30","author":"Feuerriegel","year":"2024","journal-title":"Nat Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-024-10474-y","article-title":"Machine learning in predicting heart failure survival: a review of current models and future prospects","volume":"30","author":"Kokori","year":"2025","journal-title":"Heart Fail Rev"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2025.123929","article-title":"Predicting conversion in cognitively normal and mild cognitive impairment individuals with machine learning: is the CSF status still relevant","volume":"21","author":"Russo","year":"2025","journal-title":"Alzheimers Dement"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202405596","article-title":"AI-powered mining of highly customized and superior ESIPT-based fluorescent probes","volume":"11","author":"Huang","year":"2024","journal-title":"Adv Sci"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1008-1062.2007.11.014","article-title":"Application and value of color Doppler ultrasonography in the diagnosis of vasculogenic erectile dysfunction","volume":"18","author":"Chen","year":"2007","journal-title":"J China Clinic Med Imaging"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1080\/13685538.2020.1742682","article-title":"Serum testosterone status in men with penile corporoveno-occlusive dysfunction","volume":"23","author":"Canguven","year":"2020","journal-title":"Aging Male"},{"key":"B11","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12933-025-02615-w","article-title":"Predicting major adverse cardiac events in diabetes and chronic kidney disease: a machine learning study from the Silesia Diabetes-Heart Project","volume":"24","author":"Kwiendacz","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"87","DOI":"10.7257\/1053-816x.2015.35.2.87","article-title":"Erectile dysfunction in the older adult male","volume":"35","author":"Mola","year":"2015","journal-title":"Urol Nurs"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.21037\/tau-2025-581","article-title":"Vascular aging-driven erectile dysfunction: pathophysiological mechanisms and emerging therapies-a narrative review","volume":"14","author":"Zhong","year":"2025","journal-title":"Transl Androl Urol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1042\/cs20100476","article-title":"Aging and vascular endothelial function in humans","volume":"120","author":"Seals","year":"2011","journal-title":"Clin Sci (Lond)"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.5935\/abc.20170091","article-title":"Vascular aging and arterial stiffness","volume":"119","author":"Oliveira","year":"2022","journal-title":"Arq Bras Cardiol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijir.3900792","article-title":"Smooth muscle pathology and erectile dysfunction","volume":"14","author":"Wespes","year":"2002","journal-title":"Int J Impot Res"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(24)00199-2","article-title":"Male hypogonadism: pathogenesis, diagnosis, and management","volume":"12","author":"De Silva","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-2190","article-title":"Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men","volume":"90","author":"Pitteloud","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s00210-023-02696-y","article-title":"Sodium acetate abates lead-induced sexual dysfunction by upregulating testosterone-dependent eNOS\/NO\/cGMP signaling and activating Nrf2\/HO-1 in male Wistar rat","volume":"397","author":"Besong","year":"2024","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod55.3.567","article-title":"Androgen and pituitary control of penile nitric oxide synthase and erectile function in the rat","volume":"55","author":"Penson","year":"1996","journal-title":"Biol Reprod"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1172\/jci146607","article-title":"Testosterone replacement in aging men: an evidence-based patient-centric perspective","volume":"131","author":"Bhasin","year":"2021","journal-title":"J Clin Invest"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2019.1659244","article-title":"An update on the drug safety of treating erectile dysfunction","volume":"18","author":"Gul","year":"2019","journal-title":"Expert Opin Drug Saf"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1210\/endo-meetings.2011.part3.p27.p3-209","article-title":"Effects of testosterone treatment in older men","volume":"374","author":"Snyder","year":"2016","journal-title":"N Engl J Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2017.07.004","article-title":"Quality of life and sexual function benefits of long-term testosterone treatment: longitudinal results from the Registry of Hypogonadism in Men (RHYME)","volume":"14","author":"Rosen","year":"2017","journal-title":"J Sex Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.esxm.2022.100550","article-title":"Effect of high testosterone levels on endothelial function in aorta and erectile function in rats","volume":"10","author":"Kataoka","year":"2022","journal-title":"Sex Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9568.2003.02558.x","article-title":"Extra-cellular dopamine increases in the paraventricular nucleus of male rats during sexual activity","volume":"17","author":"Melis","year":"2003","journal-title":"Eur J Neurosci"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9568.2009.06912.x","article-title":"Oxytocin injected into the ventral subiculum or the posteromedial cortical nucleus of the amygdala induces penile erection and increases extracellular dopamine levels in the nucleus accumbens of male rats","volume":"30","author":"Melis","year":"2009","journal-title":"Eur J Neurosci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbr.2019.112147","article-title":"Oxytocin induces penile erection and yawning when injected into the bed nucleus of the stria terminalis: a microdialysis and immunohistochemical study","volume":"375","author":"Bratzu","year":"2019","journal-title":"Behav Brain Res"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2006.08.020","article-title":"Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study","volume":"176","author":"Kupelian","year":"2006","journal-title":"J Urol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3390\/ijms252413294","article-title":"Systemic and cardiac microvascular dysfunction in hypertension","volume":"25","author":"Durante","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B31","doi-asserted-by":"publisher","first-page":"189","DOI":"10.5551\/jat.rv22015","article-title":"Cigarette smoking and atherosclerotic cardiovascular disease","volume":"31","author":"Ishida","year":"2024","journal-title":"J Atheroscler Thromb"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00473.2016","article-title":"Vascular endothelium in diabetes","volume":"312","author":"Goligorsky","year":"2017","journal-title":"Am J Physiol Renal Physiol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1849563\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:36:08Z","timestamp":1779338168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1849563\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":32,"alternative-id":["10.3389\/fendo.2026.1849563"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1849563","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"article-number":"1849563"}}