Erectile dysfunctMD Ageless Solutionsion is no longer a reason for embarrassment. Even younger men are now aware that the problem is widespread; it is medical in nature and has a number of distinct causes; and most important, it is highly responsive to treatment.
First, the variety of causes. While we are accustomed to thinking of menopause in terms of female mid-life, males also experience a drop in hormone production that starts as early as their 20s. By the time most men are in their 40s and 50s, some of the results of declining hormonal levels are apparent: thinning hair, loss of muscle tone and fuzzy memory, among them. Last but not least, erectile dysfunction (ED).
An estimated 30 million men are affected by ED, according to the National Institute of Diabetes and Digestive and Kidney Diseases, which defines
ED as a problem getting or keeping an erection firm enough for sexual intercourse.
An older term, impotence, is still in play.
ED affects about 4% of men in their 50s but 17% of men in their 60s. By the 70s, half of men report some problem with ED. This probably understates the prevalence, as many men have been slow to come forward.
Hypogonadism, which indicates total testosterone levels below 400 [ng/DL— nanograms per deciliter] is often not diagnosed because men’s menopause, called andropause, comes on very gradually.
While in females, hormones drops off dramatically over a short period of time— and behavioral and physiological consequences can be equally dramatic— for men, it’s more of a slow decline that many attribute to simple aging.
Women experience a drop in estrogen levels. For men, reduced production of the primary male sex hormone, testosterone, is the primary culprit.
An erection is caused by blood flow into the penis, either stimulated by erotic thoughts or by physical contact. Ironically, when a man is
sexually excited, the penile muscles relax. This allows blood to flow through the penile arteries. When blood fills the chambers inside the
penis, an erection occurs. Erections end when the muscles contract and the blood exits the penis.
ED may be caused by damage to the penile arteries, which sometimes happens in patients with poor circulation due to cardiovascular disease, diabetes, injury, stress or anxiety (especially anxiety about relationships).
ED can also be brought on by drugs, alcohol, or smoking, which affects the circulatory system.
It’s difficult for men to believe that this important aspect of their life could disappear while they are still in their middle years, and they
are right on. These days, there is absolutely no justification for suffering in silence when we have a handful of treatments available.
These include hormone replacement therapy— which also affects other aspects of aging— as well as lifestyle changes, implants and penile pumps, and various prescription medications.
Our usual recommendation, if the man is otherwise healthy and has no serious underlying condition, is to try testosterone replacement therapy.
Testosterone, the quintessential male hormone, not only affects sexual function and desire; it defines and characterizes masculinity. That’s why we think the benefits of testosterone therapy go beyond sexual satisfaction.
Testosterone is one of a group of compounds known as anabolic steroids. It is secreted by the testes but is also present in smaller quantities
in women. This ratio of testosterone to other hormones is part of what determines gender.
Testosterone production starts to decline in men around the age of 30. This has a number of measurable effects on health, including mental, sexual and physical well-being. Testosterone replacement therapy is prescribed to treat hypogonadism and its various symptoms and consequences. (The media has dubbed this syndrome ‘Low T’, which essentially means less than optimal levels of natural testosterone in the male.)
By the way, women are also prescribed testosterone replacement therapy, most often to address low sexual desire.
Erectile dysfunction is the most disturbing outcome of low teststerone production, but there are other consequences, including:
Our male patients don’t always lead off the conversation with a discussion of sexual impotence. Some begin by confiding that they are just ‘feeling old’. At this point, we start asking them some questions.
This last question is the finale. Most of his answers to the preceding questions tell the doctor what he or she needs to know. This isn’t simple aging. This is hormone deficiency, and it is definitely treatable.
If the doctor has a sense of what’s going on with a patient, he or she will order lab work to analyze levels of free and total testosterone. In a man over 40 or someone with a family history of prostate cancer, a rectal exam is recommended to rule out prostate problems. Thereafter he will be scheduled for a check-up every three to six months.
Although there is no clear evidence linking testosterone replacement therapy with prostate cancer, current recommendations are to rule out
prostate cancer before initiating therapy in men over 40, and to monitor men during the first year of testosterone replacement therapy.
Testosterone therapy is now used by an estimated 400,000 American men. Many more are just starting to appreciate how testosterone levels decline with age. In the past, how many men suffered physical and mental symptoms as a result of an easily-correct hormone deficiency?
ED is not just an issue between a man and his partner. It affects his quality of life, his self-perception, his enjoyment of everyday activities,
responsibilities, relationships . . . Many males report that being able to retain an erection basically put their lives on a different course.
It’s a known phenomenon that hormones start to decline in one’s 20s, which seems a tad early to start thinking of oneself as aged. Until the past century or two, males had a much shorter life expectancy. Declining hormones are now a problem only because males are living longer. Now that we understand the chemistry, it’s a fixable problem.
Why live under the cloud of ED? Make an appointment to speak with our clinical director, and find out if testosterone therapy can put your life back on track.