DEAR DR. GOTT: I am a 54-year-old male. I’ve had ED problems for about 10 years, resolved through the use of Viagra. But why? I do have low testosterone levels, for which I take injections, but for the most part I am healthy, fit, not overweight, a nonsmoker, a nonalcoholic-beverage drinker and, per my physician, do not suffer from any other cardiovascular problems. So why do I have blood-flow problems in this one department?
DEAR READER: Erectile dysfunction (ED) affects almost 30 million American men. Almost every man will experience difficulty achieving and maintaining an erection at some stage of his life. This is normal when the instances are infrequent.
Testosterone levels decline after about the age of 40. Low testosterone is identified as less than 300 nanograms per deciliter of blood. Symptoms, as I am sure you are aware, include ED, reduced libido, fatigue and mood swings, much the same as women going through menopause.
Testosterone replacement to bring deficient levels to within normal range can be accomplished through a skin gel, skin patch, oral tablets or injection.
The causes for impotence fall into three broad categories — an inadequate flow of blood, a nervous system dysfunction and hormonal abnormalities. Medical conditions that may contribute to the condition include arteriosclerosis in the lower portion of the body, prostate cancer, stress, anxiety, depression, diabetes, hypertension, liver disease, alcoholism and kidney failure. A great number of medications also have impotence as a side effect. Our bodies change as we age, and what was taken successfully in the past might not be so successful today.
Treatment options are varied. If you suspect a medication might be to blame, speak with your physician to determine if he or she will allow a trial period without the drug. There are a number of prescription medications available to enhance sexual performance or to combat impotence, including mechanical devices, such as vacuum pumps, and penile implants. Another important consideration is counseling for both you and your partner. If all physiological possibilities have been ruled out, you might consider seeing a sex therapist, psychiatrist or psychologist. You may have a degree of stress in your life you are unaware of, and certainly the perception of failure is a possibility. Sometimes just speaking with your partner or a third-party therapist will help alleviate issues and solve the problem.
Make another appointment with your primary-care physician. If you haven’t had complete blood work performed recently, ask about scheduling it. Get your blood pressure checked and a complete examination. Give a therapist a try. Once you identify the possible source for the impotence, the faster you can get on with your life in a way you will approve of.
To provide related information, I am sending you a copy of my Health Report “Erectile Dysfunction.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
