Erectile Dysfunction

Erectile Dysfunction or ED

The incidence of Erectile Dysfunction (ED) like that for Low-T increases with age. For most men the decrease in his sexual function is a slow process which can start in his 30s. Its definition is the inability to sustain an erection of enough duration to achieve penetration, intercourse and completion after reaching orgasm. Some men describe their problem as losing their erection shortly before or shortly after penetration. ED should not be confused with Premature Ejaculation

Common Male Midlife Symptoms

The symptoms and presentation of erectile dysfunction as described above tend to differ from those of low testosterone (hypogonadism). The symptoms of Low-T can include erectile dysfunction itself, decreased libido (sex drive/interest), decreased energy level, decreased sense of well-being, moodiness, decreased lean muscle mass as well as falling asleep before bedtime.

Possible Causes for ED

Most men with ED will have several factors contributing to his ED and usually his age is counted as his first. Other common contributing factors include obesity, smoking, hypertension (high blood pressure), diabetes, antihypertensive medications, chronic opioid pain medication use, antidepressants, H2 blockers used for acid reflux as well as others. Unfortunately, most men need to take these same medications to treat other health conditions that can then contribute to their ED.

Treatment for ED

Erectile dysfunction is typically treated in a stepwise fashion, starting with the most basic option such as pills and increasing in complexity all the way up to the more invasive, yet very effective option of a penile prosthesis. Most men have already heard of Viagra, Levitra, Cialis, as well as the newer pills. These prescription drugs can be effective but unfortunately they are quite expensive and are not well covered by Medicare and most private insurance plans. It is not uncommon for any one of these pills to work initially and then their effectiveness deteriorate over time. The eventual failure of pills is likely secondary to the progression of whatever medical conditions caused the ED to begin with.

Treating Low T prior to Treating ED

It is not uncommon to see a better response from the ED pills if any testosterone deficiency is corrected at the same time.

In order to make an accurate diagnosis of low T, the blood work should be drawn in the early a.m., no later than 10 AM and should include both a Total and a Free Testosterone.  There is no need to fast before testing.

The treatment for low testosterone ranges from intramuscular injections to daily self-application of gels, to testosterone pellets implanted under the skin of the upper thigh – buttocks and which can last between three and four months. It is very important to monitor the PSA, hematocrit and testosterone levels to ensure adequate levels and for safety. As long as the hematocrit is kept in check and the PSA is not increasing at a fast rate, correcting a low testosterone will be safe.

Male Mid-Life Quality of Life

ED can affect a man’s quality of life and at times his marriage. Most men can be treated successfully by a Board Certified Urologist with special interest in ED who will be able to provide every treatment option available.

ED Treatment Options:

  • Pills: ie Viagra, Levitra, Cialis.
    Convenient but very expensive.
  • MUSE:
    Efficacious but very expensive and can cause penile pain.
  • External Vacuum Device: simple and low tech
    couples do not stay with it for very long as it can be a mood breaker.
  • Intracavernosal Injections: Efficacious but can cause priapism and land men in the ER.
    Must be refrigerated
  • Penile Prosthesis:  highest success rate. Covered by Medicare and most private insurance.
    Outpatient surgery.