Erectile dysfunction – Is there hope?
My wife and I have been married for over 40 years and we are both in our sixties. We have had a very active sex life. However over the last two years, we have been suffering from erectile dysfunction (ED) (I am including my wife because it also adversely affects her.)
Here is some additional background. I have the following medical conditions:
1. Sleep apnea – controlled with a CPAP for the last 15 years.
2. Hypertension – controlled with medications, some of which have been known to be implicated with ED.
3. Overweight – Yes, I know that losing weight could help.
4. Pre-diabetic – the blood tests show that my blood sugar levels is slightly above normal range, and yes, maybe losing some weight and exercising more could possibly reverse it.
5. Testosterone level – 10 years ago, a blood test showed that I was on the low end what is considered “normal”, whatever that means.
I think that many men in the past who have suffered from this, don’t talk about it and just suck it up. They accept it as something that comes with old age. I am not ready to give up.
Okay, my questions are “Is there hope for a reversal of my condition?” and “What should I pursue with my doctor?”
The overweight/hypertension/pre-diabetic are all related and may contribute to the ED (as well as the medication for the hypertension). I’d start there, not because of the ED, but because general health is so important. Yes, testosterone could play into that, but you can begin getting healthier even before the testosterone evaluation is in. Exercise and healthy eating should not be underestimated, and they can help the mental confidence as well.
I’d look at the overweight/hypertension/pre-diabetes part of the equation first. Think about the lifestyle changes you can make to improve your diet and get more active. This will likely help the sleep apnoea and is likely to have a beneficial effect on erectile dysfunction.
Thinking about this a bit more, I wouldn’t necessarily leap to the conclusion that it’s low testosterone. I say this because you say that you were on the low end of normal 10 years ago, but have only been having erectile dysfunction for 2 years. We haven’t got any data on what your testosterone levels have been like over the last 10 years, so whilst it can’t be ruled out, there isn’t enough evidence to say that the two are definitely related.
However, we do know that you’re taking medication for hypertension which can cause erectile problems as a side effect. We also know that you’re overweight and pre-diabetic, both of which will make erectile problems worse, even if they’re not the underlying cause.
If it was me, I’d get your testosterone checked (and also get a PSA test whilst you’re there, because lots of men in their 60s have prostate cancer, and if you detect it early there’s a better chance of both curing it and preserving sexual function), but also focus on trying to eat more healthily and get more active because that will help anyway, and will likely give you a longer healthy life expectancy.
Low T could definitely be a factor, not just with your ED but with your other issues as well. The fact of the matter is it’s hard to lose weight and get your eating under control if your testosterone level is such that it’s affecting your motivation to get healthy. It’s a vicious cycle: you know you should lose weight and eat and exercise better, but because of the low T the desire to do those things is very low as well. So, if you get your T levels up, you will find you’ll have far more motivation to do the other things too.
That being said, I will tell you that just raising T levels may not help as much in the ED department as you want. ED is far more complicated than most think, and there are a variety of factors that go into it. I’ve had optimal T levels for years (started on T replacement over 10 years ago now), but I still have ED (even though I feel better than ever, largely due to T replacement). Every man is unique in this area, and so T replacement may not be the “end game” that you need to help with your ED.
Personally, I’d stay away from Viagra and Cialis, although they are helpful. I had too many side effects that made their use uncomfortable for me. However, a few years ago a urologist started me on penile injection medication (which is really not as bad as it sounds to inject your penis!!), and it has worked wonders! There are no side effects, and erections are dependable and long-lasting. So, there’s another avenue you may consider as you work through what is best for you.
My question now is “what should a good t-level be?” I did a little research and things look confusing to me.
This is where it can get kind of grey. The labs will generally say a “normal” T level is anywhere from 200-1000, which is a huge gap. If you have a T level of 200, you are not going to feel good at all, but they will still say you are “low normal” and may resist giving you any kind of treatment. This is where you have to really be your own health advocate and not just swallow what a lab result says.
When I first started on T replacement, my total level was about 400, and I could not concentrate, was gaining weight, had bad moods, and was generally irritable, listless, and lacked motivation to do much of anything. My doctor at the time was resistant to trying anything because I was “normal” and because of the scare tactics going around at the time about how bad testosterone replacement was for you. I pushed for it, though, and once I started have never looked back! I found a good total T level for me is around 900-950. I did get permission for a time to boost the number up to about 1100, but started to have some adverse side effects, so I went back down.
It’s all about finding a “sweet spot” that works for you. That may be 500 or 1400 or somewhere in between. There is also free testosterone levels to consider as well, although I’ve found just paying attention to my total number is the best indicator for me.
There’s hope! The options for treating ED are the best there’s ever been. How successful the treatments will result in aren’t certain, hopefully you’ll have fewer problems.
But I feel that the onus has to be taking serious serious attention that the ageing process and Western culture doesn’t usually help our health, so we’ve got to aim ourselves to live healthy lives.
Obesity is a known factor in the worsening progress of type 2 diabetes, hypertension and sleep apnoa.
So you must find a plan to lose some weight. My actions in myself losing weight – my BMI is 25.5 – is just to eat smaller portions. It works to a significicant degree.
I’d guess that anti-hypertensive meds will affect and possibly worsen ED. But there’s much more about ED than just blood pressure meds.
I’m 90% sure that hormone replacements can help with testosterone levels if they’re appropriate.
UPDATE: I would like to address my overweight issue. Conventional wisdom, with which I agree, would seem to be a huge part of the problem. However, since the low T serum test, I put on an additional 50 pounds, despite making at least two or three abortive attempts at losing weight. I would lose about 10 pounds or so, and the weight loss stopped, despite making changes in my diet. That is why I strongly suspect that low-T is a culprit. As a result of the weight gain, it has been harder to control my hypertension so the doctor has increased the dosages of the meds which have been implicated with ED.
So, I have an appointment with my GP this next Tuesday and would like to go over my bp meds with him, and request a testosterone level test and a PSA test. (I have been doing my homework on this.) Is there anything else that I should go over with my GP? I also intend to talk with him about different treatments. I feel pretty confident that he will try to steer me towards a urologist, but there are other courses that can be followed, like the Defy Medical one as suggested above.
I also need to note that I started a structured weight loss program at the clinic where my GP practices. We shall see what happens.
Yes, this is a personal problem for me, but I would like to discuss these issues because I have the feeling there are other men who similarly suffer from this problem.
at 50+ I take 7 keto, DHEA, arginine, ginseng and numerous other vitamins. My biggest help with impotence is my wife full attention to me and no inhibitions. Since she is often on facebook at the beginning of intimacy and seems not so into it…I have limp issues.