What is Erectile Dysfunction (ED)?
Erectile Dysfunction can be described as erection that is not sufficient to achieve or maintain the desired performance for a satisfactory sexual experience. Men suffering from low testosterone will often complain of weak erections, or the lack of morning erections, or the inability to maintain an erection.
Sometimes ED can be due to psychosomatic issues and this can lead to vasoconstriction ED which can have many causes, testosterone deficiency can be one of them but not the only reason for it and testosterone on its own does not always improve erectile dysfunction.
Medications called PDE5 inhibitors like (tadalafil(cialis®), or sildenafil(viagra®) can help relax the smooth muscle in the penis by vasodilating those blood vessels causing you to achieve an erection.
Having erectile dysfunction is actually very common around there are estimated to be around 15-30 million men who suffer from it. As you age erectile dysfunction becomes more common and on average 15-25% of men over the age of 65 experience problems maintaining an erection.
Symptoms of Erectile Dysfunction
- Unable to get an erection with stimulation
- Weak or soft erections
- Short lasting erections lead to unsatisfactory sexual experience
- Change in Angle of erection
- Penis has decreased sensitivity (feels like you are wearing 5 condoms)
- Erections are less girthy
Causes of Erectile Dysfunction
There are many men suffering from ED in the world, and the reasons behind ED are wide and varied. Below we have listed the more common causes for suffering from ED.
- Cardiovascular disease affecting the flow of blood to the penis
- Nerve damage affecting the penis
- Smoking, alcohol abuse, lack of exercise
- High Blood Pressure
- Certain medications including SSRIs, and beta-blockers
- Performance Anxiety- Psychosomatic
- Low Testosterone
- Hormone imbalance
- Damage to the penis
- Peyronie’s disease (plaques causing a curvature of the penis)
- Sleep disorders or sleep apnea
- Damage to pelvic area
- High cholesterol
- Kidney disease
- Loss of Penile Sensitivity and erections due to excessive aromatisation inhibition
Erectile Dysfunction Treatments
- PDE5 Inhibitors
- Prostaglandin Analogues injected into the penis before sexual activity (alprostadil, caverject)
- Prostaglandin Analogues inserted into the urethra with insertion device (aloprostadil Muse device)
- PRP-Platelet Rich Plasma Treatment (unapproved use)
- Stem Cells- (unapproved use as not approved by regulatory agencies but data to demonstrate effectiveness in small studies)
- Bremelanotide, sold under the brand name Vyleesie for women(unapproved use and difficult to titrate) also can improve sexual desire (libido).
- Shockwave therapy at clinic
- The Rocket- home shockwave therapy device (pending approval, CE)
PDE5 inhibitors and low testosterone
If you have low testosterone and you have tried viagra and cialis, chances are it may not have worked for you. PED5 inhibitors work best with an adequate amount of free testosterone.
PDE5 Inhibitors with Testosterone
Some men who have tried PDE5s like cialis or viagra who are unable to maintain a desired erection with testosterone alone will often dismiss adding a PDE5 to treatment because of treatment failures in the past when they have had low testosterone.
As mentioned earlier PDE5s work best when there is an optimal amount of testosterone present. So you may want to reconsider and ask your doctor if adding a PDE5 is right for you.
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ED can be caused by several factors as described above, if you would like us to check your testosterone levels please use the form below to get in touch with us.