Testosterone Therapy and Erectile Dysfunction
Erectile dysfunction (ED) is the inability to develop or maintain an erection of the penis during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.
Testosterone therapy can improve sexual function in some men with low testosterone levels. However, it does not work for all men and can have serious side effects, such as heart problems, sleep apnea, and an increased risk of heart attack and stroke. Testosterone therapy can also lead to enlarged breasts, shrunken testicles, and decreased sperm count. These side effects usually go away after treatment ends.
ED may occur because of damaged nerves, arteries, smooth muscles, and fibrous tissues. These structures work together to fill the erectile tissue with blood. Nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum).
An erection occurs when sexual stimulation triggers the nervous system to release chemicals that relax muscles in the penis. This allows blood to flow into the corpus cavernosum and fill the spaces in the penis. As the penis fills with blood, it becomes erect. The veins that normally drain blood from the penis become compressed. This limits the amount of blood that drains from the penis. As a result, the penis becomes larger and firmer. The erection ends when the muscles contract and the accumulated blood can flow out through the penile veins.
ED can occur if any of these structures are damaged or if blood flow to the penis is reduced. Reduced blood flow can be caused by conditions that affect the heart and blood vessels, such as atherosclerosis (hardening of the arteries), coronary artery disease, and heart failure. In addition, diabetes, obesity, smoking, and certain medications can damage nerves and arteries.
Certain lifestyle choices can contribute to ED, including:
- Excessive drinking
- Illegal drug use
- Certain medical conditions, such as high blood pressure, diabetes, and heart disease
In addition, certain medications, such as antidepressants, can cause ED. Stress, anxiety, and relationship problems can also contribute to ED. Surgery, such as surgery to remove the prostate gland or surgery for colorectal cancer, can also lead to ED.
Your doctor will ask about your symptoms and medical history. A physical exam will be done to check for signs of ED. Your doctor may also order blood tests to check for low testosterone levels.
In some cases, your doctor may refer you to a urologist or a mental health counselor.
Treatment for ED depends on the cause. In some cases, medications or surgery may be needed.
Medications that can be used to treat ED include:
- Phosphodiesterase type 5 inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra