Tired? Low sex drive? Problems sleeping? Wouldnt it be nice if there was an easy answer to these common problems often caused simply by aging?

For men, one solution promoted by drug advertisers is testosterone replacement therapy. Having low testosterone even has its own snappy name: Low T.

But as the use of these medications increases, so do concerns about possible harm if theyre taken unnecessarily.

The Food and Drug Administration requires prescription testosterone replacement therapy products be clearly labeled to inform men about a possible increased risk of heart attacks and stroke.

So is low T a real thing? And when is it OK to embark on testosterone replacement therapy?

Testosterone is the male sex hormone made in the testicles. It is what makes a boys voice drop lower and facial and other body hair grow. It is also necessary for male sexual functions like erections and the production of sperm.

If you are not producing enough testosterone it can lead to several symptoms:

Testosterone replacement therapy usually comes in the form of patches, injections, pellets that are implanted under the skin or gels. Testosterone cannot be given in pill form because the liver breaks it down very quickly.

Our experts say there are many people who would benefit from testosterone replacement therapy. If you have had a serious medical treatments like chemotherapy or radiation, or you have injured a testicle, you may need testosterone replacement therapy.

But taking it to solve problems with fatigue, low energy or sinking sex drive without a full check-up can mean the real causes of these symptoms are overlooked.

There are a lot of reasons why you could have low testosterone. Assessing it in the right way is essential, says Conor Best, M.D., assistant professor in Endocrine Neoplasia and Hormonal Disorders at MD Anderson Cancer Center.

Testosterone should be checked at least twice using a blood test. Both tests should be done in the morning between 7 a.m. and 10 a.m.

If the tests do show a low level, you should discuss the possible causes with your doctor before deciding if testosterone replacement therapy is right for you.

Diabetes and obesity, as well as increasing age, can lead to low testosterone.

If theres no clear cause for low testosterone, working on your diet and increasing exercise can often be the answer.

Over-the-counter supplements for testosterone generally do not contain any of the hormone. Manufacturers claim that the herbs and minerals in them will increase your natural production of testosterone.

But our expert says there is no herbal supplement that will reliably increase testosterone.

And over-the-counter supplements are not regulated. This means that the ingredients in them are not checked, so supplements might include more than what is written on the label, or less.

We are concerned that an unregulated supplement that boosts testosterone could have potentially toxic versions of testosterone in it, or another medication with unintended side effects, says Best.

If you are concerned about your testosterone level, the best thing to do is talk to your doctor and get properly tested.

In addition to masking the underlying problem, testosterone supplements come with their own risks.

Testosterone replacement therapy can lead to blood clotting problems because they cause the body to make more red blood cells.

Excess testosterone can turn into estrogen, which comes with risks. Extra estrogen also can lead to blood clots. And it can cause breast tissue to develop, which puts you at a higher risk of male breast cancer, although this risk is small.

Problems with heart disease have also been seen in some large population studies, which led to the FDA warnings about heart attacks and strokes.

Were still learning new things about what all these hormones do. You cant always predict what the downstream effects will be, says Best.

If someone has a pretty normal level, maybe supplementing does potentially do more harm because youre overriding the bodys natural state.

See the rest here:
Testosterone replacement therapy: Yes or no - MD Anderson Cancer Center

Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. The Massachusetts Male Aging Study surveyed 1,709 men aged 4070 years between 1987 and 1989 and found there was a total prevalence of erectile dysfunction of 52 percent. It was estimated that, in 1995, over 152 million men worldwide experienced ED. For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide.

In the past, erectile dysfunction was commonly believed to be caused by psychological problems. It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.

According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases.

Direct risk factors for erectile dysfunction may include the following:

Prostate problems

Type 2 diabetes

Hypogonadism in association with a number of endocrinologic conditions

Hypertension (high blood pressure)

Vascular disease and vascular surgery

High levels of blood cholesterol

Low levels of HDL (high-density lipoprotein)

Chronic sleep disorders (obstructive sleep apnea, insomnia)

Drugs

Neurogenic disorders

Peyronie's disease (distortion or curvature of the penis)

Priapism (inflammation of the penis)

Depression

Alcohol use

Lack of sexual knowledge

Poor sexual techniques

Inadequate interpersonal relationships

Many chronic diseases, especially renal failure and dialysis

Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

The following are some of the different types and possible causes of erectile dysfunction:

Organic ED involves abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis--being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking--can cause erectile failure often before progressing to affect the heart.

Many experts believe that atrophy, a partial or complete wasting away of tissue, and fibrosis, the growth of excess tissue, of the smooth muscle tissue in the body of the penis (cavernous smooth muscle) triggers problems with being able to maintain a firm erection. Poor ability to maintain an erection is often an early symptom of erectile dysfunction. Although the condition is called venous leak, the real problem is not with the veins but malfunction of the smooth muscle that surrounds the veins. The end result is difficulty with maintain a firm erection (losing an erection too quickly) that is now believe to be an early manifestation of atherosclerosis and vascular disease.

Diabetes. Erectile Dysfunction is common in people with diabetes. An estimated 10.9 million adult men in the U.S. have diabetes, and 35 to 50 percent of these men are impotent. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in people with diabetes.

Depression. Depression is another cause of ED and is closely related to erectile dysfunction. Because there is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors. Some antidepressant medications cause erectile failure.

Neurologic causes. There are many neurological (nerve problems) causes of ED. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.

Drug-induced ED. A great variety of prescription drugs, such as blood pressure medications, antianxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with ED.

Hormone-induced ED. Hormonal abnormalities, such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by bodybuilders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause ED. Low testosterone can contribute to ED but is rarely the sole factor responsible for ED.

Premature ejaculation is a male sexual dysfunction characterized by:

Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration.

Inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

Premature ejaculation is divided into lifelong and acquired categories:

Lifelong premature ejaculation. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus.

Acquired premature ejaculation. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.

Performance anxiety. Performance anxiety is a form of psychogenic ED, usually caused by stress.

Diagnostic procedures for ED may include the following:

Patient medical or sexual history. This may reveal conditions or diseases that lead to impotence and help distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

Physical examination. To look for evidence of systemic problems, such as the following:

A problem in the nervous system may be involved if the penis does not respond as expected to certain touching.

Secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involve the endocrine system.

Circulatory problems could be indicated by an aneurysm.

Unusual characteristics of the penis itself could suggest the basis of the impotence.

Laboratory tests. These can include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measurement of testosterone in the blood is often done in men with ED, especially with a history of decreased libido or diabetes.

Psychosocial examination. This is done to help reveal psychological factors that may be affecting performance. The sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse.

Specific treatment for erectile dysfunction will be determined by yourdoctor based on:

Your age, overall health, and medical history

Extent of the disease

Your tolerance for specific medications, procedures, or therapies

Expectations for the course of the disease

Your opinion or preference

Some of the treatments available for ED include:

Sildenafil. A prescription medication taken orally for the treatment of ED. This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication. Sexual stimulation is required for sildenafil citrate to have the best efficacy.

Vardenafil. This drug has a similar chemical structure to sildenafil citrate and works in a similar manner.

Tadalafil. Studies have indicated that tadalafil citrate stays in the body longer than other medications in its class. Most men who take this medication find that an erection occurs within 4 to 5 hours after taking the pill (slow absorption) and the effects of the medication may last up to 24 to 36 hours.

Avanafil

The FDA recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take tadalafil or vardenfil should use alpha blockers with care and only as instructed by their physician, as they could result in hypotension (abnormally low blood pressure). Experts recommend that men have a complete medical history and physical examination to determine the cause of ED. Men should tell theirdoctor about all the medications they are taking, including over-the-counter medications.

Men with medical conditions that may cause a sustained erection, such as sickle cell anemia, leukemia, or multiple myeloma, or a man who has an abnormally-shaped penis, may not benefit from these medications. Also, men with liver diseases or a disease of the retina, such as macular degeneration or retinitis pigmentosa, may not be able to take these medications, or may need to take the lowest dosage.

These medical treatments should NOT be used by women or children. Elderly men are especially sensitive to the effects of these medical treatments, which may increase their chance of having side effects.

Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.

Two types of implants are used to treat ED, including:

Inflatable Penile Prosthesis (3-piece hydraulic pump). A pump and two cylinders are placed within the erection chambers of the penis, which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis.

Semi-rigid Penile Prosthesis. Two semi-rigid but bendable rods are placed within the erection chambers of the penis, which allows manipulation into an erect or non-erect position.

Infection is the most common cause of penile implant failure and occurs less that 2 percent of the time. Implants are usually not considered until other methods of treatment have been tried but they have a very high patient satisfaction rate and are an excellent treatment choice in the appropriate patient.

Erectile dysfunction can cause strain on a couple. Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. It is important to communicate openly with your partner. Some couples consider seeking treatment for ED together, while other men prefer to seek treatment without their partner's knowledge. A lack of communication is the primary barrier for seeking treatment and can prolong the suffering. The loss of erectile capacity can have a profound effect on a man. The good news is that ED can usually be treated safely and effectively.

Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions. Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions.

Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health. By asking patients more directly about their sexual function through conversation or a questionnaire during a checkup, doctors may be able to detect more serious health conditions sooner.

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Erectile Dysfunction | Johns Hopkins Medicine