Erectile Dysfunction

ED is common among men over 40, but many don’t seek treatment

 

Special to the Miami Herald

For some men who have erectile dysfunction, low testosterone may be the cause.

A significant percentage of men over 40 who suffer from erectile dysfunction may have abnormally low levels of testosterone, according to Dr. Lawrence Hakim, chairman of urology at the Cleveland Clinic in Weston.

“As men age, they are going to have an increased chance of having low testosterone,” he said.

With age, the body’s production of this hormone declines, somewhat similar to the decline in estrogen and progesterone in women that causes menopause.

Some medical conditions can increase risk for low levels of testosterone, including testicular cancer, alcoholism, obesity and other chronic illnesses.

Symptoms of low testosterone, or hypogonadism, include erectile dysfunction, decreased sex drive, feeling depressed or fatigued, difficulty concentrating and overall decreased sense of well-being. Low testosterone can lead to a variety of other health problems including decreased muscle mass, obesity, cardiovascular issues and osteoporosis.

“If a man has very low sex function, desire, fatigue — it certainly has an impact on his quality of life, his partner’s quality of life,” Hakim said.

He warns against trying over-the-counter remedies, such as testosterone supplements. Taking these supplements can turn off the body’s own production of testosterone and have a negative impact on fertility.

In addition, the underlying cause of the symptoms may be something more severe, such as prostate cancer. It’s important to consult with a physician before taking supplements.

Doctors can use a simple blood test to determine whether a man’s testosterone levels fall within or below a healthy range. Factors such as age and medical history are considered during the screening.

For patients whose testosterone levels fall below normal, testosterone replacement therapy is a common solution. There are an array of treatment options including injections, patches, topical gels, pills and implants.

Testosterone replacement therapy is not recommended for men who are suffering from erectile dysfunction who have normal levels of testosterone. Men who have a history of prostate problems should also avoid these treatments.

Returning a patient to normal sexual function and overall health should involve a big-picture approach, Hakim said.

“Sexual dysfunction is a couples’ disease, so we look at the partner, too,” he said. “Usually, it’s not purely a physical problem. We can address that by looking at all the factors — blood flow, hormones, psychological factors, partner’s sexual problems.”

Referring patients and their partners to a psychologist, in addition to medical treatment, is common practice. In many cases, it’s the psychologist who makes the referral to doctors for testing.

Partners affected by the symptoms of their ailing men will often seek out counseling, and that is what gets the ball rolling, said a psychologist who specializes in sex therapy, Christina Pozo-Kaderman at Mount Sinai Comprehensive Cancer Center in Miami Beach.

“It will come from the wife or the partner, and they think it’s depression, so I send them back for testing for low testosterone,” she said.

Many intervention campaigns are now targeting wives and partners, she said. This is particularly true for men over 40, many of whom still believe asking for help is a sign of weakness.

Pozo-Kaderman suggests partners who want to help their loved ones should approach them along these lines: “I’ve noticed these things, and I wonder if there’s something we can do.”

Focusing on the overall lifestyle rather than the sexual dysfunction can help them open up, she said.

In Hakim’s practice he frequently sees patients who have been suffering with erectile dysfunction in silence for years, because they were too embarrassed to seek help. Yet erectile dysfunction is a common problem — affecting more than 50 percent of men over 40. In the United States it is estimated that 20 million men suffer from erectile dysfunction.

“They need to make that first step — tell their doctor they’re having problems, and see a specialist,” he said. “They’re not alone. There are excellent treatment options to improve libido or fatigue, etc. And, keep in mind, when you’re improving testosterone you’re improving general health as well.”

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