ED - Other Causes
Many men have ED due to an assortment of other causes. Below is a brief overview of the most common.
Drug induced (medication)
Many prescription medications can cause
problems with erections, but the ones that are the most commonly associated with this complaint are anti-hypertensive (blood pressure) medications, beta blockers, and anti-depressants. These cause ED by interfering with the nerve impulses or blood flow to the penis. Important: Medications should never be changed without your doctor's permission. Talk to your doctor about any concerns you have regarding the potential effects of medication on ED.
Alcoholism and Smoking
Alcoholism disrupts hormone levels and can lead to permanent nerve damage, causing impotence. Smoking may lead to vascular disease or other health problems, which may cause ED. Tobacco is a major cause of erectile dysfunction; in my practice, over 68% of all of my patients either smoke or have a history of tobacco smoking.
Peyronie's Disease (acquired penile curvature or bent penis)
Peyronie's disease is an inflammatory condition of unknown cause, and while typically affecting men in their 50's and 60's, is also seen in much younger men. Deformity or narrowing of the penile shaft is usually associated with this condition. In some circumstances, it can be subtle and will only be noted during an erection. Fibrosis/scarring of the penile tissue will cause erection problems by allowing blood to leak back into the circulation (venous leak).
Many patients report significant pain with an erection, which typically lasts for six to twelve months. Most treatments, including anti-inflammatory medication, Vitamin E, Verapamil, Colchicine, are unfortunately ineffective. For men also suffering from Erectile Dysfunction and Peyronie's Disease, insertion of the
Internal Penile PumpTM is the best option. For most men, this should be considered early in order to prevent permanent penile shortening and deformity as well as to restore potency.
Physical or Nerve (neurologic) Trauma
ED can result from physical or neurological trauma to the body. These include pelvic fracture, spinal cord injuries, brain injuries or tumors, stroke, birth defects or muscular diseases. Patients with neurological diseases such as those caused by diabetes, Parkinson's disease, Alzheimer's, brain tumors, lumbar disc herniation, multiple sclerosis can all have
Erectile Dysfunction.
Psychological Problems
While most
Erectile Dysfunction is physically caused, the psychological aspects are still present in many patients. It is normal for a man who suffers from erectile dysfunction to have a psychological reaction to a loss of a normal bodily function (erections). The primary problem, however, is physical, and for most men, restoring potency will do wonders for their psychological wellbeing.
Many men under stress may experience some performance anxiety and have unreliable erections on a temporary basis. If the condition persists, then the patient should be evaluated by an expert. Depression or anxiety disorders and the medications used to treat these conditions can also cause Erectile Dysfunction.
Priapism
If an erection lasts longer than four hours, it can cause tissue injury, which will result in ED. Causes of priapism include sickle cell anemia, injection therapy for ED that is improperly prescribed or used; illegal drug use or misuse of medications such as Viagra.
Effects of Aging
It is estimated that 65 percent of men over age 65 have some type of ED. Statistically, the number of men experiencing ED rises as their age increases. However, age alone does not cause ED. It is simply that older men are more likely to have the illnesses.
Hormonal Problems
This is a rare cause of erectile dysfunction. It is natural for a man's hormone level to decrease with age, and studies show that hormonal replacement is rarely successful. Certain diseases, such as kidney failure and liver disease can disrupt the balance of hormones, which control erections. Furthermore,
hormonal replacement, more specifically testosterone, has a lot of side effects including stroke, sterility, prostate enlargement, and atrophy of the testicles. Low levels of testosterone can also be a factor.
Low Testosterone
Testosterone is a hormone that is produced by the testes in males. It performs many physiological roles in the body, including maintenance of muscle strength and muscle mass, bone density, fat distribution, production of sperm, and regulating sex drive. Testosterone levels hit their highest level in adolescence and early adulthood, and most men have some decrease in their testosterone levels around age 40. For a majority of men, this middle-age drop does not cause any harmful effects.
Obesity also plays a role metabolic syndrome in causing abnormalities in testosterone levels. Accumulation of fat around the waistline, also known as central obesity, ED, cardiovascular disease, diabetes and the metabolic syndrome share another feature in common: low male testosterone. As obesity increases, the levels of the active or free testosterone declines.
Free vs. Total testosterone
Approximately 2% of total testosterone exists in the free or unbound form, and approximately 40% is tightly bound to sex hormone–binding globulin (SHBG). The remaining testosterone is weakly bound to albumin and other proteins. Free and albumin-bound testosterone are considered the active or bioavailable testosterone. Several medical conditions may cause free testosterone to be low when total testosterone appears to be normal. Also total testosterone may be low and free testosterone levels normal. When evaluating and treating men for low testosterone levels it is therefore important to measure both the free and total testosterone before initiating testosterone replacement therapy. Because testosterone levels vary greatly in the same individual depending on when it is measured therapy should not be initiated until several measurements are made.
Testosterone replacement therapy
Unfortunately, testosterone supplementation does not exist. Whenever testosterone is added to the male human body, it causes a cessation of ones natural testosterone, shrinkage of testicle and sterility. Therefore this should never be given to young men contemplating fatherhood, as the effects of long-term therapy may be permanent.
Small subsets of men actually choose to undergo
testosterone replacement therapy, which for some patients restores energy and sex drive. It is important to note that testosterone replacement therapy, or TRT, should only be reserved for the most severe of cases, and this treatment option should always be discussed with Dr. Eid, who can properly diagnose you with a deficiency.
At our office, we will measure the total and free testosterone in your blood, and will likely measure prolactin (to assess the function of the pituitary gland), as well as SHBG, FSH, LH, and thyroid levels. Testosterone levels normally falls between 250-800 nanograms per deciliter of blood. However, this level will vary even for the same person, depending on exercise and time of day, as well as other factors.
Symptoms of low testosterone can only be diagnosed by a medical professional, but one suffering from a deficiency may notice erectile dysfunction, depression, anxiety, low sex drive, high cholesterol, weight gain, or problems concentrating. However, these symptoms are not specific for low testosterone levels and can be caused by many other factors. If it is determined that the patient is suffering from androgen deficiency, long term TRT may be initiated. Testosterone can be administered in gels, creams, pills, injections, or through an implant underneath the skin. Receiving the hormone orally is generally not the preferred route of delivery, as it is not well absorbed and may lead to complications in other organs such as the heart and liver. Transdermal delivery is currently the best way to replace testosterone.
Side effects and contraindications
TRT is not without side effects of its own, which commonly include nausea, vomiting, increased appetite, and changes in mood. More severe side effects include priapism (an erection that does not go away, and requires medical attention), liver damage, and swelling. In addition, TRT should be used cautiously, and is not the ideal treatment for most healthy adult men with low normal testosterone levels. It should not be used in patients with heart disease or prostate cancer, those with known prostate problems, or men with high cholesterol. In addition, treatment with testosterone may activate prostate cancer in men with undiagnosed cancer. So men considering this treatment should be screened for prostrate cancer, as well as have future screenings.
Results and efficacy
Almost all of the clinical trials studying TRT have been inconclusive or have not followed patients long-term, so this treatment option is still a bit experimental in practice, and the treatment should not be administered to anyone not deemed an exceptional candidate. Because of the serious nature of TRT, patients with less severe testosterone deficiencies may look into safer, alternative treatment options. Any man currently taking TRT needs to see their doctor regularly for checkups, and should report any medical issues immediately. In addition, prostate screenings are essential.
