Low Testosterone and Erectile Dysfunction
Erectile Dysfunction and Low T
The media has bombarded us with commercials for PDE-5 Inhibitors medications which treat male sexual dysfunction, specifically, erectional dysfunction, or “E.D.” In the United States almost four out of ten men over the age of 57 experience some degree of E.D. The results with the “blue pill” have been favorable, and men are starting to initiate talks with their physicians about these matters, where they may have been uncomfortable doing so in the past. During the course of these discussions it was discovered that about a third of men that age developed decreased desire for sexual activity, a term called “decreased libido.” Along the same time, clinical laboratories continued to develop increasingly sensitive and accurate tests for testosterone, the male hormone. As it turned out, about the same numbers of men were found to have testosterone deficiency as men with E.D. (about 37%). Clinical studies were carried out, and it was confirmed that decreased testosterone could cause both E.D. and decreased libido. So in terms of therapy, we’re talking about treating a symptom with the “blue pill”, and treating a cause with hormone replacement. It’s like treating the symptoms of a strep throat with acetaminophen and the cause with penicillin: they’re both legitimate medicines.
It’s no hard stretch of the imagination that testicular secretion of testosterone would diminish with age. It’s been long-accepted that women’s ovaries begin to decline in their production of the female hormone, estrogen, as they age or develop certain illnesses. This “winding-down” of glandular function can occur at different ages depending upon a lot of factors including heredity and general health. Men tend to hold up icons like Senator Strom Thurmond, who fathered a child at eighty-three, and somehow promote this to be the norm, which just isn’t the case.
As further testosterone testing was carried out, it was discovered that there were certain clinical signs that went along with low testosterone. Yes, men can, and do, have hot flashes. They often have fewer spontaneous erections and diminished libido. They can have a loss in body hair, decreased shaving, breast tenderness, and small or shrinking testicular volume. They can have decrements in height and decreased bone density, as well as less muscle mass and strength with concomitant increase in body fat. Other findings might be somber mood or depression, difficulty with concentration, less assertiveness, sleep disturbance, and decreased blood count. A rather surprising finding was that the risk of cardiovascular disease and all cause death rates were both elevated in the presence of low testosterone levels.
The production of testosterone can decrease for a few major reasons. First, the testosterone- producing cells in the testicle, called Leydig cells, can become less hormone-productive, or they can become unresponsive to the LH (luteinizing hormone) which is made by the pituitary to signal increased production of testosterone. The second reason would be that the pituitary stops making LH, and there is no signal to the Leydig cells to step up testosterone. A third reason would be that the hypothalamus part of the brain is not communicating with the pituitary gland in a normal fashion. Sometimes these pituitary problems are due to tumors and other medical conditions which have to be treated.
So, how do we measure testosterone? It is a blood test or salivary test which should be drawn in the morning when levels tend to be the highest. The usual cutoff value is 300: levels below that are considered low. If a low value is obtained, the test should be redrawn at least once. Sometimes the values are diagnostically indeterminate and your doctor may order a free testosterone level or other variations of the protein- bound testosterone levels to sort this out.
So now we come down to treatment. Unfortunately you can’t usually just take a testosterone pill. It is directly absorbed into the liver circulation where it is immediately broken down into inactive forms, and this can damage your liver. One way to receive it is by regular shots of esterified testosterone. This hurts a bit, and it sometimes has levels which go up and down. There is a depoT shot in oil which lasts three or four weeks, but it is a shot with its drawbacks. There is a mucosa-adherent tablet which sticks to the oral lining of the cheek, and is carried around that way. It can leave a taste in the mouth. There are patches to be placed on the skin and changed every twenty-four hours. This works pretty well but can cause skin irritation. Then there is a skin gel which can be applied every twenty-four hours, but you have to be careful not to touch pregnant women or children with it. Finally there are pellets of testosterone which can be placed under the skin with a special trochar which lasts for several months. Probably the most widely accepted avenue of treatment is the gel. There is a form of treatment which can be tailored to fit a patient’s schedule and medical needs.
The take-home message is this: if you’re having a problem with your sexual health, discuss it openly and comfortably with your doctor. If you’re “accidentally” falling asleep on the couch every night, if you’re having E.D., or having any other of the symptoms of low testosterone, bring it to your doctor’s attention. Testing is easy, and treatment is easy. The big thing is that you have to stick with the treatment. It can take a few months to start seeing the benefits of treatment, and the long-term benefits may not even be apparent to you. You need rechecks of your hormone levels and a prostate check at regular intervals during the course of your treatment. Primary care physicians are assuming care for a lot of this problem, but if yours is not comfortable or current in treatment practices, seek the care of a physician who is.
About the Author
Dr. Laurusonis was conferred his Doctor of Medicine degree in 1983 and has been actively taking care of patients since completing his Internal Medicine residency in 1987 in the Garden State of New Jersey. Dr. Laurusonis has been licensed in four states but ultimately chose to permanently relocate to Georgia with his family and begin a private practice. Through his extensive experience in Internal Medicine, as well as in Emergency Rooms throughout the United States, Dr. Laurusonis saw how traditional Emergency Rooms were often overwhelmed by patients suffering medical conditions that were urgent but may not need the traditional “Level I Trauma Center”. Patients often waited six to twelve hours to be seen by a physician, were riddled with thousands of dollars in medical bills, and were generally unhappy with the system.
Dr. Laurusonis decided to open an Urgent Care Center instead of a 9-5 doctor’s office. Through the last fifteen years he has received accolades from the community and his patients. He has expanded his practice to include many cosmetic therapies that have previously been treated with painful and extensive plastic surgery. He has been invited to the White House numerous times, has been named Physician of the Year, as seen in the Wall Street Journal, and has served as Honorary Co-Chairman on the Congressional Physicians Advisory Board
Dr. Laurusonis and his practice, Doctors Medical Center, is open 7 days a week from 7:30 am to 9:30 pm offering such services as lab, x-ray, EKGs, aesthetics (Botox, dermabrasion, sclerotheraby and veins etc.), cold/flu, sore throats, fractures, sprains, lacerations, GYN, Pediatrics, Anxiety/Insomnia/Depression Treatment, skin tag/mole removal, veins, allergies, asthma, physicals–just to name a few. Dr. Laurusonis welcomes you to either make an appointment or just walk-in to see him. Dr. Laurusonis will take the time to speak with you about your concerns–no problem is too big or too small. If you need additional services we have specialist referrals available or we can refer you to the neighborhood hospital emergency room. Give Doctors Medical Center a call–Dr. Laurusonis will be happy to speak with you.
John Drew Laurusonis, MD
Doctors Medical Center
3455 Peachtree Industrial Blvd
Suite 110
Duluth, GA 30096
770-232-1101
www.doctorsmedicalctr.com
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