Erection Help
Erection problems can be helped
It is very distressing to lose sexual function and often difficult to build up the courage to seek help. The good news is that whatever the cause, most cases can be successfully treated. In the past it has been difficult to find experienced medical help.
There are now specialised services and interested doctors in both the NHS and in private clinics, who treat erectile dysfunction [ED].
It is best to get a diagnosis for ED before starting treatment
There are several possible causes of ED and Viagra-like drugs may not be the solution. They will improve 50-60% of cases but many men have low testosterone that needs correcting. Further, If testosterone is low they will not work on their own, alone. Combinations of testosterone and Viagra-like drugs can be very effective for some men. With age, multiple factors may reduce the strength of a man’s erection and more than one treatment may be needed.
The optimum medical approach has 3 stages
- 1. Check for hidden health hazards – eg high blood pressure, diabetes, raised cholesterol, medications that affect the erection.
- 2. Measure testosterone – if testosterone is low then testosterone treatment is indicated.
- 3. Offer treatment – Testosterone or a Viagra-like drug – or a combination – whichever is indicated.
About Treatments
Testosterone treatment
Testosterone is given in 2 main ways:
– An injection lasting ~ 12 weeks – after which it is repeated
– A daily dose of skin gel – the hormone is absorbed through the skin
Not everyone absorbs enough testosterone from the skin gel but the injection will be effective for all.
Viagra-like drugs
There are 3 licensed drugs in this group of drugs. They are known as PDE5 inhibitors [PDE5i’s] because they inhibit one of a family of enzymes called phosphodiesterases. Viagra [sildenafil], Levitra [vardenafil] and Cialis [tadafil] all work in the same way. Cialis has a longer duration of action than the other two and this is popular with some individuals. All have minor side effects in a small number of cases.
Side effects of Viagra like drugs
There is one contraindication and one area of caution.
- 1. Nitrates used for angina interact with PDE5i agents severely. Therefore these 2 drugs must never be combined.
- 2. Some blood pressure treatments may combine with PDE5i agents to lower blood pressure further than expected.
Other treatments for angina are available when someone needs a PDE5i for their ED and also needs treatment for angina.
When there is hypertension, treatment of ED is always possible but expert supervision of the drugs used is needed and the physician needs to be sympathetic to the man’s wish to preserve erectile function.
Is testosterone treatment dangerous?
No it is definitely NOT dangerous – there have been over 16 safety studies published. There is no evidence of increase in any life threatening problem – ie no increase in cancer, heart disease or any other serious condition.
This is because the treatment replaces missing testosterone with an identical hormone at a dose that returns the level to normal. The treatment is monitored to ensure there is no under or over-dosing.
In fact the impact of treatment is likely to be a reduction in mortality. For an explanation see dangers of low testosterone.
There are only two concerns that may affect the decision to prescribe testosterone treatment:
- It is important to exclude any pre-existing prostate cancer by physical examination and the PSA screening test. Testosterone does not increase the risk of prostate cancer occurring but may encourage growth of an existing tumour.
- A blood abnormality called erythrocytosis [an abnormal increase in red cells] may occur on treatment if too high a dose of testosterone is given. This complication is not definitely dangerous but should be detected and treated if it occurs. This is easily achieved by having a blood count [usually annually on treatment]. If erythrocytosis occurs it is correctable by reducing the dose of testosterone or by blood donation.
How does the doctor decide which treatment is appropriate?
If you have erectile dysfunction [ED], in other words your sexual performance is troubled by erection problems, then it is certain that you need some help. You need to restore your sexual function but you also need to check if you have low testosterone and a possible risk of heart or metabolic problems see dangers of low testosterone.
The only way a doctor can decide what is best for you is by checking your testosterone level. [See testosterone]. If your doctor offers you a PDE5i [A Viagra-like drug] treatment without a blood test then you should ask for a testosterone blood test or you may end up with the wrong treatment.
What about more complex cases?
In a small handful of cases neither testosterone not a combination with a 5PDE inhibitor solves the problem. A specialist urologist may order ultrasound or X-ray studies of the blood vessels of the penis, recommend surgery for penile abnormalities or prescribe alternative vessel dilators such as alprostadil. Some cases are helped with a vacuum device and a tiny few treated with a penile implant.
