Occasionally a patient would tell me that her husband was having trouble with erections, but that he would not go to the doctor (sound familiar, fellows?). He wanted her to ask me if it could have something to do with low testosterone.
So what is testosterone? It is the male hormone, it is produced by the testicles, and it accounts for everything masculine:
- deep voice
- body hair
- muscle mass
- sex drive
Women have menopause, where the female hormones decline rapidly. Men also have a type of menopause, but the male hormone, testosterone, declines gradually over the lifetime. Declining testosterone levels can impact sexual wellness in men, including erections, this is not however the same thing as “erectile dysfunction”. Many men with ED may have low testosterone levels, but low testosterone does not cause ED.
Hormone replacement for women has been well studied, the risks and benefits are well known, and for most women, hormone treatment after menopause is very effective. However, since the hormone decline is gradual in men, hormone treatment has not been widely used, it has not been well studied and it is impossible to say if it is effective and safe.
There is the medical condition hypogonadism, which means the same thing as low testosterone. Symptoms include:
- low sex drive
- decreased spontaneous erections
- decreased energy
- decreased body hair
- depressed mood
It is diagnosed by a series of low testosterone blood results, at least three, along with the symptoms described. It responds to testosterone medication.
What are the risks of using testosterone treatment?
- acne
- breast swelling or tenderness
- ankle and wrist swelling
- decreased testicular size
- infertility
It is speculated that there also may be an increased risk of developing prostatic cancer, accelerating prostatic cancer growth, and heart attack. Studies continue and there is currently not enough data to say one way or the other.
Testosterone is only recommended for the medical diagnosis of hypogonadism. It is NOT recommended to increase sexual drive or to improve sexual performance in those men with normal testosterone levels.
So what did I tell my patients? That there are many common causes for erection problems other than low testosterone, including:
- Heart disease
- Clogged blood vessels
- High cholesterol
- Diabetes
- Obesity
- Medications
As men get older it is important to be open with their partners and doctors about issues they are facing. Erectile dysfunction and symptoms of lower testosterone should be diagnosed to aid in sexual wellness, as well as good health in general.
So what was my advice to my patients with questions about their husbands’ erection problems?
Make the appointment with her husband’s doctor for him, and accompany him to the visit. Chances are, there are solutions for this problem.
