Erectile Dysfunction

Testosterone and sexual health

Erectile Dysfunction

Erectile dysfunction (ED) is the regular and repeated inability to achieve or sustain an erection suitable for sexual intercourse. There are multiple possible causes for erectile dysfunction, ranging from chronic illness to being too tired.

Penile erection is managed by two different mechanisms:

  • Reflex erection – achieved by direct touch to the penile shaft.
  • Psychogenic erection – achieved by erotic or emotional stimuli.

The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, a healthy neural system is required for complete erection. In addition, adequate levels of testosterone and an intact pituitary gland are also required for healthy erectile function.

Male Andropause

Although men go through andropause (male menopause) later than females go through menopause, it is inevitable and is caused by low testosterone.

From the age of 30, men experience a gradual decline in hormone production. The body manufactures less and less testosterone, losing roughly 1-3% per year. Between 40 and 55, testosterone levels start to dramatically drop, signalling the onset of andropause and the associated symptoms.

Men are led to believe that they should just accept the symptoms of andropause as a part of the ageing process. It can, however, have a negative impact on work performance, relationships and, most importantly, enjoying life.

Primary physiological causes of erectile dysfunction

  • Hormonal insufficiencies – testosterone
  • Cardiovascular disease
  • Diabetes
  • Neurological problems e.g. trauma from prostatectomy surgery
  • Drug side effects
  • Potassium deficiency
  • Arsenic poisoning.

Psychological impotence (10-20%)

When erection or penetration fails due to thoughts or psychological reasons rather than physical impossibility. Psychological impotence is significantly less likely than physiological causes for erectile dysfunction, resulting in 10-20% of cases. Some of the causes are:

  • Stress
  • Clinical depression
  • Schizophrenia
  • Panic disorder
  • Generalised anxiety disorder.

Treatments for erectile dysfunction

  • HRT – testosterone replacement
  • PDE5 inhibitor drugs (Sildenafil or Viagra)
  • Prostaglandin tablets in the urethra
  • Injections into the penis
  • Penile prosthesis
  • Penis pump
  • Vascular reconstructive surgery.