Brief Answer:
Questions so that I can advise

Detailed Answer:
Hello and welcome,

Many men start to get erectile dysfunction as well as slow down in their sexual interest in their 50s. I am wondering if this is erectile dysfunction or low libido? The latter can be due to lower levels of testosterone or health problems and medications.

So I have the following questions for you:

1. When did this problem start?

2. Do you have morning erections as you always did in the past?

3. Do you have difficulty maintaining an erection during masturbation?

4. Do you have difficulty reaching orgasm during masturbation?

5. Is the problem only when you are with a partner?

6. I see that you wrote your medical history is fine. Have you had more fatigue, weight gain, or any other symptoms?

7. Have you been masturbating exclusively to porn for more than a few months, and have you had sex with a live partner in the past year? The reason I'm asking this question is because many men, including young men in their 20s, who have masturbated to pornography, develop difficulties functioning with partners. There is research happening in this area and thinking is that with pornography, a man becomes used to very specific stimulation, both visually and in the control he has masturbating himself; in addition the visual is idealized. It is speculated that there is some rewiring of neural pathways due to becoming habituated to this.

Thanks - I'll write back more after I hear back.

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Brief Answer:
Information

Detailed Answer:
Thanks for the additional information.

Given that you are not having normal morning erections, I do not think the problem is psychological (such as from anxiety or depression) or from brain rewiring from pornography. This would be a physical problem. You may still be having some erections during sleep though, and that can be checked.

I recommend going to your doctor, or if you don't need a referral from your primary doctor, skipping him or her and going to a urologist. Testosterone levels and thyroid tests should be checked along with blood sugar (fasting blood sugar or A1C to assess blood sugar control).

If you smoke or use tobacco in any form, it's time to stop as this can affect the blood vessels, including those involved in erections.

The doctor may also do some of the following physical exams:
1. Check pulses in your groin and legs to look for vascular causes.
2. Palpation of the penis to check for scarring or plaques (this is usually done if there is a sideways "bend" in the penis from scarring).
3. Assess male hair pattern distribution, breast size, and testicular size (to see if there are signs of low testosterone, etc).
4. Evaluation of the cremasteric reflex, an index of the integrity of the thoracolumbar erection center. This is done by stroking the inner thighs and observing for same side contraction of the scrotum. A normal response is cremasteric contraction with elevation of the testis.
5. A search for visual field defects, present in hypogonadal men with pituitary tumors.
6. Tests:
fasting glucose or (A1C) to check for blood sugar control
TSH (to rule out thyroid problems)
lipid panel (cholesterol, triglycerides)
serum testosterone, and if low, prolactin level also

The doctor may also get a CBC and comprehensive metabolic panel as well.

Nocturnal penile tumescence testing — A device is used to measure night time erectile rigidity. This is done in your own home while you sleep and the data is then downloaded. Men with psychological causes for ED will have normal NPT results. Men with testosterone deficient ED usually still have some erectile activity during sleep. Those with very impaired NPT usually have vascular or neurological causes.

Doppler/Ultrasound imaging or occasionally angiography of the penile deep arteries, may be done to see if the there are vascular problems (arterial insufficiency or venous leak).

So - in answer to your first question, I don't think this is just exhaustion from too much sex in the past. I also do think there is a good possibility of your situation being improved once the cause is found.

I hope this information gives you a way to go forward.

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