Developed Gynecomastia And Not Feeling Aroused. What Is The Cause And Required Treatment?

Posted on Sat, 2 Mar 2013

Question: Hi Doctor
I have mulitple questions to you,
a) I am a male and I had developed gynecomastia from my childhood , my father also had it, my question to you is how my chest can be made more firmer and tighter so it looks better , I have developed quite a large chest ? I dont want to go for surgery , Please let me know?
b) I feel the aroused when I see women exposing on TV or movies or internet , but same feeling I dont get when I see in reality , example : if I see a navel on TV , it is arousing , but when I see it real in front of eye , i dont feel aroused, is this something wrong with me , I am married and also on Anti Psychotic medication (Olanzapine 5 Mg).
c) I am also fond of new things , a new women on TV, movie , internet is more arousing than the old one which I have already seen ? why is this happening ? Also now days , i dont get much arousing feeling towards my wife.
d) When having Sex , I get aroused only for very short time , then mind get distracted and I lose the erection very soon ? why is this happening , am I becoming impotent ? Why I am not aroused for long time ? It looks like purely in the mind which is not supporting. Even I had been to Infertitlity clinic , some investigation were done , then they gave Viagara , even that doesnt help much , basically my mind is the problem. What can be done for this?
Right Now we are taking fertility treatment , currently on HMG 75 Injection , Fertiflax & Caramed , I Cannot discuss all these question in front of my wife, she would feel bad , if she gets to know that I dont feel much aroused towrds her now a days. Please suggest.

Answered by Dr. Sundar Gnanavel (18 minutes later)

Hello Mr XXXXXXX ....
Thanks for your query.
1. With regard to soggy chest you can learn pectoral exercises that would help you out.
2. Olanzapine and most other antipsychotics do reduce libido to an extent and i do not find point no.2 as abnormal
3. Novelty seeking is a normal human trait; I would suggest new postures; new places at home for the sexual act and may be even a honeymoon to rekindle the old spark. This boredom in marital life after a point is quite common.
4. This lack of sustaining erection could be due to the drug olanzapine. Viagra is indeed a good choice. However, you can also try natural aphrodisiacs like almonds, walnuts and XXXXXXX leafy vegetables. Ginseng extracts are also quite useful. Other drugs like tadalafil might be effective for you. I would also suggest yoga/meditation/breathing relaxation exercises.
Just to clarify, infertility can be due to low semen count on the male side but usually never due to lack of sustaining erection.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sundar Gnanavel (22 minutes later)

Thanks Doctor for Feedback, My Estradiol (E2)(METHOD : ECLIA) 90.72 pg/ml , they say this is female hormone , which is more , and my Total Testostitrone 4.94 ng/ml , I am fat could that be the reason for the Estradiol to be on higher side ? Also would that be a factor for diminished interest in sex , rather than anti psychotic which I am taking?
The sperm count is ok 200 mil/ml , but the impression is Asthenozoospermia and DNA Fragmentation index (DFI) =52% (Poor Sperm DNA integrity) , for which I am taking medication from fertility center.

Answered by Dr. Sundar Gnanavel (37 minutes later)

Hello.......
Thanks for further information. As you aptly mentioned obesity leads to higher aromatisation, a biochemical process leading to higher levels of oestrogen. However, i do not expect it to have reduced your libido significantly. I also understand hat you are diagnosed with asthenozoospermia. You can continue your infertility treatment. It would take care of the hormonal imbalance as well. Wish you a happy sexual life.
Regards
Dr Sundar
Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sundar Gnanavel (30 minutes later)

Thanks Doctor,

One more question I have is , now days when I plan to have sex , I get into anxiety whether I will get erection or not, some times the medicines taken for erection don't work on time , some time late in the night while sleeping I get the erection. This is making me scared when I think of sex , is there anything I can do to reduce the sexual anxiety and be normal and relaxed.

Thanks
XXXXXXX

Answered by Dr. Sundar Gnanavel (4 minutes later)

This is referred to as performance anxiety similar to the time when we face examinations or interviews. I would suggest you take propranolol 20 mg tab (trade name-inderal/betacap) around an hour prior to sexual act to avoid sex-related anxiety. Also try meditation/breathing relaxation exercises. This should help you out.
Regards
Dr Sundar

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sundar Gnanavel (10 hours later)

Thanks Doctor you have been very helpful , the last question which I have is , my Genital , both leg (foot and little above close to Calf muscle feels very chill (Cold) and irritable) even when fully covered with dress and also I wear shoes , . Since my Genital feels cold ,it also makes the size of penis to shrink , not normal size and cause anxiety,it makes me restless , not relaxed , why is this cold sensation and irritable sensation? , this going on for quite some time now , I really dont know why I feel this Chillness and irritable.Is it because of the Anti Psychotic medicine ? or some other reason ?

Thanks
XXXXXXX

Answered by Dr. Sundar Gnanavel (11 hours later)

Hello
Do not worry. Feeling of coldness in the genitalia is not a pathological symptom and is just a transient normal phenomenon. It is not due to antipsychotic either. I would suggest you use themal inner wear if you find it uncomfortable.
Regards
Dr Sundar

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar