Hello and welcome to Healthcare Magic. Thanks for your query.

The hormonal tests indicate that your free testosterone levels are way below normal and your serum prolactin levels are above normal. Both low testosterone and the high prolactin result in decreased sexual drive and are likely to be major contributory factors for your sexual dysfunction.

Regarding the medication which you have been prescribed:
- Injection Sustanon is a testosterone replacement treatment.

- Semibrom (Bromocriptine) is a prolactin inhibiting medication, that is it reduces the prolactin levels - so indirectly increases sexual drive.

- Zyprima (Apomorphine) is a medication which increases the levels of a chemical called dopamine. Low dopamine levels are associated with erectile dysfunction and decreased sexual drive.

- Nano Leo capsules are herbal supplements which are claimed to enhance sexual functioning.

So, in my opinion, the medications which have been prescribed to you are appropriate for your problem. Sustanon injections and Semibrom tablets are the essential ones because they are specifically targetted to correct the hormonal abnormalities which have been detected. Zyprima and Nano Leo capsules can be beneficial but may not be absolutely essential.

Medication such as Tadalafil act by increasinh the blood flow to the penis and thereby promoting erection, but can have side effects like headache, nasal congestion, flushing, etc. If you have found this helpful, then you can try it at a lesser dose in order to avoid the side effects.

Hope I have answered your query. Feel free to get back to me if you have any further questions or clarifications.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again,

You will need regular monitoring of your testosterone levels and prolactin levels, usually done once in 3 months. The Sustanon injections and Semibrom tablets need to be continued till your hormonal levels normalize and get stabilized.

Since these are hormonal medication, it will take time to bring about their effects. The hormonal imbalance may take upto a few months to come to normal. Only when this happens will you start seeing an improvement in your sexual functioning. So, you will have to be patient and wait for some more time.

I would suggest trying Bupropion, which is a dopaminergic antidepressant and is often used in cases of sexual dysfunction, especially when high prolactin levels could be a likely cause of the sexual problems. You can also try taking a good multi-vitamin plus anti-oxidant supplement daily, because certain vitamin deficiencies can also be a contributing factor for sexual dysfunction. Avoid smoking, alcohol or any other unecessary medication, and adopt a healthy lifestyle - with a nutritious, balanced diet and regular physical exercise.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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The normal range for free Testosterone level is 9 - 30 pg/ml. However, for good sexual functioning, we expect the level to be in the upper one-third of the reference range.

The normal range for serum Prolactin level is 2 - 18 ng/ml.

Tadalafil is not a habit-forming or addictive medication. It acts by temporarily dilating the blood vessels in the penis, so that there is increased blood flow and thereby promoting better erection. It does not have any permanent effects on erection or sexual functioning.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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The reasons for low testosterone and high prolactin could be the following:
- age-related
- hormonal disorders
- pitutary gland problems
- testicular problems
- medical conditions like diabetes, obesity, etc.

There is indeed a direct corelation between diabetes and erectile dysfunction. Diabetes can cause erectile dysfunction in many ways: one is by causing damage to the nerves (known as "neuropathy"); another is by causing microblockages to blood vessels and thereby resulting in decreased blood flow; another way is by causing hormonal imbalances such as low testosterone levels.

In your case, since your tests clearly reveal hormonal abnormalities, it is improtant to correct them appropriately. Also, a tight control of sugars is essential to prevent further complications due to diabetes. Weight reduction and adopting a healthy lifestyle are also important in improving sexual functioning.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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