Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Erectile dysfunction can be a result of a psychological or physical problem.

Psychological causes: Most common cause in young patients. These include performance anxiety, emotional weakness, inferiority complex, stress, marital or relationship problems, low mood, feelings of guilt, and the effects of a past sexual and emotional trauma. Men with psychological problem usually have normal nocturnal erections and erections upon awakening (like in your case), whereas men with physical problem often do not.

Physical causes: Include neurological disorders, alcoholism, drug abuse, hormonal imbalances, diabetes, hypertension, blood vessel disease and chronic diseases.

What I can understand from your query is that you are not able to have erection which is required for intercourse inspite of normal testosterone and penile doppler. You are 30 years of age and at this age, any difficulty in getting or maintain an erection is due to psychological reasons in most of the cases. I hope you are not taking any alcohol or smoking as sometimes these can also cause erectile dysfunction.

The commonly prescribed drug by the doctors is sildenafil (Viagra) or Tadalafil (Cialis), which causes erections to be stronger and long lasting. It is important to rule out medical conditions specially related to cardiovascular system before starting such treatment. Both of these medicines have excellent result in physical causes of erectile dysfunction. First for treatment you should not depend only on Cialis.

I will describe some simple measures which you can incorporate and these should help you:
-First of all, quit smoking and alcohol (if you are taking any)
-indulge in physical exercise and eat a healthy diet
-Have faith in yourself and do not take any stress. You can talk to your partner openly and indulge in plenty of foreplay before sex.
-Exercise, particularly aerobic exercise is very effective.

We need to rule out certain medical conditions. These include diabetes, high blood pressure, heart or thyroid conditions, poor circulation, penile venous incompetency and neurological causes. For that comprehensive evaluation and tests, help of other specialist may also needed.

Apart from that in person examination by psychiatrist may be necessary in your case to identify and treat psychological cause of ED.

As you are in Gurgaon, you can visit me personally also after taking my address from XXXXXXX in Columbia Asia Hospital.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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Hello again,

Thanks for follow up

Following steps will help you:
-In person Cognitive behavior therapy and supportive therapy from psychotherapist for lost self confidence.
-indulge in physical aerobic exercise and eat a healthy diet
-If you tolerated cialis 10mg well without improvement in erection then you can try take cialis 20mg after prescription from physician.

Please accept my answer in case there are no further queries and recommend XXXXXXX services to your friends too if you have found it helpful.

Wish you good health.
Regards.

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Hello again,

Thanks for follow up

Effective dose of cialis is 10 to 20 mg. It is usual to give 20 mg dose if patient do not get benefit with 10 mg. 20 mg cialis is not high dose and can be given if patient do not have cardiovascular problem.

But we can not advice medicine directly here due to ethical reasons, so prescription is must.

Please accept my answer in case there are no further queries and recommend XXXXXXX services to your friends too if you have found it helpful.

Wish you good health.
Regards.

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