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Suggest Treatment For Erectile Dysfunction In A Diabetic Patient
Question: I am 34 yrs old male. I am diabetic since last 3 yrs. I am on insulin mixtard 30 hm 24 units daily morning and evening respectively with Amaryl 2mg once daily and JalraM 50/500mg twice daily along with TAZLOC 40 for BP and Rosuvas 10 once daily at night.
I am taking medicine + insulin as my doctor want me to put off insulin and put me on medicine. Earlier I used to take 30 units of insulin daily both times.my sugar level ranges from 93-105 in morning (Fasting) and 140-170 during daytime after meals. my bp is normal.
Now I am having problem of low sex drive or no sex interest at all. it goes weeks or months without sex as it clearly shows mine sexual weakness to my partners. which i am really scared off and affects my marital relationship.
With the same problem of low sex drive i went to urologist year back he gave me cernos depot to increase my testosterone which made mine sperm count zero. also it did not make any huge impact on my sex drive it was only temporary kick for a week after which i had no sex with my wife for 2 months. now i checked my semen analysis - Reaction - Alkaline, colour- whitish, my sperm count is 166 million with 22% motile, 30%slugggish motile, 48% immotile, morphology-nil and pus cells 25-30 /hpf. I have also done LH SERUM - 2.96 mIU/ml Ref Range- 1.8-8.6 mIU/ml
FSH SERUM - 3.28 mIU/ml Ref Range - 1.4-18.1.
Kindly let me know what is the reason behind my low sex drive what could be the solution so that i can relieve myself otherwise it is like a very bad situation for me now. Is my BP OR SUGAR MEDICINE AFFECTS MY SEX DRIVE pls advise.
I am taking medicine + insulin as my doctor want me to put off insulin and put me on medicine. Earlier I used to take 30 units of insulin daily both times.my sugar level ranges from 93-105 in morning (Fasting) and 140-170 during daytime after meals. my bp is normal.
Now I am having problem of low sex drive or no sex interest at all. it goes weeks or months without sex as it clearly shows mine sexual weakness to my partners. which i am really scared off and affects my marital relationship.
With the same problem of low sex drive i went to urologist year back he gave me cernos depot to increase my testosterone which made mine sperm count zero. also it did not make any huge impact on my sex drive it was only temporary kick for a week after which i had no sex with my wife for 2 months. now i checked my semen analysis - Reaction - Alkaline, colour- whitish, my sperm count is 166 million with 22% motile, 30%slugggish motile, 48% immotile, morphology-nil and pus cells 25-30 /hpf. I have also done LH SERUM - 2.96 mIU/ml Ref Range- 1.8-8.6 mIU/ml
FSH SERUM - 3.28 mIU/ml Ref Range - 1.4-18.1.
Kindly let me know what is the reason behind my low sex drive what could be the solution so that i can relieve myself otherwise it is like a very bad situation for me now. Is my BP OR SUGAR MEDICINE AFFECTS MY SEX DRIVE pls advise.
Brief Answer:
Treatment depends on cause
Detailed Answer:
Hi Mr XXXXXXX
Welcome to HCM. I have gone through your question and understand your concerns.
Erectile dysfunction is seen in up to 30% of people with diabetes. The treatment depends on cause.The causes of erectile dysfunction can be:
1. Hormonal - low testosterone (less than 3ng/ml) or high prolactin levels. This can be treated with testosterone injections or medicines to lower prolactin
2. Vascular - common in diabetics. Here blood vessels are not working properly to cause an erection. Treatment is with medications like Sildenafil (Viagra) or Tadalafil (Tazzle)
3. Neuronal - seen in diabetics. Here nerve supplying penis is affected. Treatment is difficult. Penile injection like alprostadil, or even implants can be tried
Initial tests we do is serum testosterone (morning sample), LH, FSH, and prolactin. I think all these blood tests are normal in your case. If it is normal a trial of Tadalafil 10 mg alternate days x 2 weeks is tried. If it is not improving your sexual function, consult an XXXXXXX who will evaluate you further and suggest treatment.
Testosterone injections will suppress our own testosterone production, so is not preferred if you haven't completed your family as this will decrease your sperm count.
Diabetes can cause sexual problems. The medications you are currently on wont cause sexual dysfunction.
Hope I have answered your query. If you have any further questions I will be happy to help
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist.
Treatment depends on cause
Detailed Answer:
Hi Mr XXXXXXX
Welcome to HCM. I have gone through your question and understand your concerns.
Erectile dysfunction is seen in up to 30% of people with diabetes. The treatment depends on cause.The causes of erectile dysfunction can be:
1. Hormonal - low testosterone (less than 3ng/ml) or high prolactin levels. This can be treated with testosterone injections or medicines to lower prolactin
2. Vascular - common in diabetics. Here blood vessels are not working properly to cause an erection. Treatment is with medications like Sildenafil (Viagra) or Tadalafil (Tazzle)
3. Neuronal - seen in diabetics. Here nerve supplying penis is affected. Treatment is difficult. Penile injection like alprostadil, or even implants can be tried
Initial tests we do is serum testosterone (morning sample), LH, FSH, and prolactin. I think all these blood tests are normal in your case. If it is normal a trial of Tadalafil 10 mg alternate days x 2 weeks is tried. If it is not improving your sexual function, consult an XXXXXXX who will evaluate you further and suggest treatment.
Testosterone injections will suppress our own testosterone production, so is not preferred if you haven't completed your family as this will decrease your sperm count.
Diabetes can cause sexual problems. The medications you are currently on wont cause sexual dysfunction.
Hope I have answered your query. If you have any further questions I will be happy to help
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
how can i assess if it is neuronal in my case as my erection is normal when i watch any pron movie or clip. it is only with my partner that sometimes i get normal erection with penetrative sex but sometimes she does everything even then i do not get erection or no interest in sex at all. Also you did not comment on my semen analysis report is it normal. pls advise further
Brief Answer:
Please see detailed answer
Detailed Answer:
Hi,
Welcome back.
If you are getting normal erection and ejaculation with a porn clip, it is unlikely to be a hormonal, vascular or nerve problem. It could be a psychological problem. Some people find it difficult to get erection with partner or a particular partner. In some cases it is difficult to find out the cause of erectile dysfunction.
I suggest you to consult a psychologist first, who can help you with this. Tadalafil is a medication that will help you to have sustained erection along with psychotherapy.
Do a serum testosterone level and prolactin level if not done previously. A trial of tadalafil or similar medications after consulting an endocrinologist is worth trying.
Your semen analysis is ok, even though motile sperms are slightly less, the count is good enough to have fertility.
Hope this will clear your doubts.
Please see detailed answer
Detailed Answer:
Hi,
Welcome back.
If you are getting normal erection and ejaculation with a porn clip, it is unlikely to be a hormonal, vascular or nerve problem. It could be a psychological problem. Some people find it difficult to get erection with partner or a particular partner. In some cases it is difficult to find out the cause of erectile dysfunction.
I suggest you to consult a psychologist first, who can help you with this. Tadalafil is a medication that will help you to have sustained erection along with psychotherapy.
Do a serum testosterone level and prolactin level if not done previously. A trial of tadalafil or similar medications after consulting an endocrinologist is worth trying.
Your semen analysis is ok, even though motile sperms are slightly less, the count is good enough to have fertility.
Hope this will clear your doubts.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir I have already visited psychatric he told me after 3 yrs of marriage the interest in sex goes down but at that time i was not diabetic he gave me some medication but it was of no use. can you suggest some alternative treatment like ayurvedic or something. Also in my semen analysis there is 25-30 /hpf pus cells. I don't know it is pus cells or it may be precursor cells because only few lab differentiate it. Sir what is this precursor cells?? The pus cells in semen may affect mine normal sperm and how do i get the treatment of this. Earlier urologist also did my anti sperm antibodies test in which there was no anti-sperm antibodies found he gave me 3 months antibiotic treatment also last year for this pus cells. pls help in clearing my doubt.
Brief Answer:
see detailed answer
Detailed Answer:
Hi,
Welcome back.
The answers to your questions:
1. Pus cells in semen need not always be abnormal. You can do a semen culture before starting antibiotics. Again non pathogenic ( non problematic) organisms may be seen in semen which is not of any significance.
2. Immature sperms are called precursor cells. Sperm cells initially will look like pus cells which later develop tail and form mature sperm cells. So pus cells can be early sperm cells or precursors.
3. Genital tract infections can affect sperm count. Proper antibiotic treatment can improve it.
4. You may try Ayurvedic treatment since your testosterone is normal. Please consult an expert in Ayurvedic medicine and discuss the medical options you have.
5. I suggest you to revisit the psychiatrist since your blood sugars are controlled and hormonal work up is normal.
Regards
Dr Ajish TP
see detailed answer
Detailed Answer:
Hi,
Welcome back.
The answers to your questions:
1. Pus cells in semen need not always be abnormal. You can do a semen culture before starting antibiotics. Again non pathogenic ( non problematic) organisms may be seen in semen which is not of any significance.
2. Immature sperms are called precursor cells. Sperm cells initially will look like pus cells which later develop tail and form mature sperm cells. So pus cells can be early sperm cells or precursors.
3. Genital tract infections can affect sperm count. Proper antibiotic treatment can improve it.
4. You may try Ayurvedic treatment since your testosterone is normal. Please consult an expert in Ayurvedic medicine and discuss the medical options you have.
5. I suggest you to revisit the psychiatrist since your blood sugars are controlled and hormonal work up is normal.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can I take tadalafill 10 mg along with ayurvedic treatment for my problem. Sir can i take this tadalafil life time on alternate days for my problem. At what time should i take this tablet? I take my BP medicine Tazloc 40 at bedtime. Pls suggest.
Brief Answer:
You can try tadalafil for 2 weeks initially
Detailed Answer:
Hi,
Welcome back.
You can start Tadalafil 10 mg alternate days for 1 week - if no change increase dose to 20 mg alternate days for 1 week. If still there is no improvement you can stop this medication as it is of no benefit.
You can take it along with ayurvedic medications.
The medication is usually taken at bedtime before sex.
You can take it can take it continuously if not associated with any side effects.
You can take BP medications along with this.
Regards
Dr Ajish TP
You can try tadalafil for 2 weeks initially
Detailed Answer:
Hi,
Welcome back.
You can start Tadalafil 10 mg alternate days for 1 week - if no change increase dose to 20 mg alternate days for 1 week. If still there is no improvement you can stop this medication as it is of no benefit.
You can take it along with ayurvedic medications.
The medication is usually taken at bedtime before sex.
You can take it can take it continuously if not associated with any side effects.
You can take BP medications along with this.
Regards
Dr Ajish TP
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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