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What Causes Erectile Dysfunction?
Question: Hi, I have been taking Cialis for some 9 months now, in view of my mild ED symptoms. That works fine but I strongly prefer to stop using the ED drugs and try to remove the underlying ED causes. My physical tests (Blood, BP, etc) show no anormalities that could induce ED. How can I figure out whether there could be other causes of psychological nature (or other, like masturbation)? Thanks!
Brief Answer:
Please answer the following questions
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concern.
Presence of erectile dysfunction in middle age could be due to multiple factors which includes psychological to organic problems.
Before we can make any conclusions I request you to provide following details so an impression can be made about the cause of problem.
1. How long you are facing this problem ?
2. How the problem started whether it was sudden in onset or build up slowly over the months or years
3. Frequency of the problem in a week ?
4. In a typical month out of what number of sexual interactions/masturbations ?
5. What are the factors that increase the problem?
6. Factors that relieve the problem- thoughts, situations, partner, place etc
7. Do you get early morning erection?
8. If yes how frequent
9. Your relationship status and partner details- Is she very critical, demands sex more than what can you think, does she feel superior to you or bothers you in some other regards
10. Effect on your relationship so far
11. Details of medical illness, if any
12. Medications you are receiving currently, if any
13. Medication you received in past and their effect?
14. Do you have any psychiatric illness?
15. Investigations done till date and reports of most latest investigations?
I must assure you that once we identify cause it will be easy to correct it.
I look forward to see more details.
Thanks and regards
Please answer the following questions
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concern.
Presence of erectile dysfunction in middle age could be due to multiple factors which includes psychological to organic problems.
Before we can make any conclusions I request you to provide following details so an impression can be made about the cause of problem.
1. How long you are facing this problem ?
2. How the problem started whether it was sudden in onset or build up slowly over the months or years
3. Frequency of the problem in a week ?
4. In a typical month out of what number of sexual interactions/masturbations ?
5. What are the factors that increase the problem?
6. Factors that relieve the problem- thoughts, situations, partner, place etc
7. Do you get early morning erection?
8. If yes how frequent
9. Your relationship status and partner details- Is she very critical, demands sex more than what can you think, does she feel superior to you or bothers you in some other regards
10. Effect on your relationship so far
11. Details of medical illness, if any
12. Medications you are receiving currently, if any
13. Medication you received in past and their effect?
14. Do you have any psychiatric illness?
15. Investigations done till date and reports of most latest investigations?
I must assure you that once we identify cause it will be easy to correct it.
I look forward to see more details.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello, many thanks for your reply. I am trying to be as precise as I can but am not sure if my answers are to the point for you, so please ask more specific questions wherever you deem necessary, thanks.
1. probably some 2 years ago I may have noticed that occasionally my erections got somewhat weaker. That time it did not impact making love with my wife, I rather could notice it when masturbating. By the way, I always masturbated a lot ( which is still the case).
2. Approx. one year ago I unexpectedly strongly lost erection power which made intercourses largely impossible or difficult, for 1 or 2 weeks. That upset me very much, in a time that I had a lot of stress due to my work and felt emotionally very unstable. I felt out of control in many aspects then. From that time on this ED issue always stayed on my mind as a concern. Also, that difficult moment triggered much more intimacy with my wife in terms of openly speaking about this subject.
3. Frankly, a bit difficult to quantify. We both travel a lot so there have not been many times recently that were long enough to define an average. Secondly, using Cialis effectively masks the symptoms of the problem. But for this moment, assuming no use of Cialis/Viagra, I estimate that during sex I mostly will be able to penetrate, after good foreplay. And most of times, once I have penetrated her, that will make my erection pretty stiff, even up to full 100%. Outside my partner and if not stimulated, I will lose erection quickly, also when aroused. Somehow Istrongly feel the problem is in my head, at least for a big portion.
4. Typically we may have 2-3 intercourses in a week, and I masturbate daily, alone or with my wife's help. When not on Cialis, I will be stressed if I can penetrate her and then indeed, occasionally I will fail to penetrate.
5. Bad sleep, very busy or stressy working day will reduce my sex drive and also the actial performance. That's easy to accept and to deal with. Thinking about this problem creates it also, but I cannot put my finger on it.
6. Longer holidays and being together all the time. My wife's desire fo sex does miracles but unfortunately happens very rarely ( she is post- menopause and very low on libido). Talking with her explicitly about making love very much arouses me, like flirting does.
7+8. On Cialis: yes, pretty much alike it was before = 4-6 times a week, when not overworked etc.. Without medication: maybe 2-3 times and mostly only partial erection.
9. My wife is not the dominant party in our relationship and is not demanding regarding sex. There is no kind of pressure I would feel from her side that would stress me in sex or otherwise. We are very intimate and I talk to her about all my problems at work etc. which gives me meaningful support. I openly talk to her about my ED concerns and she takes it seriously because I do. Reason being that I desire much sex with her, well beyond of what she needs. I encouraged her many times to visit the doctor and work on her libido which is way too low. She agrees with me but does not really take serious steps yet ( seek support from her gyneacologist etcetera.). That frustrates me sometimes.
10. Ironically, our emotional intimacy only strongly improved from this and our relatiomship has become more precious. But it does not relieve my ED concern :(
11. I am diagnosed of BPH with a limited prostate enlargement, within the norm for my age. I have no specific symptoms from that. I had two inguinal hernia surgeries, last one in 2014, with no complications. I have done an extensive health check last February, with a complete blood/urine tests, hormons etc. I cannsend you any information that may be relevant to diagnose.
12. I take Terbinafine 250 mg against toenail fungus. Cialis 5 mg daily ( I now reduced from daily to as-needed). Supplements like omega-3, D3, E, selenium, zink, L-arginine, DHEA. I frequently use OTC sleep aid pills.
13. In the past only occasional medication, never used antidepressants or alike. In 2014 I was on an antibiotic for some 2 months to cure prostatitis and an inflammation of my testicle.
14. No, never had any issues here
15. I have an extensive health check report and can share with you whatever is relevant. On ED I never underwent an in-depth test or investigation. Based on my generally good health profile, the doctors say they don't see a medical condition that woul directly cause ED. You are the first person I am talking to in more depth, especially on the psychology/relationship side.
Hope this makes some sense to you. Please ask anything that you deem important. I really want to get a better grasp on this problem.
Thanks a lot and best regards,
1. probably some 2 years ago I may have noticed that occasionally my erections got somewhat weaker. That time it did not impact making love with my wife, I rather could notice it when masturbating. By the way, I always masturbated a lot ( which is still the case).
2. Approx. one year ago I unexpectedly strongly lost erection power which made intercourses largely impossible or difficult, for 1 or 2 weeks. That upset me very much, in a time that I had a lot of stress due to my work and felt emotionally very unstable. I felt out of control in many aspects then. From that time on this ED issue always stayed on my mind as a concern. Also, that difficult moment triggered much more intimacy with my wife in terms of openly speaking about this subject.
3. Frankly, a bit difficult to quantify. We both travel a lot so there have not been many times recently that were long enough to define an average. Secondly, using Cialis effectively masks the symptoms of the problem. But for this moment, assuming no use of Cialis/Viagra, I estimate that during sex I mostly will be able to penetrate, after good foreplay. And most of times, once I have penetrated her, that will make my erection pretty stiff, even up to full 100%. Outside my partner and if not stimulated, I will lose erection quickly, also when aroused. Somehow Istrongly feel the problem is in my head, at least for a big portion.
4. Typically we may have 2-3 intercourses in a week, and I masturbate daily, alone or with my wife's help. When not on Cialis, I will be stressed if I can penetrate her and then indeed, occasionally I will fail to penetrate.
5. Bad sleep, very busy or stressy working day will reduce my sex drive and also the actial performance. That's easy to accept and to deal with. Thinking about this problem creates it also, but I cannot put my finger on it.
6. Longer holidays and being together all the time. My wife's desire fo sex does miracles but unfortunately happens very rarely ( she is post- menopause and very low on libido). Talking with her explicitly about making love very much arouses me, like flirting does.
7+8. On Cialis: yes, pretty much alike it was before = 4-6 times a week, when not overworked etc.. Without medication: maybe 2-3 times and mostly only partial erection.
9. My wife is not the dominant party in our relationship and is not demanding regarding sex. There is no kind of pressure I would feel from her side that would stress me in sex or otherwise. We are very intimate and I talk to her about all my problems at work etc. which gives me meaningful support. I openly talk to her about my ED concerns and she takes it seriously because I do. Reason being that I desire much sex with her, well beyond of what she needs. I encouraged her many times to visit the doctor and work on her libido which is way too low. She agrees with me but does not really take serious steps yet ( seek support from her gyneacologist etcetera.). That frustrates me sometimes.
10. Ironically, our emotional intimacy only strongly improved from this and our relatiomship has become more precious. But it does not relieve my ED concern :(
11. I am diagnosed of BPH with a limited prostate enlargement, within the norm for my age. I have no specific symptoms from that. I had two inguinal hernia surgeries, last one in 2014, with no complications. I have done an extensive health check last February, with a complete blood/urine tests, hormons etc. I cannsend you any information that may be relevant to diagnose.
12. I take Terbinafine 250 mg against toenail fungus. Cialis 5 mg daily ( I now reduced from daily to as-needed). Supplements like omega-3, D3, E, selenium, zink, L-arginine, DHEA. I frequently use OTC sleep aid pills.
13. In the past only occasional medication, never used antidepressants or alike. In 2014 I was on an antibiotic for some 2 months to cure prostatitis and an inflammation of my testicle.
14. No, never had any issues here
15. I have an extensive health check report and can share with you whatever is relevant. On ED I never underwent an in-depth test or investigation. Based on my generally good health profile, the doctors say they don't see a medical condition that woul directly cause ED. You are the first person I am talking to in more depth, especially on the psychology/relationship side.
Hope this makes some sense to you. Please ask anything that you deem important. I really want to get a better grasp on this problem.
Thanks a lot and best regards,
Brief Answer:
Please reply with following reports
Detailed Answer:
Hello,
Thanks for reverting back to me with required details.
I gone through your answer and glad to inform you that they are complete in true sense.
I have sensed few possibilities for which we need to work on.
Firstly talk to your doctor about change of terbinafine if possible. Although ED is not a common side effect of terbinafine but it is reported in many case reports. If it is not possible to change for him stop for few days and observe the response. It is possible that this simple measure can bring your Ed problem under control.
Secondly please get the following investigations done.
Serum prolactin
Serum Testosterone
Serum LH
Serum FSH
Penile doppler study
These are not absolutely essential and I feel in sync with your doctor to a certain extent. But the gradual onset of problem indicates we may locate some cause for ED although it is highly unlikely in your case.
Thirdly let me know details of all medication/supplements/sedatives with dose range and duration.
Details of prostate size and any medication, if prescribed.
I hope to find some permanent solution for the current problem.
Thanks and regards
Please reply with following reports
Detailed Answer:
Hello,
Thanks for reverting back to me with required details.
I gone through your answer and glad to inform you that they are complete in true sense.
I have sensed few possibilities for which we need to work on.
Firstly talk to your doctor about change of terbinafine if possible. Although ED is not a common side effect of terbinafine but it is reported in many case reports. If it is not possible to change for him stop for few days and observe the response. It is possible that this simple measure can bring your Ed problem under control.
Secondly please get the following investigations done.
Serum prolactin
Serum Testosterone
Serum LH
Serum FSH
Penile doppler study
These are not absolutely essential and I feel in sync with your doctor to a certain extent. But the gradual onset of problem indicates we may locate some cause for ED although it is highly unlikely in your case.
Thirdly let me know details of all medication/supplements/sedatives with dose range and duration.
Details of prostate size and any medication, if prescribed.
I hope to find some permanent solution for the current problem.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello, many thanks for your comments, here follows the additional information:
1. Terbinafine: I will follow-up at first opportunity with my family doctor. By the way, I started the Terbinafine cure some two months ago and never noticed any difference between my condition before- and after. I also re-checked my liver function blood tests to be sure there is no harm to the liver. There was no change in liver function. I will finish the Terbinafine cure within two months.
2. Hormons: I attached my most recent test on SHBG, Testosterone, FSH, LH and Prolactine. Some remarks: I tested T and SHBG some 8-10 times over the last year. Testosterone has been consistently in the low range of 9-10,5, sometimes around 12-13 and once it peaked at 20 nmol/L. Remarkably, SHBG quite exactly followed the fluctuations of T, with SHBG value being +/- two times higher than T. My Albumin level is always high and quiteconstant around 51 g/L. I heard that that could be important for the bio-available T levels (???).
Over time Prolactin and LH always remained normal, in the somewhat lower range. LSH mostly around the median of the normal reference range.
Testosterone peaked back in July when I was quite rapidly loosing weight (in a healthy manner), after my weight stabilized, it returned to the usual low values. No idea whether there is any correlation, just wanted to share with you.
3. Penile Doppler study. I will do it within the next weeks. But could you please indicate which test I need? I need to be able to accurately explain what I want from the medical services provider ( In my country, I can buy such a test, without prescription from a doctor). Thanks!
4. Supplements/ sedatives:
Per day:
DHEA 1x 50 mg
Vit. A 8000 IU
Vit. D3 1x 1000 IU
Vit. E. 1x 1000 IU
Selenium 1x 100 ug
Zinc 50 mg
L-Arginine 1x 1000 mg
Omega-3 1x 1000 mg
Sedative: Diphenhydramine HCL 25 or 50 mg before bedtime, 3-5 times per week. My problem is not to fall in sleep, but typically I wake up much too early.
Prostate size: I enclose two ultrasound results: May 2014 (external) and February2015 (transrectal). I also enclose the ultrasound result of the testes (May 2014). FYI, in May 2014 I was diagnosed of prostatitis and a chronical infection in the right testicle. To cure both, I took an antibiotic for approx 1,5 months, at a low daily dosage. I do not remember its name but it was a common cure that is often used at infections of bladder, urinary tract etcetera.
I hope I am complete in giving you the required information.
Can you share any comments or suggestions related to the psychological/behavioral part of the questions I was trying to answer in my previous note? I will highly appreciate as that part is really hard to self-assess... I will really appreciate your feedback here.
Many thanks and I really look forward to your response.
Best regards,
XXXXXXX
1. Terbinafine: I will follow-up at first opportunity with my family doctor. By the way, I started the Terbinafine cure some two months ago and never noticed any difference between my condition before- and after. I also re-checked my liver function blood tests to be sure there is no harm to the liver. There was no change in liver function. I will finish the Terbinafine cure within two months.
2. Hormons: I attached my most recent test on SHBG, Testosterone, FSH, LH and Prolactine. Some remarks: I tested T and SHBG some 8-10 times over the last year. Testosterone has been consistently in the low range of 9-10,5, sometimes around 12-13 and once it peaked at 20 nmol/L. Remarkably, SHBG quite exactly followed the fluctuations of T, with SHBG value being +/- two times higher than T. My Albumin level is always high and quiteconstant around 51 g/L. I heard that that could be important for the bio-available T levels (???).
Over time Prolactin and LH always remained normal, in the somewhat lower range. LSH mostly around the median of the normal reference range.
Testosterone peaked back in July when I was quite rapidly loosing weight (in a healthy manner), after my weight stabilized, it returned to the usual low values. No idea whether there is any correlation, just wanted to share with you.
3. Penile Doppler study. I will do it within the next weeks. But could you please indicate which test I need? I need to be able to accurately explain what I want from the medical services provider ( In my country, I can buy such a test, without prescription from a doctor). Thanks!
4. Supplements/ sedatives:
Per day:
DHEA 1x 50 mg
Vit. A 8000 IU
Vit. D3 1x 1000 IU
Vit. E. 1x 1000 IU
Selenium 1x 100 ug
Zinc 50 mg
L-Arginine 1x 1000 mg
Omega-3 1x 1000 mg
Sedative: Diphenhydramine HCL 25 or 50 mg before bedtime, 3-5 times per week. My problem is not to fall in sleep, but typically I wake up much too early.
Prostate size: I enclose two ultrasound results: May 2014 (external) and February2015 (transrectal). I also enclose the ultrasound result of the testes (May 2014). FYI, in May 2014 I was diagnosed of prostatitis and a chronical infection in the right testicle. To cure both, I took an antibiotic for approx 1,5 months, at a low daily dosage. I do not remember its name but it was a common cure that is often used at infections of bladder, urinary tract etcetera.
I hope I am complete in giving you the required information.
Can you share any comments or suggestions related to the psychological/behavioral part of the questions I was trying to answer in my previous note? I will highly appreciate as that part is really hard to self-assess... I will really appreciate your feedback here.
Many thanks and I really look forward to your response.
Best regards,
XXXXXXX
Brief Answer:
Stop worrying about terbinafine
Detailed Answer:
Hello,
Thanks for reverting back to me.
First of all I like to make it clear that there seems no role of terbinafine as there is no temporal correlation. So it is advisable to stop the idea about current medications.
Regarding hormonal profile, there is no worry again as they are within normal limits. Lower range of testosterone is common finding with advancement of age and low testosterone is generally associated with low libido which is not a problem in your case.
Regarding penile doppler there is nothing special required. You need to expalin your radiologist that doctor asked me to get penile doppler study for erectile dysfunction. That is enough to make him understand. At your part stop amoking at least three days before , if you happen to smoke.
Regarding psychological aspect I am keeping my opinion reserve till the report of doppler available as making conclusion before getting all possible reasons ruled out is not advisable.
So once you get the report of doppler study, revert back to me and we will discuss about that issue and the study.
I will be happy to explain the contribution of psychological issues in current problem.
Thanks and regards
Stop worrying about terbinafine
Detailed Answer:
Hello,
Thanks for reverting back to me.
First of all I like to make it clear that there seems no role of terbinafine as there is no temporal correlation. So it is advisable to stop the idea about current medications.
Regarding hormonal profile, there is no worry again as they are within normal limits. Lower range of testosterone is common finding with advancement of age and low testosterone is generally associated with low libido which is not a problem in your case.
Regarding penile doppler there is nothing special required. You need to expalin your radiologist that doctor asked me to get penile doppler study for erectile dysfunction. That is enough to make him understand. At your part stop amoking at least three days before , if you happen to smoke.
Regarding psychological aspect I am keeping my opinion reserve till the report of doppler available as making conclusion before getting all possible reasons ruled out is not advisable.
So once you get the report of doppler study, revert back to me and we will discuss about that issue and the study.
I will be happy to explain the contribution of psychological issues in current problem.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Hello,
Many thanks. I will see when I get the Doppler done, may take a few weeks because I am going to travel a lot now.
How do I revert to you after a few weeks? I thought they will normally close this correspondence string after 1-2 weeks so that I can't pick-up our contact again...
I understand and fully accept your approach to first carefully aand completely diagnose and not be too fast in psychological conclusions. But if you have any tips or suggestions that I could adapt anyway without waitin, I am very open and curious to that.
Thanks again and regards!g
Many thanks. I will see when I get the Doppler done, may take a few weeks because I am going to travel a lot now.
How do I revert to you after a few weeks? I thought they will normally close this correspondence string after 1-2 weeks so that I can't pick-up our contact again...
I understand and fully accept your approach to first carefully aand completely diagnose and not be too fast in psychological conclusions. But if you have any tips or suggestions that I could adapt anyway without waitin, I am very open and curious to that.
Thanks again and regards!g
Brief Answer:
There is psychological contribution
Detailed Answer:
Dear XXXXXXX
Welcome back,
As I said earlier I will prefer to wait for doppler before making any conclusion there is still doubt about the real contribution of psychological issues. I must admit here that there is psychological contribution and no body can deny it. But the true extent of problem can be discussed once we are sure from other contributors.
One thing to do is to decrease any stressors or anxiety you might be having.
Regarding further contact you can use my url which I am going to mention below
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
With this you can post your query directly to me.
At this moment you can close the query and rate the answer if you feel appropriate.
Thanks and regards
There is psychological contribution
Detailed Answer:
Dear XXXXXXX
Welcome back,
As I said earlier I will prefer to wait for doppler before making any conclusion there is still doubt about the real contribution of psychological issues. I must admit here that there is psychological contribution and no body can deny it. But the true extent of problem can be discussed once we are sure from other contributors.
One thing to do is to decrease any stressors or anxiety you might be having.
Regarding further contact you can use my url which I am going to mention below
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
With this you can post your query directly to me.
At this moment you can close the query and rate the answer if you feel appropriate.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Hello, many, many thanks, you are really helping me in this. Much appreciated. I will come back to you ince Penile Doppler done.
Meanwhile I wanted to share two items for your comment:
1. Natural morning erections. Just recently I paid more attention to my body, thanks to this dislogue with you. I do have occasionsl 100% strong morning erections. Like today, it was fir 30 min or even longer. Thus brings myself more to the thoughts that my extremely intense life style ( travel, jetlags, work) brings continual stress and I might be engancing it into ED symptoms by behavior, habits or alike. I suspect that the sedative I mentioned previously kills my morning erections...I haven't taken it yesterday, first time this week. Slept poorly and too short, but probably a healthier sleep...
2. You really set me at fundamental thinking about things that really drive me through the life. My marriage plays an extremely central role for me, keeping me moving and happy. Sex is, in turn, one (but not the only) crucial part within my relationship that is very precious to me. That's why I found my way to you to prevent (more) severe ED in the future.
But also stress is like oxygen to me, I cannot enjoy life without that. Heavy dilemma for an aging male. I need dome counseling on this level. May I assume you're the right person to ask some questions on stress control etcetera?
Thanks again and best regards,
XXXXX?
Meanwhile I wanted to share two items for your comment:
1. Natural morning erections. Just recently I paid more attention to my body, thanks to this dislogue with you. I do have occasionsl 100% strong morning erections. Like today, it was fir 30 min or even longer. Thus brings myself more to the thoughts that my extremely intense life style ( travel, jetlags, work) brings continual stress and I might be engancing it into ED symptoms by behavior, habits or alike. I suspect that the sedative I mentioned previously kills my morning erections...I haven't taken it yesterday, first time this week. Slept poorly and too short, but probably a healthier sleep...
2. You really set me at fundamental thinking about things that really drive me through the life. My marriage plays an extremely central role for me, keeping me moving and happy. Sex is, in turn, one (but not the only) crucial part within my relationship that is very precious to me. That's why I found my way to you to prevent (more) severe ED in the future.
But also stress is like oxygen to me, I cannot enjoy life without that. Heavy dilemma for an aging male. I need dome counseling on this level. May I assume you're the right person to ask some questions on stress control etcetera?
Thanks again and best regards,
XXXXX?
Brief Answer:
There is no link with sedative and erections
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me and great feedback.
Regarding your first update I slightly disagree with your assumption that no use of sedative brought out the morning erections. As I can remember well you had two to three morning erections without cilais and almost everyday on cialis. It is possible that you assumed that sedative creates problem and the same thought brought out the better morning erection, realizing that you did not take sedative last night.
Your another assumption that stress creates problem with erection have scientific basis. It is our common day to day life experience that excess of stress do not allow better erections as body need to handle more important things. I hope you understand that naturally body gives more emphasis to manage stress that bringing erections.
We all have the feeling to excel in our respective fields and don't spend adequate time with our own self trying to understand our own needs. In such situations it becomes important to spend more time for biological needs of self rather than material needs.
I understand that stress is oxygen for you and it is applicable for almost everyone. The concept of stress is divided in multiple ways, among which one is concept of distress and eustress.
Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress.
Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behavior.
So having stress is good thing but definitely we need to draw line where to stop.
I hope this will help you to have balance in eustress and distress.
Thanks and regards
There is no link with sedative and erections
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me and great feedback.
Regarding your first update I slightly disagree with your assumption that no use of sedative brought out the morning erections. As I can remember well you had two to three morning erections without cilais and almost everyday on cialis. It is possible that you assumed that sedative creates problem and the same thought brought out the better morning erection, realizing that you did not take sedative last night.
Your another assumption that stress creates problem with erection have scientific basis. It is our common day to day life experience that excess of stress do not allow better erections as body need to handle more important things. I hope you understand that naturally body gives more emphasis to manage stress that bringing erections.
We all have the feeling to excel in our respective fields and don't spend adequate time with our own self trying to understand our own needs. In such situations it becomes important to spend more time for biological needs of self rather than material needs.
I understand that stress is oxygen for you and it is applicable for almost everyone. The concept of stress is divided in multiple ways, among which one is concept of distress and eustress.
Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress.
Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behavior.
So having stress is good thing but definitely we need to draw line where to stop.
I hope this will help you to have balance in eustress and distress.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello and a big Thank You again for you thoughtful feedback.
I will try to reduce or replace the sedative that I now regularly uee, as this always gives me a hangover-like feeling the first 2-3 hours. Of course that is rewarded by some 2 extra hours of sleep which gives mre energy later in the day, but I will look for alternatives.
Thanks for your warning not to over-interpret momentarily observations, point taken. But still I feel better that at least there are moments that the whole "machinery" is capable of bringing naturalspontaneous 100% erections when not using drugs like Cialis.
Could you please tell me whether regular taking DHEA and Arginine makes sense in my case? I am not short of libido, maybe I have even too much of it for my age (???). Rather, I would prefer supplements that support the erectile function.
Thanks and greetings,
XXXXX
XXXXX
I will try to reduce or replace the sedative that I now regularly uee, as this always gives me a hangover-like feeling the first 2-3 hours. Of course that is rewarded by some 2 extra hours of sleep which gives mre energy later in the day, but I will look for alternatives.
Thanks for your warning not to over-interpret momentarily observations, point taken. But still I feel better that at least there are moments that the whole "machinery" is capable of bringing naturalspontaneous 100% erections when not using drugs like Cialis.
Could you please tell me whether regular taking DHEA and Arginine makes sense in my case? I am not short of libido, maybe I have even too much of it for my age (???). Rather, I would prefer supplements that support the erectile function.
Thanks and greetings,
XXXXX
XXXXX
Brief Answer:
Neither useful nor harmful except cost, in case of dhea
Detailed Answer:
Dear XXXXXXX
Welcome back to HCM.
Regarding use of both molecules there is not much evidence in favour but in recent years there is kind of fashion in regard to supplements.
Regarding DHEA, you already said that you have good libido and I dot think DHEA is going to help beyond the normal limits. Although I must admit that 50 mg of hea is not associated with significant side effects so using or not using is unlikely to help your health, except psychological advantage.
Almost similar thing is applicable for Arginine, which is precursor for nitric oxide, a chemical responsible for vasodilation, necessary for erections. So it can be said that there is at least theoretical advantage although robust data are lacking for arginine.
In my view the current dos of supplements are unlikely to cause any serious side effects except hole in pocket and can be continued with optimism, that they help.
The real benefit is not known properly but there is theoretical benefit which helps the individuals psychologically.
I hope this clears your doubt about argnine and DHEA.
Thanks and regards
Neither useful nor harmful except cost, in case of dhea
Detailed Answer:
Dear XXXXXXX
Welcome back to HCM.
Regarding use of both molecules there is not much evidence in favour but in recent years there is kind of fashion in regard to supplements.
Regarding DHEA, you already said that you have good libido and I dot think DHEA is going to help beyond the normal limits. Although I must admit that 50 mg of hea is not associated with significant side effects so using or not using is unlikely to help your health, except psychological advantage.
Almost similar thing is applicable for Arginine, which is precursor for nitric oxide, a chemical responsible for vasodilation, necessary for erections. So it can be said that there is at least theoretical advantage although robust data are lacking for arginine.
In my view the current dos of supplements are unlikely to cause any serious side effects except hole in pocket and can be continued with optimism, that they help.
The real benefit is not known properly but there is theoretical benefit which helps the individuals psychologically.
I hope this clears your doubt about argnine and DHEA.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Many thanks again! I guess I will use up my stock of supplements and move on without them... Is your opnion about the Vitamines A,D3, E also sceptical? I read somewhere that water-solubles may be bioavailable but the fat solubles weren't really proven as effective.
I am heading for extensive intercontinental travel now, so it will take me several weeks before I get the penile doppler study done. I then will come back to you.
Meanwhile I'll try to mindfully deal with the stress and see what my efforts do to my body. I think that changes in my erectile function may be a sensitive indicator of any effects.... But probably only after at least several weeks, correct?
Again, thank you cery much for you help here, your support means a lot to me. Just focusing on fixing the ED symptoms won't work sustainably, I am convinced
Best regards,
XXXXXXX
Many thanks again! I guess I will use up my stock of supplements and move on without them... Is your opnion about the Vitamines A,D3, E also sceptical? I read somewhere that water-solubles may be bioavailable but the fat solubles weren't really proven as effective.
I am heading for extensive intercontinental travel now, so it will take me several weeks before I get the penile doppler study done. I then will come back to you.
Meanwhile I'll try to mindfully deal with the stress and see what my efforts do to my body. I think that changes in my erectile function may be a sensitive indicator of any effects.... But probably only after at least several weeks, correct?
Again, thank you cery much for you help here, your support means a lot to me. Just focusing on fixing the ED symptoms won't work sustainably, I am convinced
Best regards,
XXXXXXX
Brief Answer:
You can continue Vitamin D3, A and E
Detailed Answer:
Dear XXXXXXX
Welcome back to me.
It is commonly observed that people who have less sun exposure tend to develop deficiency of Vitamin D3 and it is recommended by experts across the globe to take the required dose in supplements. 1000 IU is likely to supplement deficiency due to inadequate sun exposure and there is enough evidence in middle age to supplement same.
On similar lines vitamin A supplementation have shown its usefulness across the studies and recommended by experts.
Regarding Vitamin E there is debatable evidence and not everybody agrees on its usefulness. Few studies claimed anti oxidant properties of it and they were replicated in other studies. At the same time few other studies pointed out that there is no advantage conferred with Vitamin E supplementation.
To conclude Vitamin A and D supplementation is required but Vit E is supported by contradictory evidence.
I hope this clears the situation about supplementation.
Thanks and regards
You can continue Vitamin D3, A and E
Detailed Answer:
Dear XXXXXXX
Welcome back to me.
It is commonly observed that people who have less sun exposure tend to develop deficiency of Vitamin D3 and it is recommended by experts across the globe to take the required dose in supplements. 1000 IU is likely to supplement deficiency due to inadequate sun exposure and there is enough evidence in middle age to supplement same.
On similar lines vitamin A supplementation have shown its usefulness across the studies and recommended by experts.
Regarding Vitamin E there is debatable evidence and not everybody agrees on its usefulness. Few studies claimed anti oxidant properties of it and they were replicated in other studies. At the same time few other studies pointed out that there is no advantage conferred with Vitamin E supplementation.
To conclude Vitamin A and D supplementation is required but Vit E is supported by contradictory evidence.
I hope this clears the situation about supplementation.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Hello again and many thanks for this explanation!
I am looking for a nearest opportunity to do the penile doppler test as we discussed...one question to this: is it true that penile doppler result may provide a early and reliable indication of a coronary artery desease in men? If this is correct, that would be one more major motivator for me to do this test...I never had any problems but have been too high on cholesterols for some years, till early 2014, when I strongly improved my life style.
Thanks and best regards!
XXXXXXX
Brief Answer:
No, but co-occurance is common
Detailed Answer:
Dear XXXXXXX
Welcome back to HCM again.
Although there is no direct correlation, co-occurrence of problems are common due to similar risk factor profile. Having high cholesterol is etiological factor both for coronary artery disease and Erectile dysfunction.
Having said this I will take this opportunity to suggest routine cardiac evaluation at this stage. The Mayo clinics recommend that every person in their 50s should have minimum five evaluations in a decade. (every two years)
If you have not undergone routine cardiac evaluation in last two years, there is valid reason to go for cardiac evaluation. This is not only for ED, it is for overall well being of person.
For ED problem isolated Doppler with other tests (already completed) is enough to identify the etiology.
I hope this assists you.
Thanks and regards
No, but co-occurance is common
Detailed Answer:
Dear XXXXXXX
Welcome back to HCM again.
Although there is no direct correlation, co-occurrence of problems are common due to similar risk factor profile. Having high cholesterol is etiological factor both for coronary artery disease and Erectile dysfunction.
Having said this I will take this opportunity to suggest routine cardiac evaluation at this stage. The Mayo clinics recommend that every person in their 50s should have minimum five evaluations in a decade. (every two years)
If you have not undergone routine cardiac evaluation in last two years, there is valid reason to go for cardiac evaluation. This is not only for ED, it is for overall well being of person.
For ED problem isolated Doppler with other tests (already completed) is enough to identify the etiology.
I hope this assists you.
Thanks and regards
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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