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What Is Men’s Endocrine Health?
for medications are often the culprit when libido wanes and erectile vigor can no longer be sustained.
Men’s endocrine health incorporates physical activity and sound nutrition to maintain a strong body; however, a ma- Not all doctors are comfortable discussing sexual problems jor emphasis includes male sexuality and erectile dysfunc- and betray their own anxiety by responding to the word tion. The “Power of Prevention” can be applied to any “sex” or “ED” by writing a prescription for Viagra, Levi- man’s life in order to live a healthy lifestyle.
tra or Cialis to dispose of the problem and the patient as quickly as possible.
Signs & Symptoms
Insist on a full evaluation, which should consist of history, Signs and symptoms of male sexual and erectile dysfunc- including a detailed inventory of current medications of tion include: difficulty having an erection, difficulty main- tobacco and alcohol use, and physical exam as well as blood taining an erection, loss of sexual desire, and low blood tests for hormone levels. Effective treatment follows proper Conditions
LoW TESToSTEronE and Ed
My doctor said I have a very low testosterone level and that could In order to help you better understand male endocrine dis- cause ED. He recommended that I have testosterone injections every orders, the following are male endocrine disorder condition two weeks. I am squeamish about injections. Is there any other way I scenarios presented in the form of questions from patients Yes, a low serum testosterone level may be responsible for LoSS of SExuaL dESIrE
ED and therapy designed to increase serum testosterone My husband, now 60, seems to have lost interest in sex. We were levels can be helpful in restoring a man’s sexual vigor. Sev- having sex once a week or at least once every other week until about six eral treatment options exist to help normalize serum testos- months ago. Now whenever I want to have sex he says he is too tired terone, including testosterone injections into a man’s but- or not interested. Is there something wrong with him or me? Does he tocks or shoulder muscles, as well as skin surface treatment involving the application of a testosterone impregnated patch on the back or shoulders, or one of two testoster- Interest in sex-libido is governed by a man’s mood, his abil- one gels rubbed onto the shoulders or abdomen will raise a ity to concentrate his mind on sex-sensate focus as well as the free flow of blood into the erectile chambers of his penis so that when sexually aroused, he responds with a Treatment
fully rigid erection. An adequate quotient of testosterone ensures that the system runs smoothly.
TESToSTEronE opTIonS
When a man is young his testicles spew out generous sup- Testosterone administered by injection maintains normal plies of testosterone; and, as sexual thoughts surface, he is blood testosterone levels only for a fortnight. Testoster- easily aroused responding with an erection to almost any one levels then decline and another injection is required. sexual cue. As he matures, erections continue in sexual In contrast, daily appreciation of the testosterone patch situations but not always with the same spontaneity and (Androderm) or either of the two testosterone gels (An- vigor of his youth. When sexual desire diminishes it may drogel and Testim) results in stable normal testosterone be due either to illness, depression, or a declining i.e., low serum testosterone. A visit to the doctor will help sort out the problem and help implement a treatment plan such as Some men experience a rash at the side of Androderm patch therapy and/or anti-depressant medication to ameliorate application, a problem that can be fended off by pretreatment depression and testosterone supplements to normalize se- of the application site with cortisone-like cream.
Both gels, Androgel and Testim, once applied to the skin A medical history is the first step to clarify the nature of are rapidly absorbed into the blood stream, and when ap- the problem. A detailed inventory of medication, both pre- plied daily are equally effective in maintaining normal tes- scription and over the counter, currently in use is critical tosterone levels in the testosterone deficient man.
Baseline and periodic prostate specific antigen (PSA) and about 5% of all men taking these medications and a hand- lipid profile measurements are routinely performed during ful, perhaps 1%, describing a bluish tint to vision in those any testosterone supplement therapy.
taking Viagra and Levitra but not Cialis. Even rarer is a condition referred to as NAJON, a condition causing loss Ed TrEaTMEnT opTIonS
of vision has been reported in a handful of men who have I see all these ads on television saying that having diabetes can cause erectile dysfunction (ED) and I should speak to my doctor. I did. My doctor gave me a prescription for Levitra just like the ad said, but I Men who take nitrates should not take any of the PDE-5 still have problems getting or holding on to an erection. Why, and what inhibitors. When used as directed, Viagra, Levitra and Cia- lis have all proven to be safe and effective treatments for the vast majority of men with ED.
You made the right first steps by seeking out advice from your physician but if all he did was hear the word “ED” I have ED and tried all three ED medications but none worked. Is and write out a prescription, he may not have done all he could do to help you. For example, after the initial enthusi-asm following the introduction of Viagra, we learned that Three options, vacuum devices, intrapenile injections, and pe- not all men responded equally well to Viagra and were nile prostheses exist to restore erectile function in ED patients deemed “Viagra failures”. When these “Viagra failures” who have failed to benefit from Viagra, Levitra or Cialis.
were studied in more detail many were found to have low testosterone levels. After treatment normalized serum tes- Vacuum devices such as the Osbon-ErecAid consist of a tosterone levels and Viagra use resumed, Viagra failures cylinder attached to a manually operated vacuum pump. “became Viagra responders” experiencing markedly im- The cylinder is designed to fit over the limp penis and the negative pressure created by the vacuum encourages blood flow into a progressively swelling penis. A band like struc- Although the company that makes Levitra has an aggressive ture is affixed to the base of the penis to maintain the erec- ad campaign to tout their medication as THE treatment for tion which is then sufficiently effect and engorged to allow men and diabetes mellitus ED or high blood pressure and ED, Viagra and Cialis are equally effective in treating the ED that accompanies these conditions.
Medicine injected directly into the penis makes it possible for a man to have an erection without sexual stimulation. Is there any real difference between – the three ED drugs Viagra The medication injected is called alprostadil and can be (sildenafil), Levitra (vardenafil) and Cialis (tadalafil)? instilled into the penis by means of an injection with a sy- All medications in this class are referred to as phosphodi- ringe pre-filled with alprostadil (Caverject) or an alprosta- esterase 5 (PDE-5) inhibitors and all work to enhance the dil permeated pellet (MUSE) released into the urethra-the vigor of a man’s erection. Differences exist in chemical opening in the penis through which men urinate. The penis structure, onset of action, duration of action and side ef- swells and becomes rigid shortly after the alprostadil is re- fect profile. Viagra (sildenafil) and Levitra (vardenafil) have leased into the spongy erectile tissue of the penis. Men may a similar chemical structure, onset of activity (30 minutes to experience a burning pain as the penis becomes erect.
one hour) and duration of effectiveness (4 hours) whereas Cialis (tadalafil) has a different chemical structure, similarly Penile prostheses are still implanted within the penis every rapid onset of action but a more extended duration of ef- year to help men who have not responded to other therapy. Some penile prostheses are designed so that the penis is in a permanently erect state whereas other newer models are The term “duration of effectiveness” is often misconstrued set-up so that a reservoir of fluid flows directly into the pe- leading some men to believe that after taking any of these nile tissue to create their erection. Then at the conclusion PDE-5 inhibitors they will experience an erection that may of intercourse fluid is redirected from the penis back to the scrotal reservoir to deactivate the erection allowing the pe-nis to return to its normal flaccid state. Penile prosthesis im- This is inaccurate. The PDE-5 inhibitors do not cause an plantation is usually done in the hospital under anesthesia.
erection. They make it possible for a man to have an erection only in the setting of sexual stimulation. The term “duration Written by Richard F. Spark, MD, FACE of effectiveness” refers to the time frame after taking one of these pills during which sexual stimulation will allow a man to have an erection-up to 4 hours after taking Viagra and Levitra and up to 36 hours after taking a Cialis tablet.
Side effect profiles differ to some degree among the three medications with facial flushing and headache reported by

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