Erectile dysfunction (ED), defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, affects up to one third of men at some point in their lives. The prevalence of ED in men younger than 59 years old is 12 %, and in men ages 60-69 it’s 22%, and in men older than 69 years old it’s 30%. ED may be a harbinger of undetected cardiovascular disease, so if psychological causes (e.g. anxiety, depression, guilt, stress, relationship problems) have been ruled out, an evaluation by a health care professional is recommended. ED may result from vascular disease, neurologic disease, hormonal imbalances/deficiencies, anatomical issues, drug or alcohol abuse, certain medications, or psychological issues. Obesity and smoking nearly double the risk for ED, while diabetics have a threefold greater risk. Other risk factors for ED include prostate surgery, high blood pressure, sedentary lifestyle, and advancing age.
Medications that may cause ED include opiate pain killers (e.g., vicodin), antihistamines, antidepressants, blood pressure medications (e.g., alpha blockers, beta blockers, calcium channel blockers, clonidine), heart meds (e.g., digoxin, Norpace, gemfibrozil), diuretics (e.g., Aldactone, HCTZ), and sedatives (e.g., xanax, valium, clonazempam.
First line treatment for ED is a PDE5 inhibitor (e.g., Viagra, Levitra, Cialis); however, a third of men do NOT respond well to these medications. Losing weight, exercising, smoking cessation, and caffeine and alcohol avoidance are common first-line measures that have shown benefit. Since PDE5 activity is androgen-dependent, PDE5 inhibitors listed above are not likely to be helpful if the patient has an underlying low testosterone level that hasn’t been addressed.
Alternative supplements that are worth a try:
- L-arginine (see article in this newsletter)
- Panax Ginseng 900mg 3 times daily
Another note regarding testosterone levels in men:
Normal reference ranges for testosterone are quite large, and your doctor is not likely going to address your testosterone levels until they fall out of range (less than 300). Visit Test Yourself and see if you might have symptoms of low testosterone. If you feel that you have an issue with low testosterone, but your levels are in range, it may be that your blood level is not your normal, or that you have adrenal burn out, or that you have other metabolic derangements or nutritional deficiencies that are affecting your body’s utilization of testosterone.
Article by Dr. Mila McManus MD Information contained in this article is taken from American Family Physician Feb 1, 2010, volume 81, Number 3