Erectile dysfunction (ED) is a sexual dysfunction characterized by the inability to develop and/or maintain an erection, and it is very common. The UK’s National Health Service estimates “half of all men between the ages of 40 and 70 will have it to some degree.” Unfortunately, erectile dysfunction is linked to cultural concepts of potency, success, and masculinity. Therefore it can have devastating psychological consequences including feelings of shame, loss, or inadequacy. Because of this, many men do not seek treatment, but they should. The NHs notes, “One in 10 men has a problem related to having sex, such as premature ejaculation or erectile dysfunction.” It is time to stop dealing with the problem alone.
Erectile dysfunction happens for a number of reasons, both physiological and psychological. Most of these causes are responsive to treatment.
There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:
- Vasculogenic: conditions affecting the flow of blood to your penis, like diabetes, high cholesterol, cardiovascular disease and high blood pressure.
- Neurogenic: conditions affecting your nervous system like your brain, nerves and spinal cord including multiple sclerosis, Parkinson’s disease, and stroke.
- Anatomical: conditions affecting the physical structure of your penis including Peyronie’s disease, which affects the tissue of the penis.
- Hormonal: conditions affecting your hormone levels including hypogonadism, which is a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels; hyperthyroidism, where too much or not enough thyroid hormone is produced; and Cushing’s Syndrome which is a condition that affects the production of a hormone called cortisol.
Physical causes may also include surgery in the pelvic region, severe head injury (ED is thought to occur in up to 15-25% of people who experience one.), excessive alcohol intake, illegal drug use, smoking, and pelvic or penile injuries.
In addition, certain medications may cause ED as a side effect in some men. The list of possible medications is very long and you should speak to the doctor treating your ED to see whether or not your medication could be playing a role.
Possible psychological causes of erectile dysfunction include depression and anxiety. ED can often be part of a cycle that involves both physical and psychological causes. There are many psychological issues that may also affect your physical ability to get or maintain an erection. These include:
- relationship problems
- lack of sexual knowledge
- past sexual problems
- past sexual abuse
- being in a new relationship
Hormonal causes of ED are prevalent. Studies regarding erectile dysfunction and hormone levels assume a relationship between the two because:
- There is a decrease in testosterone levels with aging and this is a time period when ED increases.
- Castration (the removal of the testicles and thus the absence of male sex hormones) usually causes a decline in sexual function.
- Sexual function returns to normal in castrated (severely hypogonadal) men who undergo treatment with male sex hormones.
Signs of low testosterone include “a decline in libido; a decrease in beard growth, muscle mass, and strength; a lack of energy; osteopenia; a decrease in cognition; irritability; and, occasionally, excessive sweating and hot flushes.” If you are experiencing any of these signs in conjunction with erectile dysfunction, it is likely that you will see the most impact to sexual function from a combination of testosterone therapy and medication, like Viagra or Cialis.
Testosterone Therapy and Medication
In a post, titled “A Logical Approach to Treating Erectile Dysfunction,” on the Harvard Health Blog, Dr. Abraham Morgentaler, an associate clinical professor of urology at Harvard-affiliated Beth Israel Deaconess Medical Center is quoted, stating, “It’s well established that testosterone by itself, for men with sexual dysfunction that includes erectile dysfunction, can improve erections in the majority of men who take it.” It is a nice starting point and can be supplemented by medications when needed, if needed.
Because of the difficulty of speaking about ED, many men will seek erectile dysfunction treatments that require the least amount of discussion: medications. But, these may not work alone for many men. Additionally, as they don’t treat issues like low testosterone at all, they won’t work independently for those causes of ED. A combination of testosterone therapy and medication approaches the condition holistically and will result in both a better, more fulfilling sex life and additional “pep” in other aspects of your everyday life.