February 05, 2021
By David Hartsuch, MD, MS
I started the Rejuvagent Clinic to address the imbalance between testosterone and estrogen that is common as men age. High estrogen and low testosterone may result in hypertension, diabetes, obesity, hyperlipidemia, depression, prostate cancer, and fatigue. This condition affects approximately 10-25 percent of men over 40 and is also associated with low libido, and erectile dysfunction.
Men are bombarded with testosterone ads promising increased sexual “performance” like we’re playing the violin at Carnegie Hall, or worse yet performing like Shamu at Seaworld. While I don’t want to dismiss the serious health implications, Valentine’s Day is here, and I’ve been asked to discuss “Intimacy”—another euphemism for sex.
“Erectile dysfunction” is a subjective condition caused by multiple factors—some physical, some psychological. Men and women rarely want to discuss the subject and often avoid sex altogether. Men are embarrassed by their inability to “perform,” and woman frequently feel undesirable. Interpersonal conflict can compound this toxic combination eliminating sex altogether.
I am a medical doctor, not a marriage counselor. But many medical conditions can lead to this problem. Libido is sexual desire, whereas erectile dysfunction (ED) is the inability to achieve an erection even with adequate libido and sexual stimulation (mental, and physical). Low testosterone usually results in low libido, a precondition for achieving an erection. Elevated Prolactin, often seen in men with Parkinson’s disease, can also result in low testosterone. Assessing the man’s hormone status is important in the evaluation of ED. A host of medications such as metoprolol can also cause ED.
Some men with adequate libido can remain flaccid even with adequate sexual stimulation. Low nitric oxide levels can prevent blood vessels from dilating and engorging the penis. Endothelial Nitric Oxide Synthase (ENOS) is an enzyme in vessels which forms nitric oxide. This is necessary to allow the penis to engorge with blood and get hard. ENOS also has positive effects on blood pressure and cardiovascular risk. Diabetes mellites reduces ENOS, contributes to vascular disease, and is associated with ED. Viagra and Cialis are medications that increase ENOS and improve erections. Cialis can be taken daily for more spontaneity. Over-the-counter supplements Pycnogenol when taken with L-arginine have been shown to improve ENOS levels and improve erectile function.
Medical conditions such as sex hormone imbalance, Diabetes, Parkinson’s disease, and vascular disease when properly treated can improve ED. Men and couples who struggle with ED should realize that open communication about their sexuality is very therapeutic. They should realize that attaining an erection may take more time and stimulation. Even if sex seems pointless and humiliating, resist the temptation to ignore sex altogether—reinforce the love you share; spend more time intimately; get creative with sexual stimulation; but most importantly, communicate.
Dr. Hartsuch is the owner/operator of the Rejuvagent men's health clinic which offers safer and more cost effective alternatives to testosterone replacement therapy. Dr. Hartsuch may be reached by calling or texting the clinic at 563-293-7424.
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