Erectile dysfunction, or impotence, is not a rare occurrence. It affects 52 percent of men between the ages of 40-70. However, due to the complexity of the erection process, treatment for ED remains a process of trial and error. Thanks to the ad campaigns of Viagra, which hit the market in 1998, men know what to ask for during their doctor visits. However, while 80 percent of Viagra users report successful erections after using the drug, the other 20 percent are not so lucky and may require different erectile dysfunction treatments.
Erectile dysfunction is often seen as a “canary in the coal mine.” In other words, it is a symptom of a larger issue. ED can often be a side effect of diabetes, heart disease, or obesity, all of which can affect blood flow throughout the body and to the penis. However, ED can also be a side effect of low testosterone levels. In these cases, testosterone therapy may be the right treatment for erectile dysfunction.
Testosterone Replacement Therapy and ED
Testosterone replacement therapy (TRT) is not a new treatment for ED. In fact, before Viagra came around 20 years ago, testosterone therapy was the standard treatment for erectile dysfunction.
Before one can pursue testosterone therapy for erectile dysfunction, any other cause must first be ruled out. Doctors will want to test for any sort of heart condition and may even consider if a psychological issue is the cause of ED. Doctors may also ask if there are any other symptoms happening along with the ED. Does the patient have a low libido? Is he experiencing fatigue?
If the patient answers “yes” to these questions, there is a chance his ED is a sign of low-T, and a testosterone treatment may be the correct solution.
Testosterone, often referred to as the “manly hormone,” is a hormone produced predominantly in the testicles. Among other things, testosterone is important to a man’s bone density, muscle strength and mass, red blood cell production, and sex drive. Testosterone levels peak in men during adolescence and early adulthood. Then, between age 30 and 40, testosterone levels start to decline by around one percent each year. This is typically just part of the aging process. However, if testosterone levels are dropping at an alarming rate, it could be a symptom of a disease called hypogonadism.
Hypogonadism is a disease that hinders the body from producing normal amounts of testosterone because of an issue in the testicles or pituitary glands. In cases of hypogonadism, or for men who are otherwise healthy but suffer from ED, testosterone therapy may be the solution.
Different Types of Testosterone Therapy
According to a recent study involving men 65 and older, participants showed more interest in sex and were able to engage in higher levels of sexual activity after undergoing testosterone therapy. There are many different ways to go about TRT. It is imperative to consult a physician before trying one of the following treatments:
The transdermal patch is often considered the easiest and most convenient testosterone therapy method. A patch is applied at the same time each day, typically in the evening. Irritation of the skin has been reported and can often be treated with a hydrocortisone cream.
Testosterone Topical Gel
Testosterone topical gel is an ointment applied directly to the skin once daily. While this is also an easy treatment that can be done, it is important that the gel not be applied to a part of the body that could be touched by another person, especially a woman or child.
A mouth patch is another method for testosterone therapy. The mouth patch is a small patch inserted into the mouth twice a day. These patches slowly release testosterone throughout the day. It is important that these patches are never chewed or swallowed, as the testosterone would be introduced into the body too quickly.
Testosterone injections can be done by a doctor or at home. These can be seen as more convenient than the other options because they only need to be done every 1-4 weeks.
A testosterone implant can be inserted under the skin to slowly release testosterone continually over a five-month period. These offer far more flexibility but must be inserted by a doctor.
Risks and Controversy
Testosterone therapy may seem like the easy and obvious choice the treat ED. However, this treatment comes with its own risks and controversies. One issue surrounding this subject is the amount of marketing surrounding ED and low-T. On the topic, Dr. Carl Pallais, an endocrinologist and assistant professor at Harvard Medical School says, “Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs. Men should be much more mindful of the possible long-term complications.”
The constant stream of commercials that tell men to talk to their doctors if they are experiencing possible signs of low-T, one of these being fatigue or “feeling tired,” is getting out of hand. Dr. Michael O’Leary, a urologist at Harvard-affiliated Brigham and Women’s Hospital says, “Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive. Tons of men who would never have asked me about it before started to do so when they saw ads that say ‘Do you feel tired?'”
Because so many men are asking about ED and low-T, tests are run, and men are put on testosterone replacement therapy even if they would have been fine without it. Once they are on the drug, their treatment can go on indefinitely. This is because testosterone treatment can be addictive. Once a patient starts taking testosterone replacements, his body’s natural hormone production gets interrupted, and it can eventually stop producing testosterone altogether. So, when the patient finally stops therapy, they may have much lower hormone levels then when they began. Mood swings, acne, swelling, and even heart attacks have been reported from TRT patients.
This would not be as much of an issue if there were long-term studies that showed that hormone therapy is safe. However, this is not the case, and many doctors are concerned about what hormone replacement therapy could lead to over time. TRT could be a practical solution in some cases of erectile dysfunction. However, it is important to know all of the risks, and to always speak with a doctor before pursuing such a treatment.
If you think testosterone replacement therapy might be the answer for you, or if you’d like to discuss other treatment options for ED, visit our website to schedule an appointment with one of our dedicated urologists today.