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Urology (Expert Forum)
ED Problem - is it Endocrine, Urological, or both?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
ED Problem - is it Endocrine, Urological, or both?
by willc06, May 13, 2007 12:00AM
I'm a 38 year old male who has had ED and/or trouble with erections my entire adult life. I have used viagra (100mg) to some success but still often need oral stimulation to achieve a sufficient erection.
My penis just seems smaller than when I was younger, also, I've been having increasingly diminished sensations on the head of the penis since my early 20's. I'll put it this way, my last girlfriend had a tongue ring and when she was giving oral sex I couldn't tell. However, with viagra on a few occasions and one time without I was able to have decent sexual intercourse.
I've experienced depression/anxiety, skin blotches/redness, joint and muscle pain, foggy thinking, tiredness for many years now off and on.
I was always told up til 2005 that the ED was psychological, however, a urologist that year noted I had testicles "half normal size" and believed it was a hormonal issue, possibly requiring Testosterone replacement. I saw an endocrinolgist in spring 2006 who said I should do a biopsy of my testicles to check for tissue or other damage.
I've traditionally had elevated FSH levels from tests going back to 1997 but most other scores all have been normal until recently, March 2007, where both FSH and LH scored "High". I've posted results below.
I saw doctors at the Mayo clinic in the fall of 2006 and though they noted my testicles were "smallish" they said they weren't as small as noted earlier by the urologist. A ultrasound of blood flow was good by the Mayo urologist, the endocrinologist said just "freeze your sperm" if you want kids ... I had a low sperm count but things still looked ok. The endocrinologist basically said everything was ok except for the high FSH. One of the conclusions/diagnosis was listed as partial testicular germ compartment failure due to sertoli cell function issues. They said use caverject or similar injections to solve my ED.
My lab results from Mayo in Fall 2006 were:
Total Testosterone: 480
Testosterone, Bioavail: 168
Prolactin: 8 ng/mL
LH: 7
FSH: 25
My Lab results from March 2007 were:
Testosterone: 18.7 nmol/L - reference range 7.3-23.5
Testosterone Free: 45 PMOL/L - reference range 31-94
DHEA-S: 5.3 umol/L - reference range 3.3-14
FSH: 17 (high) - reference range 2-8
LH: 9 (high) - reference range 2-6
Estradiol-17 beta: <100 - reference range up to 206
Prolactin: 6 - reference range 2-18
Sex Hormone Binding Globulin: 26 NMOL/L - reference range 13-71
I really need to get a handle on this. I've found most Doctors to be usually very dismissive or either totally perplexed by my "condition" which again does not help me get the answers I need. I lost my marriage because of this condition and have suffered greatly from self-esteem and confidence issues, not to mention just having quality of life affected. I want to have an opportunity for another relationship but I need to get a handle on this situation. Any help would be greatly appreciated. Thank you.
My penis just seems smaller than when I was younger, also, I've been having increasingly diminished sensations on the head of the penis since my early 20's. I'll put it this way, my last girlfriend had a tongue ring and when she was giving oral sex I couldn't tell. However, with viagra on a few occasions and one time without I was able to have decent sexual intercourse.
I've experienced depression/anxiety, skin blotches/redness, joint and muscle pain, foggy thinking, tiredness for many years now off and on.
I was always told up til 2005 that the ED was psychological, however, a urologist that year noted I had testicles "half normal size" and believed it was a hormonal issue, possibly requiring Testosterone replacement. I saw an endocrinolgist in spring 2006 who said I should do a biopsy of my testicles to check for tissue or other damage.
I've traditionally had elevated FSH levels from tests going back to 1997 but most other scores all have been normal until recently, March 2007, where both FSH and LH scored "High". I've posted results below.
I saw doctors at the Mayo clinic in the fall of 2006 and though they noted my testicles were "smallish" they said they weren't as small as noted earlier by the urologist. A ultrasound of blood flow was good by the Mayo urologist, the endocrinologist said just "freeze your sperm" if you want kids ... I had a low sperm count but things still looked ok. The endocrinologist basically said everything was ok except for the high FSH. One of the conclusions/diagnosis was listed as partial testicular germ compartment failure due to sertoli cell function issues. They said use caverject or similar injections to solve my ED.
My lab results from Mayo in Fall 2006 were:
Total Testosterone: 480
Testosterone, Bioavail: 168
Prolactin: 8 ng/mL
LH: 7
FSH: 25
My Lab results from March 2007 were:
Testosterone: 18.7 nmol/L - reference range 7.3-23.5
Testosterone Free: 45 PMOL/L - reference range 31-94
DHEA-S: 5.3 umol/L - reference range 3.3-14
FSH: 17 (high) - reference range 2-8
LH: 9 (high) - reference range 2-6
Estradiol-17 beta: <100 - reference range up to 206
Prolactin: 6 - reference range 2-18
Sex Hormone Binding Globulin: 26 NMOL/L - reference range 13-71
I really need to get a handle on this. I've found most Doctors to be usually very dismissive or either totally perplexed by my "condition" which again does not help me get the answers I need. I lost my marriage because of this condition and have suffered greatly from self-esteem and confidence issues, not to mention just having quality of life affected. I want to have an opportunity for another relationship but I need to get a handle on this situation. Any help would be greatly appreciated. Thank you.
Doctor's Answer
by Kevin Pho, MD, May 14, 2007 12:00AM
, May 14, 2007 12:00AM
There has been a comprehensive workup at this point, and I'm not sure if I can offer anything more over the internet without examination.
Clearly, the Mayo has been thorough with the endocrine workup - at this time, the testosterone levels seem to be within appropriate ranges. A testicular biopsy can still be considered at this point for a more definitive diagnosis, and a second endocrine opinion can be sought to discuss.
The ultrasound would rule out structural or blood flow issues with the penis. Further blood tests would be a sugar test to rule out diabetes or a thyroid test to evaluate for thyroid disorders.
I would consider second urological opinion at this point. If the consultations continue to be non-revealing psychogenic causes of the ED can be evaluated.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Clearly, the Mayo has been thorough with the endocrine workup - at this time, the testosterone levels seem to be within appropriate ranges. A testicular biopsy can still be considered at this point for a more definitive diagnosis, and a second endocrine opinion can be sought to discuss.
The ultrasound would rule out structural or blood flow issues with the penis. Further blood tests would be a sugar test to rule out diabetes or a thyroid test to evaluate for thyroid disorders.
I would consider second urological opinion at this point. If the consultations continue to be non-revealing psychogenic causes of the ED can be evaluated.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_