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Urology (Expert Forum)
Sexual problem
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.
Sexual problem
by Douglas__0, Jun 15, 1998 12:00AM
I am a 45 year old male in good health but with sexual difficulties.
: Up to late 1993 I had no sexual problems at all and also woke each
morning with a strong erection. I was also an alcoholic and had on and
off undiagnosed clinical depression. In autumn 1993 an article on
alcohol abuse and impotence gave me a tremendous shock and in a matter
of weeks all sexual desire and ability disappeared including morning
erections. I stopped drinking within a month and haven't drunk a drop since.
: In early 1994 I saw a urologist who advised me that there was nothing
physically wrong with me, though I did have slightly low testosterone
levels (10 with a standard range being 9-36). I struggled on until late
1994 when eventually I was diagnosed with severe clinical depression. I
was put on a 9 month course of Seroxat and was cured. At the same time I
saw an endocrinologist who again advised me that he could find no
physical cause for my sexual inability. My testosterone levels remained
unchanged from the previous year. The endocrinologist also advised me
that he could find no evidence of my previous alcohol abuse whatsoever.
: In late 1995 I was put on a course of testosterone injections. These
had modest effect on my sexual ability and temporally restored full
morning erections. After three months the course was discontinued.
: At present time I have some sexual desire and ability, but they are
pretty low and a source of great worry to me. Since the testosterone
injections ceasing I get occasional partial morning erections but they
are rare.
: My doctor is considering putting me on another course of testosterone
(pills this time). However he is of the opinion that my problems stem from
the brain rather than any physical cause.
: Can mental attitude influence testosterone production? If so, what is the best course of action? I find it very strange that everything worked properly whilst I was abusing myself with alcohol.
: Any advice would be appreciated.
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Dear Douglas
Thanks for your questions.
There are many pieces missing in your history. I presume since you have seen specialist in this area they have crossed all the “ T’s” and dotted all the “I’s. “ What test did your doctors do and what were the results? Did they check a prolactin, LH and thyroid level? Has your doctor offered to inject the penis to see if you have an erection? A response to the injection usually means nothing physical is wrong with the penis. Why were your testosterone shots stopped? You can have decreased libido when the testosterone level is borderline low. But this is seldom the case in our experience. Have any of your medications been attributed to your recital difficulties? Do you have a smoking history? Tobacco use can affect penile blood flow. Acute erectile dysfunction ( over a two week period ) is atypical for a physical cause . Could it have been going on for much longer and you not noticed it ( due to alcoholism perhaps? ) Depression can definitively affect your libido but usually not your testosterone level.
Alcoholism can lead to cirrhosis of the liver which can influence your sex drive by altering the levels estrogen and testosterone in the body. The liver has a remarkable ability to regenerate ( heal ) after abuse. The nervous system can also be afected by alcohol abuse. If your doctor can not find any long-term affects from alcohol I would tend to think that the previous alcohol abuse has nothing to do with the current problem.
I would not recommend oral/pill testosterone replacement. It has the potential for severe liver toxicity. The patch will have less toxicity.
Please use the site search function to view similar questions and answers. Use the search words libido, testosterone or possibly testosterone replacement
Hope this has helped/ .
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: libido, testosterone replacement, depression
