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Urology (Expert Forum)
Erectile Problem, need advice
Answered by
Stephen Liroff, MD - Urology, Pediatric Urology, Peyronie’s disease
Henry Ford Hospital
West Bloomfield - MI
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.
Erectile Problem, need advice
by kokefisher48, Mar 27, 2008 02:32PM
I could use some advice on how to verify that a hormonal cause of my E.D. is ruled out. I belong to a large, integrated HMO on the West Coast that is reluctant to refer me to Urology or Endo.
Here is the background: I am a 48 year old white male, about 50 lbs overweight, (working on that!), BP is normal, blood glucose normal. I have had a general decline in libido and erectile quality over the last 3 years. I also have had a significant decrease in ejaculate volume. It takes 4 or 5 days to recover even a modest amount of semen after sex. Even after a full week without sex my ejaculate volume is probably only 25% of what it used to be. My E.D symptoms have gotten much worse in the last six months with some added issues with P.E. now
I am on thyroid medication 75 mcg/day. My recent tests were as follows:
Total Testosterone: 544 ng/dl
Prolactin: 6 ng/ml (range 2-18/ng/ml
LH 1.9 mIU/ml (range 1.0-12)
FSH 2.1 MIU/ml (range 1.4-18.1
The doctor told me that my issues were not uncommon, that it was probably due to stress ( I am in a high stress job) and that I should accept this and take Viagra. I want to push for better, more thorough, treatment but want some advice so I know what to ask for.
Do any of the above readings look unusual? What, if any, additional testing should I request? One last thing: I did have a sphincterotomy about 10 years ago. That left my orgasms a little weaker but I was otherwise ok until about 3 years ago.
Here is the background: I am a 48 year old white male, about 50 lbs overweight, (working on that!), BP is normal, blood glucose normal. I have had a general decline in libido and erectile quality over the last 3 years. I also have had a significant decrease in ejaculate volume. It takes 4 or 5 days to recover even a modest amount of semen after sex. Even after a full week without sex my ejaculate volume is probably only 25% of what it used to be. My E.D symptoms have gotten much worse in the last six months with some added issues with P.E. now
I am on thyroid medication 75 mcg/day. My recent tests were as follows:
Total Testosterone: 544 ng/dl
Prolactin: 6 ng/ml (range 2-18/ng/ml
LH 1.9 mIU/ml (range 1.0-12)
FSH 2.1 MIU/ml (range 1.4-18.1
The doctor told me that my issues were not uncommon, that it was probably due to stress ( I am in a high stress job) and that I should accept this and take Viagra. I want to push for better, more thorough, treatment but want some advice so I know what to ask for.
Do any of the above readings look unusual? What, if any, additional testing should I request? One last thing: I did have a sphincterotomy about 10 years ago. That left my orgasms a little weaker but I was otherwise ok until about 3 years ago.
Doctor's Answer
by Stephen Liroff, MD, Mar 28, 2008 12:45AM
, Mar 28, 2008 12:45AM
Your lab is all negative except for your thyroid value (which is not reported). I think that you have ruled out a hormonal cause for your decreased libido. Your physician is correct in that this is a common problem and that stress may well play a large roll in your problem. Could you get to a sex therapist? Private pay? Consider a mild tranquilizer, increase your physical activity as a way to deal with your stress. If you are smoking, stop. Get away from the office more often. Basically, do behavior modification to deal with the stress
Don't get hung up on the semen volume. This changes with age.
Good luck!
S.A. Liroff, M.D.
This information is provided for general medical educational purposes only. It
does not necessarily reflect the opinions of Henry Ford Hospital or the
Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition
Don't get hung up on the semen volume. This changes with age.
Good luck!
S.A. Liroff, M.D.
This information is provided for general medical educational purposes only. It
does not necessarily reflect the opinions of Henry Ford Hospital or the
Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition
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