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www.andropause.org.uk |
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| Heart Considerations |
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| Erectile Dysfunction |
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| Info Articles |
| Potency Problems Page This is the commonest presenting problem in male sexual dysfunction clinics and peaks at the time when the andropause appears, that is the mid-forties onwards. It is a major health problem which is seldom adequately investigated or treated. The Mechanics of Erection Man's ability to have an erection, which has been worshipped from the earliest of times, is actually a recurring miracle of hydraulic engineering. It is brought about by a complex series of chemical changes and nerve reflexes, which work together to increase the amount of blood flowing into the penis and temporarily decrease the amount going out. Two elongated blood sacks, the corpora cavernosa, become engorged and create the erection. This event, which is achieved with effortless and sometimes embarrassing ease in the teens and twenties, usually becomes a more difficult feat in the thirties and forties, can be variable in the fifties and sixties, and is often a disappointingly brief and infrequent wonder in the seventies and beyond, especially in the 'hormonally challenged' andropausal male. Testosterone and Erectile Function Though it is difficult to say precisely what part testosterone plays in helping to produce erections, it certainly both primes the penis and triggers the chain of events which bring an erection about. It is surprising, but gratifying, how often when adequate testosterone therapy is given, all the symptoms of the andropause disappear within a few weeks or months, including erectile difficulties, particularly when other factors contributing to its onset or continuation are dealt with. A statistically highly significant improvement in erectile function occurred in over 70 per cent of 1000 cases treated with a variety of different forms of testosterone. This was particularly marked with the more powerful oral preparation, Restandol (Andriol), which sometimes needed to be given in high but safe doses, and with the testosterone pellet implants. Though this use of testosterone to help erection problems is controversial and not acknowledged by some authorities, which say it only increases frustration without giving back the means to perform, this is certainly not the experience in this large group of patients. The efficiency of testosterone in restoring potency is a common experience with doctors prepared to give it an adequate trial. It was even recognised over 50 years ago in the article on the 'male climacteric' by Drs Heller and Myers in an article on"The Male Climacteric" in JAMA in 1944. They found that erectile function returned in nearly all of their testosterone deficient patients when they gave the hormone and went away again when they stopped. Even though it is more difficult to restore function than desire, unless the source of the problems is obviously psychological or mechanical, it seems logical to investigate the testosterone balance of the patient, and restore it to normal as the first stage of treatment. Even if erections are not greatly improved by this alone, libido and confidence usually are. The most commonly used methods such as penile injections of prostaglandins, as in Caverject, then seem to work much better. Recent experience at in London has shown this to be particularly true when Viagra and Testosterone are combined to cure over 98% of impotence problems. |