Hello and welcome to Healthcare Magic. Thanks for your query.

I can understand that you have been going through a lot of distress due to your sexual problem. From your description of your symptoms, I can see that you are having two problems:
1) Erectile dysfunction
2) Inadequate sexual desire

Now, there can be a variety of causes for your sexual problems - both medical causes as well as psychological causes. So, the first and most important step in management is proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity.

Firstly, any medical causes (like diabetes, hormonal problems, blood flow problems, vitamin deficiencies, etc.) need to be ruled out. For this, you may need to undergo a few blood tests. In your case, since this your problems seem to be quite prominent and long-standing (you mentioned that you had major sexual problems even during your first marriage). So, in my opinion, first diagnosing the problem is more important, so that treatment can be targetted specifically.

I would advise you to have the following tests:
1) Basic blood tests - including lipid profile (cholesterol), blood sugar, urea, creatinine, etc.
2) Testosterone levels - total and free testosterone
3) FSH / LH levels
4) Thyroid function tests
5) Ultrasound doppler of the penis (to check for any blood flow problems)

These tests will give you a clear picture what your sexual problem is due to - any hormonal problems or any other systemic problems or local problems in the penis. According to the diagnosis, further treatment can be planned.

Having said this, I would also like to let you know that in more than 80% of cases of erectile dysfunction, psychological factors also play a major role in causing or aggravating the problem. Stress, anxiety, fears and doubts regarding sexual performance, feelings of sexual inadequacy, self-doubts, guilt, past negative sexual experiences, etc. can all affect sexual functioning and performance.

Often, persons who have had past negative experiences with sex develop what is known as a "performance anxiety". Basically the subconscious fears and doubts whether or not he will be able to perform well itself results in anxiety, and this performance anxiety itself then causes erectile dysfunction. In this case, counselling of the person as well as counselling of the couple will help in removing the person's doubts and fears, and improving his self-confidence levels.

So, I would advise you to have all the tests done and then consult a psychiatrist or a sexologist in person to have a systematic evaluation and sexual counselling. Don't worry, there are many options available to treat your problem. If there is a low testosterone level, the testosterone supplements will help. If the FSH / LH levels are low (indicating more of a sexual desire problem) then there are certain medication - dopaminergic anti-depressants - which can be helpful in boosting sexual desire.

Don't worry about the urethral stricture - if it is not causing any pain during erection, then this is not the cause of your sexual problems.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello again,

I have reviewed your blood test reports. Among them, your lipid profile is slightly deranged and may require further treatment and diet control. Your testosterone levels (free and total) are in the lower part of the normal range. But since your FSH and LH levels are normal, this may not require definitive intervention right now.

Since a low sex drive seems to be the predominent problem in your case, you may benefit from a trial dopaminergic anti-depressants like Bupropion. For the erectile dysfunction, you can try Tadalafil, which promotes erection by increasing the blood flow to the penis. In addition, I feel that you will definitely benefit from sexual counselling by a psychiatrist, so that you will be able to get rid of any negative thoughts, anxiety and self doubt, and improve you confidence level. Practising yoga, regular physical exercise and relaxation techniques can also be helpful in improving your overall sexual performance.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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I think it would be better to XXXXXXX a psychiatrist, specialized in sexology. This is because he will be able to prescribe the medication as well as give you sexual counselling. Bupropion and Tadalafil definitely don't have a negative impact on testosterone levels.

Regarding the testosterole levels, there are medication / supplements which can be used, but in your case, since the levels are just borderline, you can try the other medication first and then consider that option.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello,

Yes, diet, exercise and lifestyle modifications can help balancing testosterone levels and improve sex drive. There are many claims for "natural" supplements of testosterone precursors and amino acids to boost testosterone production, but these are hardly natural and many have been reported to have long term side effects. So, the safest way is to try dietary modifications and exercise.

- If you are more than your ideal weight, then plan a weight loss regimen
- Cut down on carbohydrates, especially starch and direct sugars
- Take a protein-rich diet
- Modify your fat consumption to healthy fats like olive oil, almonds, fish liver oil
- Certain minerals (like Zinc) and certain vitamins (like Vit. C, D) are important for hormone production, so beans, sprouts, cheese, yoghurt, etc. have to be included more in your diet

Weight training exercises in a proper regimen can prevent declining levels of testosterone.

Avoid alcohol, smoking as they have an adverse impact on testosterone levels.


Bupropion has to be taken on a daily, regular basis. It is better to start at a low dose first, 75mg, and then increase it gradually, if necessary. Like every medication, Bupropion can cause some side effects in a few people, but they are usuaaly mild and self-limiting. It's very unlikely that you would experience any significant side effects on a 75 mg dose.

Best wishes.

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Hello again,

I do agree with your endocrinologists line of thinking and management.

Like I had mentioned earlier, though your testosterone levels are on the lower side, it is still not below the normal range, to necessitate testosterone replacement right away. So, it would be a good idea to recheck the testosterone levels before taking a call on further treatment.

Ignitor is a supplement with minerals (like Zinc, Magnesium), vitamins (vitamin B6) and fenugreek extracts. The fenugreek extracts are claimed to contain chemicals which facilitate hormone production. It is a safe medication and is worth trying.

Rozavel (Rosuvastatin) is a cholesterol-lowering medication. Your blood test reports showed elevated cholesterol levels, and as I had mentioned earlier, this is one of the medical causes contributing to erectile dysfunction. So, yes, I think this medication is appropriate in your case.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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