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Suffer From Loss Of Libido And Erectile Dysfunction. Testosterone, Free T And FSH Are Quite Low. Cause?

Posted on Wed, 21 Aug 2013

Question: Hi Doctor,

I am 25 Year old male suffering from loss of libido and erectile dysfunction. Have got checked my testosterone, LH, FSH and free testosterone. My Testosterone, free T and FSH are quite low. I have attached my LAB results. My medical history is Relapsing Remitting MS and I am on Avonex.

What could be the reason for this? Is this MS or Avonex?

Also, what are the treatment options available to me? My endo says not to go with TRT as I am young and prescribed Fertomid. Is Fertomid 25mg (Clomiphene) safe considering I have MS? Are there other safer options available to me instead of Fertomid ?

Need your advice.

Answered by Dr. Sudhir Kumar (1 hour later)

Hi,

Thank you for posting your query.

First of all, I would like to reassure you that low levels of testosterone are not related to either avonex (interferon injections). I agree that loss of libido and erectile dysfunction do occur in patients with MS, especially in those with spinal cord involvement, and those who also have depression. However, lowering of testosterone level is not seen.

So, in my opinion, we are dealing with two distinct problems, RRMS and hypogonadism. We should continue the avonex injections to prevent the relapses of MS in future.

Regarding the choice of clomiphene over testosterone replacement therapy (TRT), I leave the decision to endocrinologist, but I would like to point out that clomiphene is a well established treatment to stimulate endogenous testosterone production.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (41 minutes later)

Hi Doctor,

Thanks for your advice

Yes I do have spinal cord lesions. I have few more questions:

1. Does fertomid has good safety profile cobsidering I have MS? My endo said he has not treated MS patients with fertmoid and TRT. So I wanted second opinion as my neurologist is out of India

2. What would you advice to me? Condlsidering my symptoms? How would you treat such symptoms in MS patient like me? Loss of libido and ED.

3. Is there any natural approach I can try?

Answered by Dr. Sudhir Kumar (5 minutes later)

Thank you for getting back.

As I mentioned, the treatment for MS would be with avonex, if it is preventing the relapses. Also, the current symptoms are unrelated to avonex.

Secondly, the treatment for low testosterone would be same in patients with or without MS. So, you can tell your endocrinologist to treat it the way he would treat in a patient without MS.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar