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Suggest Treatment For Erectile Dysfunction
Question: Hello. I am 36 and have not experienced an erection in almost 4 years. I have type 1 diabetes and I have high blood pressure . I am 6'4 and 235 pounds and not a fat guy. I've had Diabetes 20 years, and blood pressure meds for many years. I take bystolic and azor for my blood pressure and for diabetes I take lantus and apedra insulin. My blood sugars are not totally controlled and my blood pressure is not either. I have to control my bp but have been unsuccessful. I have even tried l arginine but I don't think it's working. When I first tried it I noticed my bp was dropping but then it went back up. I have tried viagra, cialis, Levites and penis pump to help with my erection but it does not work. The pills only worked on the first use and after that it was nothing. That was almost 4 years ago. Sometimes my penis fills flat and other times it fills a little thick. My penis and scrotum gets cold at times even when I'm dressed. I am able to ejaculate without an erection but am not able to have sex. Lastly my 7 inch penis has shrunk and is almost non existant unless I use a pump to blow it up but the pump is useless because my penis still does not get stiff when in use. Please help me! is this reversible? Can I get my erection back? How long will it take to fix? Why is my scrotum cold? About 4 years ago mr doctor put me on azor and bystolic and I think that's when I started to lose my erection but I'm not sure because it's been so long ago. I just thought I was not erect because I was not aroused by the person I was dating. any advice?
Brief Answer:
Erectile function
Detailed Answer:
Sorry to note your erection problem.
There can be many potential causes of this condition which require a detailed in-person assessment. But after reading your description, it seems 'Vascular' causes are likely. This refers to impaired blood flow in the penis due to uncontrolled blood glucose and blood pressure.
Do you smoke?
Do you have high blood cholesterol levels?
The above two also contribute to inadequate blood flow to the penis. The adequacy of blood flow to the penis during arousal is vital to achieving a satisfactory erection.
Aside from that, there are further tests that can be performed to evaluate this more comprehensively. Tests such as 'nocturnal penile tumescence' and 'duplex doppler imaging' are performed by specialized centers. Sometimes hormone tests are necessary like Serum testosterone and Prolactin
Erectile function
Detailed Answer:
Sorry to note your erection problem.
There can be many potential causes of this condition which require a detailed in-person assessment. But after reading your description, it seems 'Vascular' causes are likely. This refers to impaired blood flow in the penis due to uncontrolled blood glucose and blood pressure.
Do you smoke?
Do you have high blood cholesterol levels?
The above two also contribute to inadequate blood flow to the penis. The adequacy of blood flow to the penis during arousal is vital to achieving a satisfactory erection.
Aside from that, there are further tests that can be performed to evaluate this more comprehensively. Tests such as 'nocturnal penile tumescence' and 'duplex doppler imaging' are performed by specialized centers. Sometimes hormone tests are necessary like Serum testosterone and Prolactin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No I don't smoke and I have good cholesterol levels. I'm disappointed because I asked several questions that didn't get answered.
Brief Answer:
Follow up
Detailed Answer:
1 Your BMI is 28.5 This is considered overweight but I agree you are not obese. Regardless,excess body fat is associated with erectile problems.
2 Long standing diabetes is very well known to be associated with erection problems too, particularly if it is not well controlled.
3 Bystolic belongs to a family of medications that can potentially cause erection problems.
Check with the prescribing doctor if this can be addressed
4 Regarding your question whether your condition is reversible will need testing as detailed in my previous response.
to give you an example, if the tests find inadequate blood flow to the penis, then some centers in US do pudendal artery stenting.
5 I see you have tried testosterone treatment. Were your levels checked and was treatment started because your levels were low?
Follow up
Detailed Answer:
1 Your BMI is 28.5 This is considered overweight but I agree you are not obese. Regardless,excess body fat is associated with erectile problems.
2 Long standing diabetes is very well known to be associated with erection problems too, particularly if it is not well controlled.
3 Bystolic belongs to a family of medications that can potentially cause erection problems.
Check with the prescribing doctor if this can be addressed
4 Regarding your question whether your condition is reversible will need testing as detailed in my previous response.
to give you an example, if the tests find inadequate blood flow to the penis, then some centers in US do pudendal artery stenting.
5 I see you have tried testosterone treatment. Were your levels checked and was treatment started because your levels were low?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes my testosterone levels where low.
Brief Answer:
Second follow up
Detailed Answer:
Low testosterone merits a proper evaluation. this entails physical examination and blood tests to start with.
When I see someone with low testosterone I order a preliminary work up that includes
CBC
Liver, kidney function tests
Electrolytes
TSH
Free T4
Total Testosterone
SHBG
Albumin
Prolactin
Further tests may be necessary based on the findings of examination and lab test results. Examples include
FSH
LH
Ferritin
In some instance MRI of the pituitary is considered.
I suggest you see a qualified endocrinologist in person to investigate this matter.
Second follow up
Detailed Answer:
Low testosterone merits a proper evaluation. this entails physical examination and blood tests to start with.
When I see someone with low testosterone I order a preliminary work up that includes
CBC
Liver, kidney function tests
Electrolytes
TSH
Free T4
Total Testosterone
SHBG
Albumin
Prolactin
Further tests may be necessary based on the findings of examination and lab test results. Examples include
FSH
LH
Ferritin
In some instance MRI of the pituitary is considered.
I suggest you see a qualified endocrinologist in person to investigate this matter.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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