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

Your sexual problem with erection is the actually the most common sexual problem in men. Now, there can be a variety of causes for this problem - 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. This is both informative to the doctor and serves as an opportunity to educate the patient and clarify his doubts.

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 certain tests like:
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)
But, considering your young age and the fact that you are getting erections (but not able to sustain it), it is unlikely that you may be having a major medical cause for your erection problem.

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.

Treatment is targeted according to the findings on evaluation. If there are any underlying medical problems resulting in the erectile dysfunction, then those problems have to be first treated. If the problem is more psychological, then removing the person's doubts and fears, and improving his self-confidence levels will also definitely help in improving sexual performance. Also, there are certain medication which improve the blood flow to the penis and promote better erection, such as Sildenafil, Vardenafil and Tadalafil. But medication is usually advised only in severe cases.

So, I would advise you to consult a sexologist in person to have a detailed assessment and evaluation done, so that the cause of your problem can be first pin-pointed, and then tackled.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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I agree with you that there are a lot of so-called 'sexologists' who just charge a lot of money and prescribe their own medication, which are mostly unknown formulations and quite expensive also.

You can get the tests done at any standard laboratory. Regarding the vitamin tests, I would advise you to do vitamin B12 and folate levels.

Regarding the pills, there may be numerous ads or claims for pills / supplements, which are supposedly effective and "herbal". But the safety and efficacy of them is not proven, and therefore, I would suggest that it is better to avoid such unknown formulations.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Sure, you can scan and send me the reports.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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No problem, you can get back to me when the reports are ready.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Please send the scan report to YYYY@YYYY , with the subject mentioning: Reports - Query ID (0000) for Dr. Jonas Sundarakumar.

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I have gone through your reports and there seem to a few abnormal results.

Your Hemoglobin level and Vitamin B12 level are definitely low.

Your Free Testosterone level is in the low normal range. In young males, the free testosterone levels is usually expected in to be in the upper 1/3rd of the normal range.

Your LDL ('bad cholesterol') levels are slightly high, but the other parameters of lipid profile are within normal limits.

Now, it is essential that you take treatment for the low Hemoglobin and low Vitamin B12, since they could be possible causes for your sexual problem as Vitamin B12 deficiency is well known to cause nervous problems. The B12 deficiency is also likely to be the underlying cause for the anemia. So, I would suggest that you take weekly Neurobion injections for 3 months and also take Neurobion Forte tablet everyday. It is also better to take an anti-oxidant medication (e.g. Tablet Matilda-AF) in order to prevent / treat any nerve cell damage due to this.

Though your free Testosterone levels are in the low normal range, still your total testosterone, FSH and LH levels are normal. So, I wouldn't recomment rushing in for any testosterone replacement therapy. It is not essential at this stage. You can repeat the test after 3 months and then decide if it is necessary. Till then you can try dietary modifications as this will help many of your problems. Take plenty of fruits and green vegetables. Include foods like almonds, cashews, dry fruits, dates, soya, root vegetables, cheese, yoghurt and milk products. If you are a non-vegetarian include more of fsh in your diet. Avoid oily or fatty foods and red meat.

Exercise regularly. Adopt an active and healthy lifestyle. Try yoga, meditation, etc. to avoid stress.

If your erection problem is causing you major problems in sexual relationship with your partner, then I would suggest that you try Tadalafil (Megalis 10/20 mg) tablets for a short period. This is a medication which improves the blood circulation to the penis and promotes good erection.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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To clarify your doubts:

1) You can use SUHAGRA (Sildenafil Citrate) instead of Tadalafil. Both have the same mechanism of action; the only difference is that Tadalafil has a much longer duration of action (2 to 3 days) than Sildenafil. There can be minor side effects with these medication like headache, nasal congestion, gastritis, etc. but most of them are temporary and insignificant.

2) Instead of MATILDA-AF, you can try OXISAFE or SANTEVINI ACE

3) I would not advise you to go for any so-called herbal or natural supplements that are advertised extensively on the internet. The composition and safetly of these preparations are very doubtful. If you want to take any ayurvedic or herbal treatments, then I would suggest that you see a proper, qualified ayurvedic practitioner and take only known ayurvedic medication.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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