Low sex drive in men linked to chemical imbalance, study says

‘It just didn’t enter my mind to initiate sex;’ Low sex drive in men linked to chemical imbalance

By Sandee LaMotte, CNN
Updated 3:23 AM EDT, Wed April 12, 2023

This article is a repost which originally appeared on CNN

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Not everyone thinks of sex in the same way.

‧ The hormone Kisspeptin plays a role in pubertal development and reproduction.

‧ Distress over sexual interest can itself contribute to issues.

While hanging out with his college roommates, Peter (not his real name) realized he felt differently about sex than other heterosexual men.
Increasing stressors like juggling work and family and the economic slump are taking a toll on our sleep, experts say.

Lack of sleep may be ruining your sex life

“I’ve never been somebody who was interested in pornography, but I’d laugh along with their jokes,” said Peter, now 44, who is British. “Of course I never mentioned that … as a man, you’d be kicked out of the herd.”

As he developed “proper, serious relationships” with women, Peter discovered he didn’t have the sexual drive many of his partners did.

“I would make excuses around getting tired or feeling stressed, that kind of thing,” he said. “It wasn’t an issue with attraction to my partner. It just didn’t enter my mind to initiate sex.”

In 2021, Peter saw an ad recruiting male volunteers for a new study on hypoactive sexual desire disorder, or HSDD. Researchers planned to inject the study’s participants with kisspeptin —a naturally occurring sexual hormone — to see if it increased their sex drive. Kisspeptin plays a key role in reproduction; without adequate levels of the hormone children do not go through puberty, for example.

In a long-term, committed relationship with a woman he says has a higher sexual appetite, Peter signed up, intrigued by the thought that a biological imbalance might help explain his behavior.

In the week after the final session, Peter said, something amazing occurred.

“All of a sudden, I wanted to initiate intimacy. I can only presume it was driven not by my mind remembering something, but my body wanting something,” he said. “I did initiate sex more and it improved things with my partner incredibly.”

Wiring in the brain

Experts believe HSDD affects at least 10% of women and up to 8% of men, although those numbers may be low, said Stanley Althof, a professor emeritus of psychology at Case Western Reserve University School of Medicine in Cleveland, Ohio and executive director of the Center for Marital and Sexual Health of South Florida.

“Men are embarrassed to go to the doctor to begin with, and you’re supposed to be a macho guy,” said Althof, who was not involved in the kisspeptin study.

“So it’s difficult for men to say, ‘Hey, I’ve got a problem with my sex drive.’ That’s why the majority of male patients I see with HSDD are sent in by their partners.”

To be diagnosed with the disorder, a person must have no other issues that might cause a change in libido, such as erectile dysfunction or premature ejaculation.

“Losing interest due to performance issues is common, but HSDD is its own thing,” Althof said. “It’s an absence of erotic thoughts and a lack of desire for sex that has to be present for six months. It also cannot be better explained by another disorder or other stressors: It can’t be due to depression. It can’t be due to a bad relationship. It can’t be due to taking an antidepressant.”

One more key point: A man or woman must have clinically significant distress to have HSDD, said clinical psychologist Dr. Sheryl Kingsberg, a professor in reproductive biology and psychiatry at Case Western Reserve University, who was also not involved in the kisspeptin study.

“Some people aren’t bothered by their lack of interest in sex, so we wouldn’t treat them for HSDD,” said Kingsberg, who is also chief of behavioral medicine at MacDonald Women’s Hospital and University Hospitals Cleveland Medical Center.

“The women coming into my office are deeply distressed,” she said. “They tell me ‘I used to have desire but it’s gone. I could be on a desert island with no pressures, but I just don’t have the appetite. I want it back.’ Those women have HSDD.”

‘Surreal’ experience

Dr. Waljit Dhillo, a professor in endocrinology and metabolism at Imperial College London, has been studying the relationship between low sexual desire and the hormone kisspeptin for years, first in animals, then in people.

Prior studies by Dhillo of healthy men with no libido problems found giving them kisspeptin boosted levels of testosterone and luteinizing hormone, which is important for gonad function.

His newest study, published in the journal JAMA Network Open in February, enrolled 32 men with verified HSDD. Peter was one of them.

“So many people say to themselves, ‘It’s just me. I’ve got a problem.’ But actually, HSDD may be how your brain is wired,” said Dhillo, who is a dean at the United Kingdom’s National Institute for Health and Care Research Academy in Newcastle upon Tyne.

“The biology is telling us there’s increased activation of inhibitory areas in the brain — the same areas that tell us it’s not OK to walk around in public naked — and those areas are switching off sexual desire. How can we tackle that? We give a hormone that would naturally give you increased sexual desire, essentially hijacking the normal system.”

The men participating in the new study visited Dhillo’s lab twice. On each occasion, they were fitted with a device to objectively measure arousal, given an injection and asked to watch pornography while their brains were scanned via functional magnetic resonance imaging (fMRI).

Neither the subjects or the researchers knew if that day’s injection was kisspeptin or a placebo.

“It was extraordinarily surreal, lying there with something resembling a hangman’s noose around your bits and watching a mixture of ’70s to modern-day pornographic images and videos,” Peter said. “You’d get about five or six seconds of one type of image or video, rate your arousal for the researchers, and then move on to the next.”

Brain scans showed a significant dual effect after the kisspeptin injection, Dhillo said. Activity in the areas of the brain that inhibit behavior slowed, while areas of the brain connected to sexual interest lit up.

“As a group, the men had a 56% higher sexual response to sexual images after the kisspeptin than the placebo,” Dhillo said. “And we found no side effects at the very, very small dose that we are using.”

Peter noticed a difference immediately after finishing the treatments. His sex life was so robust, in fact, that it wasn’t long before his partner was pregnant with their first child.

As published, the study did not follow the men long-term to see if the effects of kisspeptin lasted. For Peter, however, its impact has been life-changing.

“I have found there’s been a lasting effect for me,” he said. “I do find I have a much better sexual appetite even now some years after the treatment.”

Even the arrival of a baby boy didn’t deter his new interest in sex.

“The cliche is when you have kids, your sex life takes a bit of a hit,” he told CNN. “But that hasn’t been the case for us. In fact, we’re pregnant with our second child, due in July.”

More research is needed

While Peter had a positive long-term result, it’s too soon to say kisspeptin injections were the reason, Althof said.

“When you hear dramatic results like Peter’s, I would be cautious in saying that is the typical outcome. While it’s wonderful that it happened for him, these fMRI studies are difficult to interpret and not conclusive,” he said.

“Sexual desire is very complicated — I say it’s a combination of brain function, hormones and love, wine and roses,” Althof added. “This study is promising, but it needs replication in larger groups.”

And even if future research does confirm kisspeptin’s benefits, medical treatment is not a substitution for healthy communication about sex between partners and with health care providers, Dhillo said.

“These are society’s taboos, but actually, the more we talk about real (sexual) issues that affect real people, the more we find it’s actually quite common,” he said.”If you’re not troubled by low libido, it’s not an issue at all, but if you are troubled by it, this can lead to marital breakdown, unhappiness and reduced quality of life.”

Can Low Testosterone Cause Anxiety and Depression?

October 6, 2022 / Men’s Health

Low testosterone levels can mimic symptoms of depression and cause anxiety over time

This article is a repost which originally appeared on Cleveland Clinic healthessentials.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our takes:

‧ Low testosterone will manifest itself via several symptoms.

‧ Depression can be a symptom but can also be a contributing factor to developing low T.

‧ Having too high levels of T may result in irritability/becoming easily angered.

If you’re experiencing low sex drive, diminishing energy and overall fatigue, you may feel like it’s just another part of getting older. But if you’re a man or a person assigned male at birth (AMAB) and you’re experiencing a host of physical symptoms, coupled with a consistent depressive mood, you could actually be dealing with hypogonadism (low testosterone) or undiagnosed depression.

But figuring out whether you’re dealing with depression or low testosterone is tricky and requires further examination from a healthcare provider. Urologist Lawrence Hakim, MD, explains more about the connection between low testosterone and your mood, and how these conditions may be related.

How low testosterone impacts your mood

Androgens, including testosterone, are the hormones that give people their “male” and “female” characteristics. They also play a critical role in puberty, the development of your sexual reproductive system and your ability to reproduce.

You can think of all hormones, including androgens, like switches on a circuit board: When the production of these hormones are turned on or off, different things happen. You can experience physical, mental and emotional changes whenever production of these hormones increase, decrease or stop completely. The severity of these changes can vary widely from one hormone to the next, and these changes don’t happen in a vacuum. When the levels of one hormone changes, others may change in response. An increase in one hormone might mean a decrease in others. And when you have these hormonal imbalances, it can cause a variety of conditions to develop.

Testosterone levels tend to decrease normally as you get older, but they can also fluctuate for many reasons. Studies show these changes in testosterone can impact your mood in different ways. And these changes can occur in response to many different factors, including stress, lack of sleep, changes in your diet, aging and increasing or decreasing your physical activity.

If your testosterone levels are too high, for example, you may feel irritable or quick to anger. In comparison, low testosterone can make you feel extremely tired, depressed, weak or low in energy.

“People with hypogonadism, or low testosterone, will often say they have no energy, no desire for sexual activity and that they noticed a decrease in muscle mass,” says Dr. Hakim.

“In fact, hypogonadism is often associated with increased fat mass and reduced muscle mass, which can lead to obesity and other health risks, including cardiovascular disease. Those are all common signs and symptoms that may be associated with low testosterone.”

Signs and symptoms of low testosterone and depression

Low testosterone and depression share a lot of the same symptoms, including:

‧ Irritability.
‧ Mood swings.
‧ Decreased libido.
‧ Fatigue.
‧ Lack of motivation.
‧ Social withdrawal.
‧ Anxiety.
‧ Difficulty focusing.
‧ Interrupted sleep and restlessness.

“When we say people are depressed, what are we describing? We’re often describing someone as having low energy and no desire to partake in activities that normally bring them pleasure — these are common things we see with low testosterone, too,” notes Dr. Hakim. “Sometimes, people are actually misdiagnosed with clinical depression and they might instead have low testosterone or hypogonadism. It is therefore important to rule-out a physical cause of the condition, such as hypogonadism, prior to treatment.”

Various physical symptoms may be associated with either depression or low testosterone. People who have depression might complain of back pain or neck pain, but might not experience other symptoms typically associated with low testosterone that include:

‧ Decrease in muscle mass.
‧ Increase in breast tissue.
‧ Loss of strength.
‧ Sudden weight gain.
‧ Erectile dysfunction

And if you also have depression or even an anxiety disorder, your symptoms may worsen over time if low testosterone levels are leading to a further decline in sexual performance and libido.

“If you come in to see your doctor with any of these symptoms, especially if you have some form of sexual dysfunction, it is important to evaluate your total and free testosterone levels, since hypogonadism may be the underlying cause,” advises Dr. Hakim. “You don’t want to ignore low testosterone. You want to address it as well as look for any other underlying diagnosis that needs to be addressed.”

When to see a doctor

If you’re experiencing physical symptoms like sudden weight gain or decrease in your sex drive or sexual performance and other mental and emotional symptoms, you should talk to a doctor about testing your testosterone levels. There are many effective treatment options to restore your testosterone levels to the normal range, if your testosterone levels are abnormally low. But even if you discover you don’t have low testosterone levels, understanding those test results will often provide some reassurance and help your healthcare provider better understand and manage your symptoms.

“Many of these symptoms, especially as men get older, can be due to other factors such as stress, anxiety, pressure, work, aging, relationship issues and even other medications,” says Dr. Hakim. “Ultimately, a multispecialty approach is important to assure the best outcomes and patient satisfaction.”

Male Hormonal Cycles

5 Things You Need to Know About the Male Hormonal Cycle

Anouare Abdou
November 8, 2022

This article is a repost which originally appeared on AskMen.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Early testing can help identify low testosterone.

‧ Unknown to many, men also have hormonal cycles.

‧ There is a correlation with optimal health and well being and optimal hormone levels.

‧ Testosterone is a stress resistance hormone.

When you hear the words “hormonal cycle,” the menstrual cycle might come to mind. You may be aware that women ovulate or have periods, for example. But men have cycles too — and it’s important to understand yours.

“Many men have little understanding of their hormonal cycle and are often dismissive of the impact it can have on both body and mind. Although most men know that hormones play a massive role in regulating sex drive and libido, the effects of the male hormonal cycles are often overlooked,” according to Dr Chia Tan, founder of Harley St M.D., a clinic that provides testosterone replacement therapy and a range of men’s health tests and treatments.

“Optimal testosterone and hormone levels help create the best version of ourselves. We feel youthful, energic, vibrant, and capable of making quick cognitive decisions. We recover quickly after exercising, keep belly fat at bay, and have a passionate libido as well as the ability to gain and maintain a strong erection,” says Ross Tomkins, co-founder of a men’s hormonal health clinic called Alphagenix.

From the impact of your lifestyle on your hormones to the effects of low testosterone, here are five things you need to know about the male hormonal cycle.

How Often Does the Male Hormone Cycle Reset?

While the average menstrual cycle lasts 28 days, the male hormonal cycle is actually built around the typical workday and resets within a 24-hour time span.

“Testosterone levels are elevated in the morning, reduce slightly in the afternoon, and are lowest late at night,” says Tan. “This basically means men tend to have more energy in the morning and afternoon, the natural time of the day when they would have been out hunting, which is when motivation, assertiveness and strength are needed the most.”

Can You Use Your Hormonal Cycle to Your Advantage?

You can therefore use that knowledge to your advantage. For example, Tomkins suggests working out or doing your most important work tasks first thing in the day to benefit from the surge of testosterone you experience in the morning. Your testosterone levels will start to decrease around lunchtime, so the period of time before that is prime time for being productive.

How Important is Testosterone?

You’ve gathered that testosterone plays a crucial role in your hormonal cycle. Its impact cannot be understated. Common signs of low testosterone levels include reduced sex drive and difficulty getting erections, fatigue, increased body fat, and mood swings, according to Tan.

Testosterone is not only responsible for your sex drive. It plays a big role in how you deal with stress and how efficient your metabolism is. “Testosterone is a stress hormone, it helps us resist stress. Low testosterone therefore often is linked with low mood, low motivation, and low vigor in life. Body fat distribution may change and one may find it harder to maintain lean muscle mass and easier to gain body fat due to a reduction in metabolism,” adds Tan.

Can Men Go Through Early Andropause?

You should also be aware of the fact that men experience the equivalent of menopause — andropause. And it can happen earlier than normal. For instance, Tomkins was diagnosed with low levels of testosterone in his early thirties, which led him to embark on a wellness journey.

Although men will always produce testosterone, they reach peak levels of the hormone in early adulthood. As they age, their testosterone levels decrease. “In some cases, these symptoms can be reported as early as in their late 30s or early 40s, but the majority of men may only start to notice it in their 50s or 60s,” says Tan.

How Does Lifestyle Affect Your Hormones?

Keep in mind that it’s not all luck and genetics. Your habits can have a huge impact on your hormonal cycle. “It’s really important to realize that this cycle is easily disrupted by poor lifestyle choices including poor diet, alcohol, smoking, no exercise and lack of quality sleep,” says Tomkins.

“If you recognize any symptoms I would start by looking at your diet, lifestyle and sleep. If these are all good, consider speaking to a specialist or at least taking a blood test to check biomarkers,” he recommends.

That being said, a blood test might not tell the full story, so trusting yourself and your awareness of your body is key. “Being within the normal range may not be sufficient for optimal well-being. The normal range determined by a laboratory takes no account of symptoms and is derived purely based on a statistical calculation of standard deviation and normal distribution curve,” says Tan.

What Can You Do to Address Low Testosterone?

If you do get diagnosed with low testosterone or embark on a journey to optimize your hormones, there are things you can do in conjunction with lifestyle changes.

Tomkins says that he now feels stronger and fitter than in his twenties after changing his diet and starting Testosterone replacement therapy (TRT). TRT is designed to bring back hormone levels to a healthy range by giving the body testosterone until symptoms start to reverse. “Restoring testosterone levels to an optimal level will significantly improve a man’s quality of life,” says Tan.

However, you’ll want to find experienced and knowledgeable doctors who will be able to diagnose you and create a personalized treatment plan. “Good TRT requires regular monitoring and tweaking, as all men are different,” adds Tan. “Everyone has a different height, body mass, and physical activity level, therefore treatment needs to be bespoke and individualized to make sure you get the best out of it.”

Men Should Check Their Testosterone Levels by Age 30, Urologist Says

Men should know their testosterone levels by age 30 to prevent health issues like weight gain and muscle loss, says top urologist

Gabby Landsverk
Oct 11, 2022, 12:31 PM

This article is a repost which originally appeared on INSIDER.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Early testing can help identify low testosterone.

‧ Low testosterone levels can cause side effects ranging from low libido and mood to muscle loss.

‧ A urologist said more men should get tested so their doctors can see how their hormone levels change over time.

‧ There is some evidence that higher testosterone levels may prevent illness like prostate cancer, not increase the risk.

Testosterone is a crucial hormone for men’s health, and a top urologist says more men should know their levels earlier in life.

Low testosterone can cause loss of energy, muscle, and libido, and can contribute to chronic illnesses such as heart disease, diabetes, and obesity, according to research.

But diagnosing low testosterone can be tricky, because natural testosterone levels can vary.

If you don’t already know your baseline, and you start experiencing these symptoms, you may not be able to trust the results of a testosterone test, said Dr. Ananias C. Diokno, former chief medical officer and chair of urology at Beaumont Hospital, Royal Oak.

“If you ask men what their testosterone levels are, they’ll scratch their heads. They don’t know and doctors aren’t testing for this. You should know what your level is by the time you hit 30 to 35,” Diokno told Insider.

What we think of as ‘normal’ testosterone, and why it’s not a perfect barometer

Testing for low testosterone is simple, using a blood test.

In healthy men, testosterone levels can range between 260 nanograms per deciliter (ng/dL) and more than 900 ng/dL, depending on age.

Low testosterone is typically defined as less than 250-300 ng/dL, according to the Cleveland Clinic.

However, since natural testosterone levels can vary widely, Diokno said many men can be misdiagnosed for hormone deficiencies.

For example, a person with testosterone levels of 400 or 500 ng/dL won’t be diagnosed with low testosterone because it’s higher than the defined standard, but if his initial levels were 700 or higher, the drop is significant and may warrant treatment.

“Many practitioners close their minds. Someone may be having symptoms but according to the guidelines, does not have low testosterone. It’s frustrating among men and among doctors who can’t help them,” Diokno said.

One solution is more routine hormone testing so men can establish what a healthy baseline looks like for them, similar to other markers of health like cholesterol, blood pressure, and blood sugar, Diokno said.

Low testosterone can cause low energy, low libido, and loss of muscle

Over time, men’s testosterone levels dwindle as a common side effect of aging. However, younger men can also have low testosterone, causing them to experience similar symptoms to much older men.

Telltale symptoms of low testosterone can be mental, physical, and emotional, including:

‧ Decreased sex drive

‧ Brain fog

‧ Depression and mood changes

‧ Fatigue

‧ Difficulty building or maintaining muscle

“The lower the testosterone, the more symptoms,” Diokno said.

Testosterone therapy may not be as risky as previously believed

For men who have had sudden dips in hormone levels, testosterone therapy can help restore quality of life, energy, and libido, Diokno said.

Previously, testosterone therapy has been carefully regulated, in part because high testosterone has been linked to a higher risk of prostate cancer in some studies.

Diokno said the opposite may be true, according to some observational studies, and healthy testosterone levels may protect prostate health.

Loss of muscle linked to low testosterone can cause other problems, too, including a decreased metabolism that can lead to weight gain and associated health issues.

Available evidence suggests that testosterone therapy, done correctly and with medical supervision, is a safe and effective way to raise hormone levels, and more research is needed to see who could benefit, Diokno said.

“It’s a Pandora’s Box, I think there are many questions that are still unanswered,” he said.

Medications that cause erectile dysfunction

What medications may cause erectile dysfunction?

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Medically reviewed by Matt Coward, MD, FACS — Written by Rachel Nall, MSN, CRNA on November 11, 2020

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection. It is a common condition that affects males of all ages and varying levels of health and fitness.

This article lists some medications that may cause or contribute to ED, and outlines some treatment options. Finally, we offer some tips to help prevent ED.

Medications that may cause ED
Certain medications may contribute to ED, although they are not usually the sole cause of the condition.

A person who suspects their ED may be due to a particular medication should talk to their doctor. Where possible, a healthcare professional may recommend changing the dosage or switching medicines.

A person should not stop taking their medications unless their doctor tells them to do so.

Some medications that may contribute to ED are below.

Anti-hypertensives

Anti-hypertensives are prescription medications to help lower blood pressure. They may contribute to ED, though doctors have not yet established why this is the case.

Examples include:

  • beta-blockers, such as metoprolol and atenolol
  • clonidine
  • spironolactone
  • some diuretics, such as hydrochlorothiazide and furosemide

Immunosuppressants

Immunosuppressants reduce the activity of the immune system. A person may take them to help control an autoimmune condition or prevent organ rejection following an organ transplant procedure.

One potential side effect of immunosuppressants is impaired sexual function.

Examples include:

  • sirolimus
  • everolimus
  • tacrolimus
  • cyclosporine

Anti-androgens

Androgens are hormones associated with male characteristics. Anti-androgens block some aspect of these hormones. Doctors may prescribe them for several conditions, such as heartburn or prostate cancer.

Examples of anti-androgens include:

  • ketoconazole
  • flutamide
  • bicalutamide
  • nilutamide
  • enzalutamide

GnRH agonists

Gonadotropin-releasing hormone (GnRH) agonists are a class of medications that doctors sometimes prescribe to treat prostate cancer. They may reduce sexual desire in men.

Examples include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)

Corticosteroids

Corticosteroids are drugs that mimic the effects of certain hormones inside the body. People typically take them to help reduce inflammation.

These drugs can also reduce testosterone levels. This may lead to decreased sexual desire and sexual function in some men.

Examples of corticosteroids include:

  • prednisone
  • prednisolone
  • hydrocortisone

Antidepressants

Antidepressants are medications that doctors may prescribe to treat or prevent the recurrence of clinical depression.

Some antidepressants may inhibit sexual desire, which may affect sexual performance. Others may also delay ejaculation.

Examples of antidepressants that may cause ED include:

  • selective serotonin reuptake inhibitors (Lexapro, Prozac)
  • noradrenaline reuptake inhibitors (Wellbutrin, Zyban)
  • tricyclic antidepressants (Pamelor)

Antipsychotics

Antipsychotics are drugs primarily prescribed for the treatment of psychosis. They may inhibit sexual desire, which may then affect sexual performance.

Examples include:

  • aripiprazole (Ability)
  • olanzapine (Zyprexa)
  • risperidone (Risperdal)

Anti-epileptics

Anti-epileptics are medications that doctors prescribe to help prevent epileptic seizures. They may affect a man’s ability to orgasm.

Examples include:

  • gabapentin (Neurontin)
  • topiramate (Topamax)

Recreational drugs

Aside from medications, some recreational drugs can also affect sexual arousal and performance. Examples include:

  • alcohol
  • hallucinogens
  • narcotics, such as heroin
  • stimulants, such as cocaine and methamphetamines

Drugs to treat opioid addiction may also lead to erectile dysfunction. These drugs include methadone and buprenorphine.

What is ED?

ED is the medical term for when a person has difficulty achieving or maintaining an erection. While this may occur periodically for all males, those with ED experience more frequent and routine episodes.

The ability to achieve and maintain an erection is dependant on several factors, including:

  • sexual arousal
  • sufficient blood flow to the penis
  • nerve sensation

An issue with any of the above factors may lead to ED.

Treatments for ED

A doctor may recommend treatments that can enhance sexual performance while allowing a person to continue taking potentially life-saving or life-extending medications. Some examples are below.

Self-care

Often, ED treatments begin with making changes to a person’s routine. These include:

  • adopting healthful eating habits
  • increasing daily exercise
  • maintaining a healthful weight
  • limiting or avoiding alcohol
  • quitting smoking
  • avoiding using recreational drugs
  • sleeping well

Males who experience mental health issues, such as stress, anxiety, or depression, may also benefit from seeing a mental health professional. These conditions can negatively impact sexual desire and sexual function. As a result, successful treatment may help manage ED.

Medications

A doctor may prescribe one of the following medications to help treat ED.

Phosphodiesterase type-5 inhibitors

Phosphodiesterase type-5 (PDE 5) inhibitors are medications that relax and widen the blood vessels to promote blood flow. The American Urological Association (AUA) recommend that males take PDE 5 inhibitors 1–2 hours before having sex.

Examples of PDE 5 inhibitors include:

  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)
  • sildenafil citrate (Viagra)

PDE 5 inhibitors are not suitable for people taking nitrates.

Injections

A vasodilator is a medication that helps widen the blood vessels, increasing blood flow.

One potential ED treatment involves injecting the vasodilator directly into the penis or urethra.

Testosterone therapy

According to the AUA, the vast majority of ED cases are due to reduced blood flow to the penis. They add that low testosterone levels may affect a person’s sex drive, but are rarely the cause of ED.

If low testosterone levels contribute to ED, a doctor may consider testosterone therapy (TT). This technique involves regularly administering testosterone in one of the following forms:

  • an injectable medication
  • a gel
  • a patch applied to the skin.

However, the AUA state that TT does not improve erections in males with normal testosterone levels or in those with low testosterone levels who experience ED as their only symptom.

Devices

A vacuum erection device (VED) consists of a plastic tube and a pump. The plastic tube fits over the penis, forming a seal against the body’s skin. Using the pump creates a vacuum around the penis, which causes an erection.

Once the penis is erect, the person slips an elastic ring onto the base of the penis. This retains the blood inside the penis for up to 30 minutes.

According to the AUA, around 75% of males who receive proper training on using a VED can achieve an erection when using these devices.

Surgical treatments

If lifestyle measures and medical treatments are ineffective, doctors may recommend surgical options for ED. These are outlined below.

Penile implant procedure

The main surgical option for ED is inserting a penile implant. This device sits permanently inside the penis, making it rigid enough for a person to have sex.

There are two types of penile implant:

  • Semi-rigid implant: Bendable silicone rods that a person can bend downward for urinating or upward for sex.
  • Inflatable implant: Fluid-filled cylinders attached to a rod inside the scrotum. Using the pump forces fluid into the cylinders, causing the penis to enlarge and stiffen.

Vascular surgery

Vascular surgery for ED helps improve blood flow to the penis. Doctors usually reserve this procedure for younger males with good vascular with ED due to pelvic trauma.