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The Men's Health Center
Any man with erectile dysfunction who does not respond to usual medical treatment for ED and wishes to have a normal, spontaneous sex life may be a candidate for penile implant surgery. Penile implant surgery has the highest rate of satisfaction of any treatment for ED. There are several types, and it is a long-term solution and typically lasts for 10-15 years. Consultation with a urologist at the Men’s Health Center is the first step of this process. Individuals must be healthy enough for surgery, and medical conditions like diabetes and heart disease must be stable before surgery can be considered.
LGBTQ people face a unique set of health challenges and, often, barriers to accessing respectful and compassionate health care. Sexual dysfunction is common; it impacts psychological wellbeing and can be a marker for changes in overall health. An assessment of sexual dysfunction may include testing metabolism and hormone levels, a psychological assessment, urologic evaluation, and cardiovascular assessment. Treatment for patients with gender dysphoria or transgender patients going through gender-confirming therapy may include hormone therapy and surgery. All of these services are provided in a professional and respectful environment at the Men’s Health Center.
Klinefelter syndrome is the most common congenital (hereditary) abnormality causing dysfunction of the testicles, affecting 1 in 1,000 male births. Men with Klinefelter syndrome often present with infertility, low or absent sperm production and/or low testosterone levels. Treatment for Klinefelter syndrome may involve advanced fertility techniques and testosterone therapy. Men with Klinefelter syndrome are at higher risk for other medical problems, like osteoporosis and certain types of cancer. They should seek care from Men’s Health Center providers with experience treating this condition.
Erectile dysfunction can occur for many reasons, and it can affect men of all ages. When ED is due to poor circulation (vasculogenic), it is a marker for increased risk for heart disease. This association is strongest in young men in their 40s and 50s. High blood pressure, high cholesterol, high blood sugar, and weight gain are all risks for erectile dysfunction, and men with ED should be screened for these conditions. A recent study published by Martin M. Miner, MD demonstrated that ED is an independent predictor of future cardiovascular events, and men with ED should have a thorough cardiovascular risk assessment before starting treatment for ED.
Testosterone therapy has not been shown to have any significant effects on the incidence of prostate cancer. While on testosterone therapy, your physician will check a blood test (PSA) and perform a digital rectal exam at regular intervals to follow prostate health closely.
Erectile dysfunction shares common risk factors with cardiovascular disease and may be an early sign of changes in the function of blood vessels. The presence of erectile dysfunction may trigger an evaluation of cardiovascular risk which is known as a cardiometabolic workup.
Testosterone deficiency can be seen in men with low sperm counts (infertility), but replacing testosterone will only cause a further decrease in sperm production. Men with low testosterone who want to preserve fertility should consider alternative methods to increase their testosterone level.
Sexual activity can be as strenuous as walking quickly up two flights of stairs or walking one mile on a flat surface at a brisk pace. Patients who cannot do these activities may need further blood tests or tests on their heart to be sure that treatment for sexual dysfunction is safe.
Erectile dysfunction can occur in sexually active males of any age. For men under age 40, psychological factors more commonly contribute to the problem.
Testosterone deficiency occurs in approximately 5% to 8% of men. It is characterized by the presence of low T and clinical symptoms of testosterone deficiency. Up to 12% to 30% of men may have low levels without any signs or symptoms. The most sensitive signs of T deficiency are the sexual signs and symptoms: loss of sexual desire, loss of morning and other spontaneous erections, and erectile dysfunction (ED). Less specific signs include obesity, profound fatigue, loss of concentration, sadness or irritability, loss of exercise endurance, and loss of motivation.
Although most guidelines do not advocate for generalized screening as men age, if a man has a common medical problem associated with T deficiency -- such as type 2 diabetes, high blood pressure or elevated blood lipids, any chronic inflammatory disease -- that man should have a baseline testosterone test and further tests if clinical symptoms persist. In the above case, if that man had no other explanation for his fatigue or if he has a medical problem associated with T deficiency, then he should have a screening total testosterone level done and repeated if low.
A study of T therapy is presently underway. This is the first such study with excellent methods and should be highly educational, though the results will not be available for 4 to 6 years. Testosterone has been used to treat medical conditions since the 1930s. Men who have low levels of T are thought to be at higher risk for heart attacks and strokes, but men who are treated with testosterone therapy appear to have the same risk as men who have normal levels of T. These relationships are known as associations, and at this time we cannot say that low T causes an increased risk of heart attack and stroke.
Currently, most forms of testosterone therapy (with the possible exception of nasal testosterone gel) do suppress testosterone production beginning at the level of the pituitary gland and ending with cessation of testosterone production in the testes. This does not tend to bother older men as most are done fathering children. Both testosterone and sperm (semen) are produced by the testes. Thus, giving a man testosterone therapy is likely to make him infertile while he is using the therapy.
In younger men with low levels and clinical symptoms, we tend to use fertility medicines such as clomiphene citrate to boost their levels of T while not suppressing production of T. These meds are safe and generally do not cause infertility or cessation of T, but rather increase that man’s ability to make his own T.