Case study ( 1713 views as of March 26, 2019 )
Harry is a 62-year-old man, who is 30 pounds overweight and has Type II diabetes currently managed by Metformin. He has noticed diminishing erectile function over the last 3 years but now he has generalized dysfunction, unable to get an adequate erection with his wife or with self-stimulation. He has also lost morning erections and has difficulty ejaculating. His wife complains of his irritability and diminished sexual drive, and is becoming sexually disinterested herself.
Harry's family doctor gives him a phosphodiesterase V inhibitor (PDE5i), which does not provide an adequate erection for penetration despite higher doses and several tries. Recognizing his symptoms of low testosterone and the failure of the PDE5i, he is found to be hypogonadal, and begins testosterone replacement therapy (TRT). While this improves his libido, fatigue, mood and improves his ejaculatory capacity, it does not improve the erectile dysfunction (ED). However, with eugonadal serum testosterone levels, the PDE5i starts to work and Harry is able to resume sexual activity without proceeding to the vacuum device or intracavernosal injection for erectile dysfunction. The improved energy allows him to become motivated to exercise and lose weight, allowing his TRT to be discontinued. However, he still requires the use of the PDE5i.
To assist Harry with continued success dealing with his testosterone levels erectile function, he would benefit from working with his family doctor, an endocrinologist, and perhaps a urologist. He could also consider consulting a sexual medicine specialist. Harry could also work with a registered dietitian and an exercise physiologist to help him with his weight loss efforts.Author: Dr. Stacy Elliott