Lots of men come to me with varying degrees of sexual dysfunction. Most want more, i.e. more sex, more desire and more functionality. Many have tried Viagra, Cialis etc etc. But somehow there is something still missing.
When I question them about whether they have ever had their hormones measured, almost all of them look at me blankly. So I measure them. A man can have a;
A) low level of testosterone and a
B) low libido, and
C) low performance, the trifecta.
Or, he can have any one or two of those without the third. It is important to establish which is missing.
When I find a low testosterone in a man, the first thing to do is to raise it up, preferably with natural hormones, although there are effective proprietary ones on the market too, including long-acting injectables. They are synthetic, but at least they have the advantage that he is unlikely to transfer any testosterone to his partner as when they use cream testosterone!
However, that may not be the answer, even then. With a normal, or almost normal testosterone level, if he still feels there is something missing, but his hormones are OK, then something else is missing. Is it desire that is missing, or performance?
If it is desire that is missing, that is going on between his ears, not between his legs. He needs to explore why that may be so. He may be tolerating a so-so relationship with his wife/partner, and he may even admit the desire is OK when he is away from home somewhere. But if a man really has a true low libido, he often is not complaining, it is often his partner that is complaining, and that can be explored too.
If the desire is normal, the testosterone is normal, then it may be the vascular supply to his penis that is affected. This is most often due to blood pressure tablets, although doctors are getting better at recognising those side effects and moving the patient to other tablets. Sometimes the vascular supply is affected by alcohol, smoking, diabetes, to mention a few. If that is the case, then Viagra etc may be the only answer.
But patients are very grateful when the whole spectrum of possibilities is explored for them to see where their problem lies, and what the possible answers are.
Regards
Maura
