Jennifer Siefert, R.Ph. * John Preckshot, R.Ph. Wade Siefert, R.Ph.

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   Erectile dysfunction (ED) affects up to half of men in their 50-70s. General interest toward ED has exploded since the introduction of "PDE5i" drugs such as sildenafil (Viagraź). In the last decade, men have started to seek medical advice much more quickly after noticing symptoms of sexual problems. However, none of the PDE5i drugs are curative - they only treat the symptoms of ED.
 
   ED is associated with unhealthy lifestyles, such as smoking or overweight, and other health problems such as hypertension, diabetes mellitus, and neurological disorders. Testosterone levels are commonly lower in men with metabolic syndrome, type 2 diabetes mellitus, obesity, depression, obstructive sleep apnea, chronic kidney disease or anorexia nervosa. In addition, certain medications, in particular cortisone-like drugs and opiolds (painkillers such as morphine, oxycodone or methadone), reduce testosterone levels. However, several other hormones, including cortisol, LH, prolactin, TSH, and FT4 are involved in sexual functioning and should be investigated in men with ED.4  A stress evaluation can also be helpful.
 
   In contrast to women who experience a sudden drop in estradiol levels around the time of menopause, the age-related drop in testosterone in men is more gradual at 0.5-2.0% per year from early adulthood onwards.5
 
   Following physical examination and lab work, testosterone replacement can be recommended for treatment of symptoms of testosterone deficiency if the physician finds no contraindications. Men with low testosterone levels typically respond very well to testosterone replacement therapy and show a marked improvement in sexual function, sense of well-being and energy levels, and maintenance of secondary sexual characteristics.
 
   Testosterone therapy may suppress sperm production. When male fertility is a concern, the following approaches may be considered:

• Change in lifestyle to include weight management, strength training, a healthy diet, and decreased consumption of alcohol and nicotine
• Use of aromatase inhibitors such as anastrazole, chrysin, resveratrol and/or zinc to decrease aromatase activity and decrease conversion of testosterone to estradiol, simultaneously affecting two potential causes of male infertility
• Use of 5-alpha-reductase inhibitors such as progesterone and/or saw palmetto

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