Testosterone 'Tune-Up' Can Rev Up Sex Drive

Erectile dysfunction and sex drive

Growing numbers of aging men turn exclusively to drugs designed to correct erectile dysfunction or ED for their sexual woes, but urologists at Baylor College of Medicine in Houston say they may be limiting their options.
"The drugs now available to treat erectile dysfunction all work better when a man's testosterone is normalized because they depend on a biochemical system in the body that is testosterone-dependent," said Dr. Larry Lipshultz, a professor of urology at BCM. "The more testosterone you have, the more the erectile dysfunction therapy has to work on to enhance erection and treat erectile dysfunction."
Lipshultz and other urologists have seen success in the combined use of erectile dysfunction drugs with testosterone (or androgen) replacement therapy in some patients. Lipshultz determines which patients stand to benefit most from the two therapies by assessing their symptoms and taking blood tests that confirm androgen deficiency.
"A patient who has erectile dysfunction may have low testosterone levels," said Lipshultz. "Some patients take testosterone and then no longer need their erectile dysfunction drugs."
Men with low testosterone levels are typically over 40 and have symptoms so subtle and generic - including fatigue, mild lapses in cognitive function, low sex drive, and problems losing weight - that their conditions are often misdiagnosed as depression.
"Unfortunately, a large number of men are being put on antidepressants who really need to have their testosterone checked because men's testosterone does decrease with aging," Lipshultz said. "Androgen deficiency is something that we now know does exist, can be measured, and is easily treatable."
A greater awareness of "andropause" or ADAM (Androgen Deficiency of the Aging Male) would result in more accurate diagnoses, Lipshultz said. Furthermore, the advent of a topical androgen gel in recent years provides a more appealing alternative to traditional injections, patches, and oral medications that were previously the only way to correct this deficiency. The latter two can cause skin irritation and liver toxicity, respectively.
While there are no known major side effects to using either testosterone replacement or erectile dysfunction treatments, they could increase the risk of blood clotting because of high levels of iron-containing blood cells. Careful monitoring of these levels can prevent health problems from developing. Men trying to have children should avoid testosterone treatment because it turns off sperm production.
Prostate cancer patients should also not take androgen supplements since their tumors are testosterone-dependent. No large studies to date suggest that testosterone treatments can cause prostate cancer, but they can stimulate existing prostate cancer cells.
The U.S. Food and Drug Administration remains concerned about a possible link between increased testosterone levels and prostate cancer, said Lipshultz. However, he said, it could stimulate the growth of as-yet unrecognized prostate cancer cells.
"If you give someone with prostate cancer extra testosterone, you're basically feeding the tumor," Lipshultz said. "But if the tumor was removed entirely at the time of surgery and if that person goes two years with a non-detectable PSA, then we do treat men with low testosterones, and we have had no problems."

Erectile Dysfunction Drugs Linked to Higher Rates of HIV, Chlamydia

Researchers have found a link between men using drugs to treat erectile dysfunction (ED) and higher rates of the sexually transmitted diseases HIV and Chlamydia. Men who use drugs like Viagra, Cialis and Levitra may also be engaging in high risk behavior suggest the scientists. Findings from a study of more than 1.4 million men revealed two to three times the rate of sexually transmitted disease among men who request drugs for erectile dysfunction, with HIV being the most prevalent STD.
Study author Dr. Anupam B. Jena, an internal medicine resident at Massachusetts General says, “Our findings suggest is that just by virtue of asking for an ED drug, these men are identifying themselves as being at two to three times higher risk of STDs." The authors suggest that physicians counsel men taking drugs for erectile dysfunction about safe sex practices. The study did not take into account sexual preferences.
The researchers also say most physicians don’t counsel older men who take drugs for erectile dysfunction about STD risk and safe sex, reserving those talks for younger men. The authors obtained the information from insurance records examined between 1997 and 2006 that included approximately 34,000 male beneficiaries.
After the first prescription for erectile dysfunction was filled, the men studied were found to have a two to three time higher rate of sexually transmitted disease compared to men over 40 not using ED drugs. The most common STD among men using ED drugs was HIV, followed by Chlamydia.
One of the reasons HIV was the most prevalent disease linked to men using ED drugs may because symptoms of HIV drive them to their healthcare provider. Dr. Jena explains, “The symptoms that are associated with a primary HIV infection are the kinds of things that make men more likely to show up to a doctor, rather than go to a free clinic where they know they can get tested for an STD anonymously."
Dr. Peter Leone, a professor of medicine at the University of North Carolina and board chair of the National Coalition of STD Directors says the findings are no surprise. Doctors have suspected it’s not just men with erectile dysfunction taking the likes of Viagra, Cialis and Levitra. Dr. Leone says, “… they're also men in high risk groups who take it to enhance sexual activity."
He suggests that physicians should screen men who use erectile dysfunction drugs for sexually transmitted diseases, adding that repeated follow up for STD testing is also important unless men are using condoms or in a monogamous relationship. He also says it’s not erectile dysfunction drugs leading to higher rates of the STD’s HIV and Chlamydia – “it’s really the other way around”. The study concluded, “Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs.”