I am 53 yrs old having erectile dysfunction for the last 3 yrs.

Patient

Q: I am 53yrs old having erectile disfunction for the last 3yrs and also having diabetic around 15 yrs . kindly advice me a remedy for overcome the sexual problem

Symptoms:  Nil
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

Erectile dysfunction can be due to multitude of causes, the principal being stress induced and secondly decrease in testosterone levels. as you have been a diabetic it is understood that your stress levels may have been chronically higher and diabetes per se itself can have an effect on testosterone production and release.
I hope your diabetes is well under control but before suggesting you any treatment i would like to learn about your serum testosterone levels. Please get it tested and review with reports. Also it would be appreciated if you can deliberate on your concern more elaborately as to whether you are unable to sustain after an initial erection or that you are unable to establish erection from start itself.

Please revert back with details,
Regards

Comments / Follow Ups

Patient: i am unable to sustain after an erection and some times not able to establish erection from start itself ,also not having the steadiness and strength on the penis for penetration process.Another thing is i feel my penis is always a shrinking stage even the climate is too hot,Due to these reasons i am not much interested in sex
In connection with these problems i consult a doctor and examine me physically and through laboratory examination the level of my serum testosterone level was a little higher than normal value .Then he prescribed a tablet named 'Forzest 20' for one month by using alternate days one hour before dinner.After using this medicine the things were comes to 60% normal .But the problem behind it is with out using the tablet the problems remain the same.So please make a permanent solution for over come my sexual weakness
Doctor: Forest 20 is a selective phosphodiesterase type 5 (PDE5) inhibitor. Inhibition of PDE5 increases cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum, causing penile erection. So basically it increases the penile blood flow and causes erection.
The cause in your case seems more psychological and stress induced and also heat is also factor which can get you disinterested in sex , so keep yourself well hydrated and if required you may be placed on low dose antidepressants which can be helpful. Unfortunately there is no permanent solution for it. In 90 percent of the cases the reason is psychological.
regards
Patient: Forzest.20, the chemical content of the tablet is tadalafil-ip.20mg . if i hardly need low dose antidepressant ,please suggest me a low side effect antidepressant medicine as well as an alternate and more effective medicine instead of forzest.20
Doctor: We can't be prescribing any medications on this platform but yes a low dose imipramine ( antidepressant) daily can be helpful. You may discuss the option with your PCP and take an informed decision.

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