If I masturbate I have no problem getting an erection and reaching climax.

Patient

Q: I'm a 34yo male.
No smoker, no STD (screened), no detected health issues.

Since around 28yo I started noticing a slow but steady slowdown of my sexual drive and general libido. Nowadays I almost have NON sexual drive or spontaneous sexual thoughts. Also I have none morning erections as had in my 20s.

If I masturbate I have no problem getting an erection and reaching climax.

Even if I like someone I meet I have almost zero sexual arousal thus during my sexual encounters I fail to get a good erection or if I do then it doesn't last.

I've tried viagra, cialis and levitra many times and I do not have erections with those (unless I masturbate). Even with Cialis at 20mg I have none spontaneus erections because I have no sexual desire in the first time.

As a side note I would like to mention I went thorugh a very stressful work year around 27-28yo that led me to half (left side) of my body losing some degree of skin sensation (dumbness). Went through CT scan but no brain anomaly was detected and was barely diagnosis with "stress" but never looked into it further (after some time my sensation came back although never fully).

I've been on psychology consultation for a year but no improvement with it.

I would like to know which tests could I take.

Also, if that stress situation could have derived in the so called "adrenal fatigue" and if so how could I detect it.

After doing my research, these are the tests that might show some light, please confirm or expand/correct:

DHEAs
FSH
LH
SHBG
Testosterone
Free Androgen Index
Thyroid (T4, Free T4, Free T3, TSH, Thyroglobulin Anti)
Full vitamin/mineral levels
Cortisol
Prolactin
DHEA Sulphate
General Liver

Thank you
Luis

Symptoms:  No sexual drive/libido, no spontaneous sexual thoughts, no morning erections.
Doctor

A:   Hi.
Thanks for your query and an elucidate history.
Read and re-read your history very carefully to get to the core of the problems and got some points that we should work on to get the diagnosis and treatment plan.
These are:
- On masturbation, you have normal erection and climax.
- You have tried viagra, Cialis and Levitra many times and I do not have erections with those (unless you masturbate)
- Stressful work at 27 -28.
- half (left side) of your body losing some degree of skin sensation (dumbness), partially recovered and only CT scan was done.
- No improvement with Psychologist.
- Since around 28 yo you started noticing a slow but steady slowdown of sexual drive
- The list of investigations is perfect and
I shall add a few to start with and more after our interaction.
* MRI of the brain and the whole spine screening as your had one sided reduced sensation that can have effect on sexual function too.
* Ultrasonography of the abdomen and scrotum for genitourinary system.
* Change the Psychologist or Psychiatrist, consult someone specialized in such matters.
* Blood Sugar fasting, post meal and random and HbAc.

Please give me additional information:
Are you married? If yes, have got kids?
Why are the STD screening done?
What is the level of stress and/ or anxiety at the moment?
Please share any further information that can help us to get a proper diagnosis and have proper treatment.

Awaiting.

Comments / Follow Ups

Patient: Thank you for your answer.
- No married, no kids. Single gay now. Even if I date people I like I do not get sexually excited.
- 3-6 month standard screening for HIV/HepC/Syphilis. All NEG. Safe sex.
- No stress in the last 2-3 years. Had some post-relationship down feelings last year. Single since then. No anxiety.

Basically I would add what I really notice is that I have
- No sexual thoughts during daytime nor dreams (yes before)
- No morning erections (yes before)
- No espontaneous sexual feelings when seeing or meeting someone I like (yes before).
- Not building that sexual momentum when getting into intimacy with someone (yes before).

I only get erections if masturbating AND if watching porn or actively thinking in some sexual thought/fantasy. Even then if I stop for a brief time I lose the erection quite easily.

- What does it mean "blood sugar fasting, post meal and random"?
- So all blood tests I mentioned are worth doing them?
- Should I start a clinical consultation with an Urologist or other specialist?

Thank you
Luis

Thank you
Doctor: Thanks for your detailed feedback.
Read and understood it all.

*I only get erections if masturbating AND if watching porn or actively thinking in some sexual thought/fantasy. This indicates that the sexual function is normal but there is a deviation of some of the norms and all they depend upon your psychological set-up. If this is altered you will have what you want. The best way is to consult a Sex-counselor or a Psychologist.

Also get all the tests done as you and I have noted above. Let us see the results and then decide what best can be done.

- What does it mean "blood sugar fasting, post meal and random"?
> To rule out diabetes.

- So all blood tests I mentioned are worth doing them?
> yes and also the tests I mentioned.

- Should I start a clinical consultation with an Urologist or other specialist?
> Sex-counselor or a Psychologist to start with.

I hope this helps you.
Patient: My lab results are back and attached, could you go through them?

I've noted abnormal or borderline results on these results:
Potassium, Chloride, Uric Acid, Ferritin, Vitamin D 25OH, FSH, Cortisol, Oestradiol, Vitamin B6, Copper



Thank you
Luis
Patient: Here are the rest of my lab results. Thank you
Doctor: Thanks for your feedback. Seen the results, nice and exhaustive study.
The one below normal are
cortisol
Vitamin D -insufficient.
Potassium
Choride.

The one above normal are
Vitamin B6
Uric acid
ferritin
Cholesterol

Consult your Doctor with these reports and consult him/her, so that you get appropriate treatment.
In addition you can have coconut water to replenish Potassium needs and add common salt a bit more to the diet or beverages.
You will get the Vit D prescription and may be a Corticosteroid just to boost up. It is just below normal and to say the midnight level are
Doctor: Adopt to better balanced diet and increase the exercises gradually . This may help to correct many of the things.

Related Q&A

Q: I have problem with keeping erection, i recently got married, can you please advice some medication for the problem.

Q: Mid-twenties. Never had morning wood and my genitals look like that of a child. Bloodwork shows that t(total: 579ng/d...

Q: Hi, This is regardingmy Erection. I am recently married and I love my wife. We have sex quite often, and sometimes it...

Q: Hi, I am a 49 years male. Since last April, I am experiencing erection problems where my erections are no longer hard...

Q: I just turned 40 and i'm having problem keeping an erection I didn't used to have this problem it gets up but not as...

 
DOCTOR ADVISORY BOARD
218

Dr. James Obaji M.D.

  • 247 Reviews
  • Family Physician
173

Dr. Suneel Sharman M.D.

  • 190 Reviews
  • Family Physician
138

Dr. Pat Golden M.D.

  • 169 Reviews
  • Cardiologist
98

Dr. Kunaal Jindal M.D.

  • 112 Reviews
  • Plastic Surgeon
CNN
BBC
MSNBC
CBS
abcNews
FoxNews