Can You Have Low Testosterone and Vascular Erectile Dysfunction at the Same Time?
Erectile dysfunction isn't always caused by one single problem.
Sometimes blood flow is the main issue. Sometimes hormones, nerves, medication, stress or psychological factors play a role. And sometimes, more than one of these things can be happening at exactly the same time.
We recently treated a patient at Men's Room Shockwave who was a particularly good example of this.
He initially came to us with what appeared to be fairly typical vascular erectile dysfunction (ED). We started treatment aimed at improving the vascular side of his erectile function.
Then, within the first couple of weeks, his circumstances changed dramatically.
His testosterone dropped, his libido disappeared and he virtually stopped getting erections altogether.
For a while, this made it extremely difficult to tell whether his ED treatment was actually doing anything.
But as his testosterone and general wellbeing recovered naturally, something interesting happened.
His erections came back - and when they did, the improvement was suddenly obvious.
Here's what was going on.
What Is Vascular Erectile Dysfunction?
Vascular erectile dysfunction is ED associated with problems with the blood vessels and blood flow involved in producing and maintaining an erection.
To achieve a strong erection, there needs to be adequate blood flow into the penis and an ability to maintain that pressure.
When vascular function is compromised, erections may gradually become less reliable or less firm.
One of the patterns we commonly hear from men with suspected vascular ED is that their erectile function hasn't disappeared overnight.
Instead, it has progressively declined.
They might tell us:
Erections used to be stronger.
Morning erections have gradually become less firm or less frequent.
Maintaining an erection has become more difficult.
Viagra or similar medication used to work better than it does now.
Erectile quality has declined across morning, nighttime and sexual erections.
That gradual deterioration was very similar to what this particular patient described when he first came to see us.
His ED Initially Looked Primarily Vascular
When we first assessed him, there weren't obvious signs that low testosterone was driving his erectile dysfunction.
He still had sexual desire and arousal.
He was still experiencing erections, including morning erections, but they weren't achieving the hardness and reliability that he wanted.
His history and symptoms were consistent with a vascular component, so he began a course of shockwave therapy for erectile dysfunction.
We use focused shockwave therapy in appropriate cases of vascular ED with the aim of targeting the vascular component of erectile function.
But then his situation changed.
Then His Testosterone Dropped
About one or two sessions into treatment, this patient went through the breakup of a long-term relationship.
It hit him extremely hard.
He wasn't sleeping properly. He wasn't eating normally. He was losing weight. His stress levels were extremely high and, most importantly from our perspective, his sexual desire disappeared.
His testosterone levels also dropped.
Before this happened, he was still experiencing sexual arousal and erections - even if the erections themselves weren't as strong as he wanted.
Afterwards, the "spark" had essentially disappeared.
He simply wasn't interested in sex.
And this created an interesting problem when it came to monitoring his ED treatment.
Low Testosterone and Vascular ED Aren't the Same Thing
This is where it's useful to separate sexual desire from erectile quality.
They're connected, but they aren't identical.
Testosterone plays an important role in male sexual function and libido. When testosterone is low, some men experience a significant reduction in sexual desire and spontaneous erections.
A vascular problem is different.
You may have the desire and stimulation required to trigger an erection, but the vascular system may struggle to produce or maintain the erectile rigidity you're used to.
In very simplified terms:
Testosterone can influence the desire and drive to initiate sexual activity and erections.
Your vascular system influences the physical blood-flow component required to produce a sufficiently firm erection.
Of course, the biology is considerably more complicated than that, and erectile dysfunction can involve several overlapping systems.
But it's a useful way of understanding what happened with this patient.
How Do You Measure an Improvement in Erections When Someone Isn't Getting Erections?
This became our biggest problem.
We had started treatment for the vascular component of his ED.
Normally, we'd monitor things such as erection hardness, reliability, morning erections and how well erections are maintained.
But suddenly, he wasn't experiencing much sexual desire at all.
So there weren't many erections to assess.
It was entirely possible that changes were taking place in the vascular component of his erectile function while another issue was temporarily preventing him from seeing the benefit.
And that's ultimately what appeared to happen.
His Testosterone Improved - Then His Erections Suddenly Returned
We continued through the treatment programme while his wider situation gradually settled.
Over time, he started sleeping and eating better. His stress reduced, his overall wellbeing improved and his testosterone recovered naturally.
His sexual desire began returning too.
And once the "spark" came back, he started getting erections again.
That's when the difference became apparent.
Towards the end of his treatment course, he suddenly reported that his erections were back and functioning much better.
From his perspective, it could have looked as though the improvement happened suddenly.
But the more likely explanation was that we had been working on one component of his erectile dysfunction in the background while the hormonal and psychological effects of an extremely stressful period temporarily masked his ability to notice the changes.
Once his desire and arousal returned, he was able to see what his erectile function was actually capable of.
Can Low Testosterone Cause Erectile Dysfunction?
Low testosterone can contribute to sexual problems, but it's important not to automatically assume that low testosterone is the explanation for every case of ED.
Symptoms associated with testosterone deficiency can include reduced libido, fewer spontaneous erections, reduced energy and other changes.
But someone can also have low testosterone and vascular erectile dysfunction.
Improving testosterone doesn't necessarily mean an underlying vascular problem will disappear.
Equally, treating a vascular component doesn't necessarily resolve low libido caused by a hormonal, psychological or wider health issue.
This is why understanding what type of erectile dysfunction you're dealing with is so important.
Why Viagra Becoming Less Effective Can Matter
Another part of this patient's history was that Viagra had previously worked better than it did by the time he came to us.
We hear this quite frequently.
PDE5 inhibitor medications such as sildenafil (Viagra) and tadalafil (Cialis) can be extremely useful treatments for erectile dysfunction.
But if medication is becoming less effective, it's worth discussing that change with an appropriate healthcare professional rather than simply assuming you need progressively higher doses.
There may be other factors contributing to your erectile dysfunction that need investigating.
Where Does Shockwave Therapy Fit In?
At Men's Room Shockwave, one of the treatments we use for appropriate cases of vascular erectile dysfunction is focused shockwave therapy.
Shockwave therapy uses acoustic energy delivered to targeted tissues.
Research into low-intensity shockwave therapy for erectile dysfunction has primarily focused on men with a vascular component to their ED.
It isn't a universal treatment for every type of erectile dysfunction.
For example, someone whose symptoms are primarily related to hormones, medication, psychological factors, nerve damage or another medical condition may require a very different approach.
That's why identifying the likely cause (or causes) matters before deciding what to do next.
Erectile Dysfunction Can Have More Than One Cause
This is probably the biggest lesson from this particular case.
We often talk about erectile dysfunction as though every man fits neatly into one category.
In reality, things can overlap.
A man might have vascular ED alongside low testosterone.
Someone may have a vascular issue alongside pelvic floor dysfunction.
Another person may have nerve-related changes combined with anxiety following previous difficulties with erections.
And someone's erectile function can change temporarily because of illness, major stress, poor sleep or significant changes in their life.
The question shouldn't simply be:
"Do I have erectile dysfunction?"
A better question is:
"What is contributing to my erectile dysfunction?"
Because once you understand that, you can start having a much more useful conversation about what might actually help.
Struggling With Erectile Dysfunction?
If you've noticed your erections becoming progressively weaker, your morning erections changing, ED medication becoming less effective, or you're simply unsure whether your erectile dysfunction could be related to blood flow, hormones, nerves or something else, it's worth getting properly assessed.
At Men's Room Shockwave, we work specifically with men experiencing erectile dysfunction and other men's health problems.
Where appropriate, we use focused shockwave therapy for vascular erectile dysfunction and nerve stimulation for certain nerve-related presentations, while also helping patients understand when further medical investigation may be required.
The important thing is not to assume that every case of erectile dysfunction has the same cause.
Sometimes there is more than one piece to the puzzle.
And as this patient's experience showed, improving one part of erectile function can still matter even when something else temporarily gets in the way.