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DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 65671
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I have had problems getting all through my 20s and

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I have had problems getting erections all through my 20s and 30s (I'm now 38). I am a gay man and I have had sex with many other men of my age (perhaps 100, over the years??), and I've never seen any of them have the same problem as me. The problem is that I can only get an erection through masturbation. I can also get an erection in the mornings, when I am lying in bed and need a piss; these erections are often very strong and go on for a long time (10, 15 minutes or more). But sexual thoughts or feeling turned on psychologically does not cause an erection in me; crucially, they do not do so EVEN IN PRIVATE (when looking at porn, or fantasising). This has been the case all through my 20s and 30s (though it wasn't a problem as a teenager; as a teenager, feeling turned on would give me an erection. I worry therefore that this ISN'T about performance anxiety; it isn't psychological (because it still affects me when I am relaxed in private). Could there be any other physical cause? I know I can get healthy strong erections from a physical cause (when lying in bed in the mornings, or when masturbating), but not from a psychological cause (feeling turned on), and so it seems to me there's some problem in the link between brain and penis... Some hormonal deficiency, or cardiovascular problem?? I have tried Viagra and it works well: I feel turned on, I get an erection. SO that shows that I am not just failing to have the right thoughts. Psychologically, I am fine: I CAN have sexual thoughts I enjoy, and feel turned on, and this can cause an erection WHEN I TAKE VIAGRA. But without Viagra, the link between thoughts/ feelings and penis doesn't happen. I have seen doctors about this before and they say it's purely a psychological problem, BUT (a) they don't test me for any other possible problems; and (b) I can't believe them, on reflection, because as mentioned above (1) thoughts and feelings alone don't give me an erection EVEN IN PRIVATE, and (2) thoughts and feelings DO give me an erection when I take Viagra. So it seems the problem is not so much with brain/ psychology as with the physical connection between brain & penis.
Here is what should be tested for.
Circulation problems in the penis.
Prostate problems
Thyroid problems
High cholesterol.
Alcohol or medication effects
Low testosterone
Psychological is highest on the list
But early problems in the other categories are possible. Testosterone certainly could be low, and this could be the problem.
OK, so that is an initial answer….
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Customer: replied 3 years ago.

Hi, Thanks for your initial answer. Various tests in the past suggest to me I do not have most of these problems (I don't have very high cholesterol; I have low blood pressure; I don't drink much alcohol or take medication; I think I don't have circulation problems in the penis, because once a specialist injected something into my penis (or nearby, I can't remember) to test my erections; I got an erection & he did an ulstrasound (?) that showed circulation was okay). However, I have never been tested for testosterone levels. I have wondered before whether this could be the cause of my problem. It's very strange that I can feel very turned on in private but NOT get an erection unless I'm on Viagra. Could low testosterone be a cause of this??

Yes low testosterone could indeed cause this.
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Customer: replied 3 years ago.

I will go to see my GP and insist on getting my testosterone levels checked if at all possible. I'm sceptical though... as I don't seem to have any other symptoms of low testosterone (when I looked it up online)... although I'm not totally sure of this of course. (I'm otherwise totally healthy, very normal man with a high enough sex drive.)

Okay, thanks. I see you have given me a list of possible causes and I really just need to get these things tested.

I read recently about a new treatment using shockwaves (it's being tested in Edinburgh in the UK)... I was curious about this. I just wanted to double check with you, is the list of possible causes you have given comprehensive? There's nothing else/ no emerging theories about other causes? What hypothetical cause of ED is that shockwave treatment actually acting on, for instance?

I'm so mystified by my problem... I wouldn't be, I think, unless I'd slept with many other young men and seen how very functional they all are in this respect... i.e. I know that I'm really out on a limb... I have a really unusually strong problem in this respect for someone of my age...

Shockwaves work in the case of microcirculation problems.
So in some cases appear to revascularize the penis.
Nothing to add otherwise except you can have no symptoms with low testosterone.
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