When Testosterone Is Not the Answer to ED

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Testosterone Pellets Are Not the Answer for All Men Who Have Symptoms of Low Testosterone.

Most men who send me their medical history and blood work for evaluation to determine whether they are candidates for testosterone pellets, usually think that I wouldn’t turn anyone down for treatment, but I do if I don’t think I can help them! This blog is about the reasons I treat men with alternate treatment or don’t treat them at all with testosterone pellets.

My bio-identical hormone replacement practice is very busy and I want to have time for anyone who I can help with a combination of testosterone pellet replacement and preventive medicine. To this end I review the information from patients before I see them and determine whether they are candidates for testosterone pellets or not. The majority of men who send me their lab are candidates for treatment, mostly because they read my website, and know the symptoms of testosterone deficiency and usually only desire to be a patient if they fit the typical “picture of hypo-gonadism”. However, self-evaluation is not always adequate and frequently a medical opinion is required. This leads to some men being told that they don’t need testosterone or that I would be glad to see them for an appointment, but that I would probably not treat them with testosterone pellets.

The most common reason for a male patient not being a candidate for testosterone replacement are as follows:

  1. These men make plenty of testosterone but, it is bound by a protein (SHBG) that is stimulated by their own estrogen production. For these patients I consult with them but explain that once we suppress their estrogen they will have adequate free testosterone and their symptoms will resolve. I use the drug Arimidex to treat this problem and these men feel great. They may need testosterone replacement in the future but for now, blocking estrogen is all they need!
  2. A man makes adequate testosterone but has very little active testosterone because he drinks too much alcohol. This is a frequent problem and it is a simple life-style adjustment for they to get their lives back on track. All these patients need to do is drink less and their free testosterone will increase and their symptoms will resolve.
  3. A man has a normal blood total testosterone level and normal active testosterone, but they still experience sexual dysfunction. This can be from advanced diabetes which decreases blood flow and nerve function to the pelvis by damaging nerves and small vessels in the pelvis, and more testosterone will not improve this problem.
  4. Another scenario that may not require testosterone replacement involves a man who is on several blood pressure medications, which he needs, but which cause him to have erectile dysfunction. If the blood pressure medicine can be changed to Benicar or Cardizem, which are less likely to cause erectile dysfunction, then ED will resolve, if he has normal blood flow and blood sugar. More testosterone is not the answer for this particular man. If we change medications, and the symptoms of hypo-gonadism is still present then I will try testosterone pellets, plus or minus Viagra or compounded Viagra sublingual tablets.

I don’t treat every patient who thinks they need testosterone with T pellets at the time of their first visit, however I do treat them with other medications or change in medications that make pellets unnecessary at the time, but all men need testosterone eventually, so I consider this a stop gap treatment.