What Factors Affect the Dose and Effectiveness of Testosterone Pellets?
But what if a man is a candidate for testosterone pellets, and the testosterone supplementation still does not resolve ED, but other symptoms get better? The following scenarios can illustrate some situations that cause ED to continue even though adequate testosterone pellets are given and an excellent testosterone free and total blood levels are achieved.
When a man has smoked for years and his oxygenation is poor, he has COPD or requires oxygen for high elevations or exercise, then they will not be able to achieve an erection even with testosterone replacement. Viagra or other medications will not usually work for this type of patient. Ceasing smoking and supplemental oxygen will assist testosterone in working to remedy ED.
Longstanding diabetes with years of poor glucose control, causes micro-vascular damage and prevents blood flow to the penis and in this cases testosterone is not the problem. Other remedies like penile injections of prostaglandins may help and if it does then providing testosterone and decreasing estrogen will work with the prostaglandins to treat ED.
Post prostatectomy patients often cause men to lose the ability to achieve an erection because of neurologic damage during the surgery. Some of the prostaglandin intra-urethral creams, MUSE, often help but testosterone replacement may also be necessary, but is not a guarantee for a cure for ED in this case. Low blood pressure is always a problem for erections. This can be caused by blood pressure medications, dehydration, medications like beta-blockers for arrhythmias, diet pills and any stimulant like cocaine, causes low blood pressure and ED. Often testosterone, plus change in medications, hydration and modification of timing of intercourse may be necessary.
A genetic and age related increase in estrogens (estradiol and estrone) causes the active portion of testosterone to decrease and even though enough testosterone is produced, it is inactivated by the estrogen being produced. In this case I give the patient a larger dose of testosterone and oral Arimidex which decreases the estrogens.
The last factor that prevents good erectile function is atherosclerosis, or plaque on the arteries. This collection of fatty material decreases the diameter of arteries and decreases blood flow to the pelvis. This often is accompanied by no response to Viagra like drugs. Testosterone may help ED minimally, but diagnosis is needed to rule out heart disease and risk of heart attack, and the safety of sexual activity. I send these men to a vascular surgeon to evaluate their pelvic arteries and blood flow because the pelvic vessels mirror the condition of the heart vessels.
This should help you decide if you should try testosterone replacement or see your primary care, urologist, or vascular surgeon before beginning testosterone. Stopping bad habits like cocaine, amphetamines, cigarettes, too much alcohol, and keeping your blood sugar tightly controlled if you are diabetic, you will be a better candidate for resolving ED and getting the most out of testosterone replacement!
