Category: Erectile Dysfunction

Nitric Oxide and Its Role in Erectile Dysfunction

Man eating healthy trying to increase nitric oxide in body

Several potential issues can cause or worsen erectile dysfunction. Many of these are discussed on our website. However, some are less discussed yet worthy of mention and attention; one such potential cause is a deficiency in nitric oxide. Nitric oxide, or NO, is a gas molecule that most cells in the body produce. It is an integral part of how our body functions and plays a role in activating the enzymes in blood vessels that, among other things, help make a normal erection. As we age, however, the body produces less nitric oxide (which is the case for many essential bodily functions).

While the prevalence of erectile dysfunction continues to be researched, studies have shown that about 20% of the United States male population and 50% of those aged 40 to 70 years may suffer from moderate ED. Greater than 60% of men over 70 may suffer as well. This data is from the early 2000s, and the obesity epidemic, for example, has significantly worsened so those prevalence figures may be even higher.

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Could How You Grow Your Hair Be Causing ED?

Man looking in mirror touching hair

One of the most concerning issues that male patients discuss with their friends or physicians is hair loss. For many, hair is a sign of virility, and despite the inevitability of male pattern, baldness, which ultimately comes down to genetics, we still fight for that hair tooth and nail. It’s no wonder that hair restoration has grown to be such a huge industry and is rife with therapies that work and others that many claim to be effective but don’t have much data to support the assertion. From micro-needling rollers to caffeine ointment, red light therapy, various essential oils, and medication, there’s an overwhelming amount of information to process and seemingly impossible decisions to make.

Enter Finasteride

Finasteride is a drug known as a five alpha reductase inhibitor. Its main claim to fame is the very effective blockage of dihydrotestosterone (DHT (finasteride blocks upwards of 90% of DHT in the prostate and 70% in the blood)). DHT is essential to the normal workings of our bodies and is instrumental in developing male characteristics. However, excess DHT on our scalp later in life can cause hair follicles to shrink and ultimately die. By controlling the DHT systemically via the oral intake of finasteride or locally through topical applications, we see some of the very best hair regrowth results of any therapy.

It’s worth understanding that finasteride was not developed as a treatment for hair loss but rather to slow the growth of the prostate to fight a natural process known as benign prostatic hyperplasia (BPH) that affects most men later in their lives. However, it soon became clear that men taking this drug grew more hair on their scalps, and you have the ubiquitous drug we are used to hearing about today.

The Side Effects of Finasteride

For all its benefits, Finasteride has some potentially significant side effects. They mostly revolve around the effects of very low DHT, including low libido, reduced general function, depression in some, and even erectile dysfunction. These effects seem more pronounced when finasteride is taken orally, but the topical version can also be problematic. Younger men seem to have greater side effects than their older counterparts. As such, if you are currently using finasteride therapy for hair loss and having difficulty maintaining an erection, you may wish to speak to Dr. Kapadia to understand more about the systemic effects that both the oral drug and, to a lesser extent, topical application can cause.

What Is the Answer?

If you look up the recommended dosages of oral finasteride, you may be shocked to see how varied they are. Dosages from .5 mg up to 5 mg are routinely prescribed. Why so much variance? We all react differently to finasteride; no single dosage makes sense for every patient. However, as with most drugs, we strongly encourage working with your primary care physician, urologist, and hair loss specialist, to take the minimum effective dose. This helps ensure the drug can take effect while minimizing its potential, side effects, and considerations. This dosage can, of course, be modified to find a sweet spot. And patients should be aware of how their body reacts in the days and weeks after changing their dosage.

It’s also important to remember that finasteride may not cause erectile dysfunction and that aging is making it more difficult for you to achieve and maintain an erection during intercourse. In this situation, we can work with you to develop an erectile dysfunction treatment plan, including medication like sildenafil (generic Viagra) or tadalafil (generic Cialis), or for more severe erectile function, problems, course of injections, or even a penile implant.

Most importantly, speak to us about this and any other erectile function issues he may have. While it may feel awkward to have that conversation, we’ve helped thousands of men with the same problem, and want you to rest, assured that it is nothing to be ashamed of. Ultimately, erectile function can be achieved, no matter how bad your condition.

Why Can It Take So Long to Regain Erectile Function After Prostatectomy

Man and woman lying together holding hands on the mans chest

In the early days of radical prostatectomy, the anatomy of the prostate remained poorly understood. Erectile dysfunction occurred in all men who underwent a prostatectomy in those times. However, with an improved anatomic description of the prostate several decades ago, we began understanding the erectile nerves that envelop the prostate gland. This led to the advent of a procedure known as a nerve-sparing radical prostatectomy, which is now performed most often robotically. Despite taking great care in sparing the erectile nerves with the incredible 3-D visualization of robotic technology, virtually all men still get erectile dysfunction temporarily. Many fortunately regain erectile function over the period of months to a year. This is not to say that the nerve-sparing feature of the surgery is not essential. Quite the opposite. However, it has become evident that the involvement of other structures during surgery contributes to ED.

How Long Does Erectile Dysfunction Last After Prostatectomy?

Despite the nerve-sparing nature of the surgery, most patients experience ED that lasts beyond the physical recovery time after a prostatectomy. We expect most patients to regain erectile function in one to 12 to 18 months. That is considered the goal; for some, it can take up to two years. Up to 50% of patients may never regain erectile function and will need to consider alternative treatment options.

What Can Be Done?

For patients that require a prostatectomy to address fast-growing or aggressive prostate cancer, the best option is to visit a urologist and men’s health specialist like Dr. Kapadia, who has a specific program for patients with post-prostatectomy impotence. Our program follows a stepwise approach to address the two most common and disruptive concerns a man will face after a prostatectomy – ED and urinary incontinence. The first phase starts soon after cancer treatment and will include daily 5mg Tadalafil, generic Cialis, or Sildenafil, generic Viagra, on demand. If necessary, we may move on to injection therapies and other proven rehabilitative options. For most, this will improve erectile function satisfactorily; however, for some, we may need to continue to the restoration phase of treatment if we do not see results within the first year to 18 months. That said, we don’t give up because everyone’s anatomy is different, and there is no linear improvement in erectile dysfunction. Learn more about Dr. Kapadia’s post-prostatectomy rehabilitation and restoration program.

The Long-term Solution

For those who have not regained satisfactory erectile function after 12-18 months, there is a good chance that the dysfunction will not reverse. At this point, it is time to discuss an inflatable penile prosthesis, also known as a penile implant. Penile implants carry a very high satisfaction rate for couples and represent an elegant solution to a complex problem. The implant is completely customized to a man’s anatomy and provides a natural-appearing erection. Most importantly, the sensation, the ability to climax, and urination are completely unchanged. This means a man can enjoy a full and normal sex life with their partner.

For more information, we encourage you to contact our office to explore erection rehabilitation options after prostatectomy. If you are experiencing erectile dysfunction for any reason, we can discuss the possibility of a penile prosthesis.

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The Different Causes and Treatments for Erectile Dysfunction (ED)

Man standing covering crotch with both hands crossed

The prospect of erectile dysfunction, or not being able to perform sexually, either due to the inability to achieve an erection or maintain that erection throughout intercourse, strikes fear into the hearts of young and older men alike. And while ED may seem like a concern that would only affect those of advanced age, that’s not necessarily the case. There are different reasons why erectile dysfunction may occur, and each of these has treatment options to address the root cause.

Here at our practice, we have no shortage of younger men – those under the age of 40 – that experience problematic ED. These men can suffer from a variety of issues, both organic (structural) and non-organic such as anxiety, poor past sexual experiences, depression, and more. Regardless, they are often relieved that the cause of their erectile dysfunction can often be treated with medication or talk therapy.

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Improve Blood Flow to Treat Erectile Dysfunction

Blood cells flow in vein

The function of a man’s erection revolves around blood, so it stands to reason that improving blood flow can work wonders to enhance sexual performance and reduce the risk of erectile dysfunction / ED. There are several other potential causes of erectile dysfunction, including medication and even psychological considerations, but those will be discussed separately. Most importantly, early detection and treatment are important. Many men, often out of embarrassment, wait months or even years as their sexual health declines before seeking treatment from a qualified urologist or men’s health specialist. Or they opt for supplements or generic medications without a complete picture of their sexual health. Ultimately, visiting a knowledgeable specialist and urologist like Dr. Kapadia is the best next step.

In the meantime, whether you are suffering from ED or not, here are some tips to improve blood flow and give yourself the best chance at a long and satisfying sex life.

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ED as a Precursor to Cardiovascular Issues  

Problems with blood flow is a common reason for ED, meaning ED could be an indication of cardiovascular issues to come

New research into the causes and correlations between disease states is always exciting, mainly because we can use correlated issues to diagnose or prevent co-occurring disorders. One fascinating correlation is between erectile dysfunction and cardiovascular concerns. Interestingly, approximately 57% of atrial fibrillation patients, a common heart rhythm disorder, also experience ED. A potential reason for this includes poor blood flow that affects the penis. However, interestingly, new cases of ED were rare in patients with existing atrial fibrillation. This research shows that ED can be a precursor or indicator of future heart disease. Why? When the blood flow in the body is compromised, the penis is often affected earlier and more apparently than other bodily structures.

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New Study Shows the Effects of a High Protein Diet on Fertility and Erectile Function

Man eats a steak as part of a high protein diet that could impact his fertility and erectile function

Male fertility and erectile function are two essential parts of a man’s physical and psychological health. As we age, these functions begin to wane. While we can’t help but think about these issues, many modifiable lifestyle considerations can negatively affect a man’s fertility and even cause ED.

Recent UK research evaluated more than two dozen other studies that included a diet very high in lean proteins. The findings were striking in that these high-protein diets increased cortisol production and lowered testosterone, contributing to erectile dysfunction and even less fertility in men. The average man should consume about 17% of their calories as protein each day as a point of reference—the men who had the worst effects consumed over 35% of their calories as protein. As a result, the study authors suggest that men consume no more than 25 g of lean protein each day even.

Unfortunately, this study suggests that departing from a balanced nutritionally balanced diet can have significant detrimental effects, even on our sexual function.

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Improving Blood Flow for ED

Erectile dysfunction or ED is a widespread and disruptive concern for men and revolves around blood flow to the penis. After all, it is the blood that is necessary to fill the Corporal bodies of the penis to create and maintain an erection.

Improved blood flow can reduce symptoms of erectile dysfunction according to men's sexual health expert Dr. Akash Kapadia

Unfortunately, many of us follow lifestyles that aren’t conducive to efficient blood flow around the body, which can significantly increase the risk of ED. In this blog, we will discuss several ways to improve blood flow. While this may not prevent or reverse erectile dysfunction, it does give you the best chance to maintain sexual function for as long as possible.

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