and Addressing Erectile Dysfunction in Young Men: A Comprehensive Guide

Q: and Addressing Erectile Dysfunction in Young Men: A Comprehensive Guide

Mr. <br>Lee： Hello, the blood flow to the penis is quite normal. <br>Perhaps it is just your concern. <br>If you feel that there is insufficient rigidity, you can perform a penile tumescence test to assess hardness. <br>However, based on the ultrasound results, it should be able

Regarding erectile dysfunction issues?

Hello, doctor.
I previously asked a question this morning.
My earlier inquiry was: Although I am only 26 years old, I have been experiencing erectile dysfunction for many years.
During middle school, my erections were consistently strong and normal.
However, starting from a certain day in my first year of high school, I noticed that my penis, when not erect, shrank significantly compared to before (it was very obvious that my penis became shorter and thinner, and the glans area decreased in size).
For the past ten years, I have believed that this situation was caused by starting to masturbate before my body had fully developed during middle school, leading to irreversible changes.
I also rarely experience morning erections.
For over a decade, I have only watched adult films without any masturbation or ejaculation, usually experiencing nocturnal emissions about once a week (sometimes after intense basketball games, I might have a nocturnal emission that night, so it may not be limited to just once a week).
By the time I reached my senior year of high school, the nocturnal emissions I experienced during sleep no longer provided the strong sensation of ejaculation that they used to; they became somewhat weak and typically occurred without an erection.
When I was 23 and discharged from military service, I was unsure if it was due to the stress of military life or excessive adult film viewing, but I found that I could not achieve a full erection even while watching adult films.
Therefore, I decided to seek medical help to find the underlying cause of my long-standing issues.
I consulted several urologists who all believed that the penis could not shrink like height.
After testing my testosterone levels, they concluded that everything was normal and prescribed medication to help me achieve full erections.
However, I felt that this approach only addressed the symptoms and not the root cause.
Consequently, I went to Kaohsiung Medical University to consult a renowned urologist (who also specializes in reproductive medicine).
He conducted blood tests, and although my testosterone level was 776.2, which is within the adult range, he also tested my LH level, which was 3.31, and deemed it insufficient.
He recommended that I undergo regular hormone injections for improvement.
However, since I began the injections at the end of June 2015, I have experienced almost no morning erections.
It can be said that there has been little to no improvement in my condition.
Doctor, what should I do? As for your suggestion to undergo penile-related examinations, I have done so.
Below are the tests I underwent and the report details: Test item: Sono, Penile vessel ultrasound.
Report content: Doppler evaluation of deep penile arteries was performed after intracavernosal injection of 20 µg of PGE1, which showed normal systolic velocity measuring up to 153 cm/sec (normal >25 cm/s) and normal reversed diastolic flow of -14 cm/s (normal <5 cm/s).
No Doppler evidence of arterial insufficiency or venous leakage was identified.
The diameter of the penile artery was measured at about 0.1 cm.
A good response to the PGE1 injection was also noted.
However, I had some questions during this examination.
The nurse placed the ultrasound device only on my testicular area for testing; was this examination specifically for the penis? If these tests have been conducted and found to be normal, what else can I do? I sincerely request your assistance.

Mr. Li, 20~29 year old female. Ask Date: 2016/01/12

Dr. Xu Weikai reply Urology

Mr.
Lee: Hello, the blood flow to the penis is quite normal.
Perhaps it is just your concern.
If you feel that there is insufficient rigidity, you can perform a penile tumescence test to assess hardness.
However, based on the ultrasound results, it should be able to maintain normal rigidity.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers found online should only be used as a reference; if necessary, it is best to seek medical attention at a healthcare facility.
This response is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/12

More Info

Erectile dysfunction (ED) in young men is a complex issue that can stem from various physical, psychological, and lifestyle factors. Your concerns, particularly at the age of 26, are valid and warrant a thorough understanding and approach to address them effectively.

Understanding Erectile Dysfunction in Young Men
1. Prevalence and Causes: While erectile dysfunction is often associated with older age, it can occur in younger men as well. The causes can be broadly categorized into psychological and organic factors. Psychological causes may include anxiety, depression, stress, or relationship issues, while organic causes can involve hormonal imbalances, vascular problems, or neurological conditions.

2. Physical Examination and Testing: It’s crucial to undergo a comprehensive evaluation. You mentioned having tests for testosterone levels and LH, which are essential in assessing hormonal health. The normal testosterone level you reported (776.2 ng/dL) is reassuring, but the LH level of 3.31 could indicate a need for further evaluation of your pituitary function and overall endocrine health.

3. Vascular Health: The Doppler ultrasound you underwent is a valuable tool in assessing penile blood flow. The results indicating normal systolic velocity and no evidence of arterial insufficiency or venous leakage suggest that your vascular function is intact. This is a positive sign, as it rules out some of the more serious organic causes of ED.

4. Psychological Factors: Given your history of anxiety related to performance and the psychological impact of prolonged ED, it’s essential to consider therapy or counseling. Cognitive-behavioral therapy (CBT) can be particularly effective in addressing performance anxiety and other psychological barriers to sexual function.

5. Lifestyle Factors: Lifestyle choices play a significant role in sexual health. Regular exercise, a balanced diet, adequate sleep, and stress management techniques can improve overall well-being and potentially enhance erectile function. Reducing the consumption of pornography and focusing on real-life intimacy may also help in regaining natural sexual responses.

Addressing Your Concerns
1. Hormonal Treatment: You mentioned receiving hormone injections without significant improvement. It’s important to discuss with your healthcare provider the effectiveness of this treatment and whether adjustments are needed. Sometimes, a combination of therapies may be more beneficial.

2. Further Investigations: If you continue to experience issues despite normal test results, consider discussing additional tests with your doctor. These could include a nocturnal penile tumescence test to evaluate erections during sleep, which can help differentiate between psychological and physical causes.

3. Communication with Healthcare Providers: It’s crucial to maintain open communication with your healthcare providers. If you feel that your concerns are not being adequately addressed, seeking a second opinion or consulting a specialist in sexual medicine may provide new insights and treatment options.

4. Support Systems: Engaging with support groups or forums where individuals share similar experiences can provide emotional support and practical advice. Sometimes, knowing that others face similar challenges can alleviate feelings of isolation and anxiety.

Conclusion
Erectile dysfunction at a young age can be distressing, but it’s important to remember that it is a treatable condition. A multifaceted approach that includes medical evaluation, psychological support, lifestyle changes, and open communication with healthcare providers can lead to significant improvements. Don’t hesitate to advocate for your health and seek the answers you need to regain your confidence and sexual health.

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