Diabetes and Your Love Life

Erectile Dysfunction Graph

To understand how diabetes leads to Erectile Dysfunction (ED), you first have to understand how erections work. Getting an erection is really a complicated process.

Anatomy of an Erection

In the shaft of the penis there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They’re mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.

The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.

When you get an erection, nerve signals from your brain or from the nerve endings in your penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.

The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.

When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis.

Diabetes: A Perfect Storm for Erectile Dysfunction

Many common problems related to diabetes all come together to cause erectile dysfunction. That’s why various studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction. If you are having difficulty getting erections, there may be a number of things going on in your body.

Nitric oxide is a chemical released into the bloodstream by the lining of blood vessels. It acts as a kind of chemical messenger that tells the smooth muscles and arteries in the penis to relax and let in blood.

High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects many processes in the body. Sexual response is one of them. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide results in constricted blood vessels and reduces blood flow to the penis.

What’s more, according to the American Diabetes Association, 73% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.

High cholesterol is also common in people with diabetes. LDL cholesterol, or what’s called “bad” cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow.

Some of the choices that men with diabetes make also feed into this “perfect storm.” Smoking, especially. Smoking by itself reduces blood flow all through the body.

Last but not least, feeling badly about your health can lead to erectile dysfunction. For most men, erectile dysfunction is mainly a physical problem, but the mind always plays some part in sexual arousal.

Although having diabetes means that you may encounter problems with your sexual functioning, you really can turn it around. By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you.

If you have diabetes and it has caused erectile dysfunction (ED), you still have every reason to be optimistic about the future and a healthy sex life. There are many proven treatments you can try.

A doctor’s first choice for treating erectile dysfunction is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there’s also Levitra and Cialis. All three drugs work in similar ways. They don’t increase sexual desire. They make it physically possible to get an erection when you are aroused.

No one of them has been proven to work better than the others, although there can be a different individual response. But the time they take to start working and the duration of their effects vary. That’s something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?

Viagra starts working in about 15 to 30 minutes and its effects last about four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours. Take note that Viagra is most affected by slow absorption if you take it after a meal.

These drugs are not good for every man. Men who take nitrate drugs for chest pain or alpha blockers for high blood pressure or prostate problems shouldn’t take Cialis, Levitra or Viagra. Other reasons why you may not be able to take these drugs include:

  • High blood pressure that isn’t under control
  • Very low blood pressure
  • A heart attack or stroke in the past six months
  • Kidney or liver disease
  • Retinitis pigmentosa (an eye disease)

Other Treatments for Erectile Dysfunction

If erectile dysfunction pills are out of the question, or if they haven’t worked for you, don’t worry. There are other good options.

Alprostadil is another drug for erectile dysfunction. However, it’s not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis, allowing blood to fill the spongy tissue that makes the penis erect.

Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erection problems. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.

Next, you may want to try a vacuum device, or “penis pump.” This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.

You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It’s safe to keep the band on for up to 30 minutes.

Alternative Treatments for Erectile Dysfunction

Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some people believe are helpful include:

  • Ginseng
  • Horny goat weed
  • Ginkgo biloba
  • Muira puama
  • Pycnogenol
  • L-arginine
  • Damiana

Before trying any alternative treatment, be sure to ask your doctor about it first. Herbs and supplements, whether they help with erectile dysfunction or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.

Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.

Male Menopause, Does Testosterone Replacement Benefit?

Male Menopause, Does Testosterone Replacement Benefit?

For decades, older women have taken hormone replacements to replenish estrogen and progesterone levels lost to aging, called Menopause. We have learned during the years that hormone replacement can be beneficial but not without risk for the stimulating effects of the hormones. Long term use (>5 yrs) is therefore advised in general for women. More recently, testosterone (the most important male hormone) supplements have been used by aging men to improve their quality of life, Male Menopause or Andropause has been described as the male decline in testosterone levels. In 2003, the number of elderly American men taking testosterone replacement therapy was already 1 million, and the number has been growing faster in recent years. Lets have a look at the current studies on effect and safety.

Testosterone and its Effects

 

It’s not clear that naturally falling testosterone levels cause any signs and symptoms in men. Studies of men who have very low levels of testosterone due to diseases and treatments may offer some clues to the role testosterone plays in a man’s body as he ages. According to those studies, testosterone deficiency can have several effects on the body, including: Decreased sexual function , Loss of bone density, Loss of muscle mass, Increase in fat mass, Reduced muscle strength, Memory loss, Mood changes and depression.

Potential benefits Potential risks
Improve muscle mass and strengthCause skin reactions
Increase bone mineral densityCause fluid retention
Thicken body hair and skinCause baldness
Improve sexual desireStimulate noncancerous growth
of the prostate and cause urinary symptoms
Boost energyCause testicle shrinkage
Decrease irritability and depressionCause acne
Improve cognitive functionStimulate growth of prostate cancer that’s already present
Stimulate blood productionEnlarge breasts
table: pro's and cons of using testosterone supplement

Some men experience these signs and symptoms, but don’t have unusually low levels of testosterone. Others may have low levels of testosterone, but don’t experience any signs and symptoms that would prompt them to seek treatment.

Testosterone replacement therapy can help older men deficient in the hormone reduce their risks of heart disease, diabetes, and death, according to new research presented at the annual meeting of The Endocrine Society.

The goal of testosterone treatment is to keep the levels within normal range. Low levels of testosterone are common with age, occurring in about 20% of 70-year-olds. Low levels of testosterone are associated with the metabolic syndrome — a cluster of risk factors such as abnormal cholesterol and high blood pressure that boost risk of heart disease, stroke, and type 2 diabetes as well as other risks to health.

The Studies found that testosterone replacement therapy reduced the metabolic syndrome risk factors and did so in a similar way in all the age ranges studied.

Testosterone Replacement Therapy and Heart Disease Risks

In the first study 95 men, aged 34 to 69, with low levels of testosterone were included.
All had metabolic syndrome. Those who have this diagnosis must have three of five risk factors: increased waist circumference, low “good” cholesterol or HDL, high triglycerides, elevated blood pressure, and elevated blood sugar.

They were treated for at least a year. Every three months, they measured cholesterol, waist circumference, and other parameters.

The testosterone replacement was given as a long-acting injection (Nebido), every three months. The men were not given a special diet or exercise program.

The supplemental testosterone reduced total cholesterol, “bad” LDL cholesterol, triglycerides, and body mass index while improving “good” HDL cholesterol. The men lost their pot bellies, appr. three or four inches off the waist, and a reduction by one-fourth to one-third of their total cholesterol. No adverse effects were reported.

Testosterone Replacement Therapy: No Age Effects?

In a second study, the same 95 men were divided into three groups, based on age: less than 57, 57 to 63, and older than 63.

They found the older men and the younger men had similar improvement in their risk factors.

Precautions with testosterone supplementation

It is well known that with prostate cancer, the cancer is usually dependent on testosterone. Prostate cancer is a slow-growing tumor. Cancer must be ruled out before starting supplements, and routine prostate checkups are advised.

A test to monitor red blood cell formation, called a hematocrit, is needed, too. The potential increase in red blood cells, can theoretically boost heart attack or stroke risk.

Testosterone and Death Risk

Low testosterone levels are associated with an increased risk of death, according to Robin Haring, a researcher from Germany.He evaluated data on nearly 2,000 men, aged 20 to 79, following them for seven years until August 2007. He noted testosterone levels, age, weight, smoking habits, and physical activity. During the follow-up, 226 men died. Men with low testosterone have a more than twofold higher risk of death during the follow-up period.

They were more likely to die of cardiovascular disease and cancer, but not of other causes.

Testosterone Replacement Therapy: Long-Term Effects Unknown

The problem area  about supplemental testosterone is the lack of knowledge on long-terms effects. Testosterone [in excess] can increase blood pressure and compromise kidney function. These problems can be seen with bodybuilders using large doses of testoterone or an equivalent derivative. If health risks with the low supplementation to “natural” levels can induce similar problems has not be seen yet in studies, sideeffects were not significant but patients were also filtered on possible prostate problems. With influx of new ways of taking TRT we wonder how this market will develop. Low testosterone levels are not [yet] indicated as a disease so reimbursement by insurance is nill. Dermal patches and gels and (long acting) injections range in price between $20 – 200 monthly excluding the tests and consultation fees.  Allthough the studies show that restoring testosterone when it is low improves metabolic syndrome factors and could help prevent type 2 diabetes and cardiovascular risks as with other therapies lifestyle changes can also have a significant effect on the hormone levels and the mentioned risk factors, especially the good old watch what you eat (and how much) and exercise !