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What Is Men’s Endocrine Health?
for medications are often the culprit when libido wanes and erectile vigor can no longer be sustained.
Men’s endocrine health incorporates physical activity and sound nutrition to maintain a strong body; however, a ma-
Not all doctors are comfortable discussing sexual problems
jor emphasis includes male sexuality and erectile dysfunc-
and betray their own anxiety by responding to the word
tion. The “Power of Prevention” can be applied to any
“sex” or “ED” by writing a prescription for Viagra, Levi-
man’s life in order to live a healthy lifestyle.
tra or Cialis to dispose of the problem and the patient as quickly as possible.
Signs & Symptoms
Insist on a full evaluation, which should consist of history,
Signs and symptoms of male sexual and erectile dysfunc-
including a detailed inventory of current medications of
tion include: difficulty having an erection, difficulty main-
tobacco and alcohol use, and physical exam as well as blood
taining an erection, loss of sexual desire, and low blood
tests for hormone levels. Effective treatment follows proper
LoW TESToSTEronE and Ed
My doctor said I have a very low testosterone level and that could
In order to help you better understand male endocrine dis-
cause ED. He recommended that I have testosterone injections every
orders, the following are male endocrine disorder condition
two weeks. I am squeamish about injections. Is there any other way I
scenarios presented in the form of questions from patients
Yes, a low serum testosterone level may be responsible for
LoSS of SExuaL dESIrE
ED and therapy designed to increase serum testosterone
My husband, now 60, seems to have lost interest in sex. We were
levels can be helpful in restoring a man’s sexual vigor. Sev-
having sex once a week or at least once every other week until about six
eral treatment options exist to help normalize serum testos-
months ago. Now whenever I want to have sex he says he is too tired
terone, including testosterone injections into a man’s but-
or not interested. Is there something wrong with him or me? Does he
tocks or shoulder muscles, as well as skin surface treatment
involving the application of a testosterone impregnated patch on the back or shoulders, or one of two testoster-
Interest in sex-libido is governed by a man’s mood, his abil-
one gels rubbed onto the shoulders or abdomen will raise a
ity to concentrate his mind on sex-sensate focus as well as
the free flow of blood into the erectile chambers of his penis so that when sexually aroused, he responds with a
fully rigid erection. An adequate quotient of testosterone ensures that the system runs smoothly.
When a man is young his testicles spew out generous sup-
Testosterone administered by injection maintains normal
plies of testosterone; and, as sexual thoughts surface, he is
blood testosterone levels only for a fortnight. Testoster-
easily aroused responding with an erection to almost any
one levels then decline and another injection is required.
sexual cue. As he matures, erections continue in sexual
In contrast, daily appreciation of the testosterone patch
situations but not always with the same spontaneity and
(Androderm) or either of the two testosterone gels (An-
vigor of his youth. When sexual desire diminishes it may
drogel and Testim) results in stable normal testosterone
be due either to illness, depression, or a declining i.e., low
serum testosterone. A visit to the doctor will help sort out the problem and help implement a treatment plan such as
Some men experience a rash at the side of Androderm patch
therapy and/or anti-depressant medication to ameliorate
application, a problem that can be fended off by pretreatment
depression and testosterone supplements to normalize se-
of the application site with cortisone-like cream.
Both gels, Androgel and Testim, once applied to the skin
A medical history is the first step to clarify the nature of
are rapidly absorbed into the blood stream, and when ap-
the problem. A detailed inventory of medication, both pre-
plied daily are equally effective in maintaining normal tes-
scription and over the counter, currently in use is critical
tosterone levels in the testosterone deficient man.
Baseline and periodic prostate specific antigen (PSA) and
about 5% of all men taking these medications and a hand-
lipid profile measurements are routinely performed during
ful, perhaps 1%, describing a bluish tint to vision in those
any testosterone supplement therapy.
taking Viagra and Levitra but not Cialis. Even rarer is a condition referred to as NAJON, a condition causing loss
Ed TrEaTMEnT opTIonS
of vision has been reported in a handful of men who have
I see all these ads on television saying that having diabetes can cause
erectile dysfunction (ED) and I should speak to my doctor. I did. My doctor gave me a prescription for Levitra just like the ad said, but I
Men who take nitrates should not take any of the PDE-5
still have problems getting or holding on to an erection. Why, and what
inhibitors. When used as directed, Viagra, Levitra and Cia-
lis have all proven to be safe and effective treatments for the vast majority of men with ED.
You made the right first steps by seeking out advice from your physician but if all he did was hear the word “ED”
I have ED and tried all three ED medications but none worked. Is
and write out a prescription, he may not have done all he
could do to help you. For example, after the initial enthusi-asm following the introduction of Viagra, we learned that
Three options, vacuum devices, intrapenile injections, and pe-
not all men responded equally well to Viagra and were
nile prostheses exist to restore erectile function in ED patients
deemed “Viagra failures”. When these “Viagra failures”
who have failed to benefit from Viagra, Levitra or Cialis.
were studied in more detail many were found to have low testosterone levels. After treatment normalized serum tes-
Vacuum devices such as the Osbon-ErecAid consist of a
tosterone levels and Viagra use resumed, Viagra failures
cylinder attached to a manually operated vacuum pump.
“became Viagra responders” experiencing markedly im-
The cylinder is designed to fit over the limp penis and the
negative pressure created by the vacuum encourages blood flow into a progressively swelling penis. A band like struc-
Although the company that makes Levitra has an aggressive
ture is affixed to the base of the penis to maintain the erec-
ad campaign to tout their medication as THE treatment for
tion which is then sufficiently effect and engorged to allow
men and diabetes mellitus ED or high blood pressure and
ED, Viagra and Cialis are equally effective in treating the ED that accompanies these conditions.
Medicine injected directly into the penis makes it possible for a man to have an erection without sexual stimulation.
Is there any real difference between – the three ED drugs Viagra
The medication injected is called alprostadil and can be
(sildenafil), Levitra (vardenafil) and Cialis (tadalafil)?
instilled into the penis by means of an injection with a sy-
All medications in this class are referred to as phosphodi-
ringe pre-filled with alprostadil (Caverject) or an alprosta-
esterase 5 (PDE-5) inhibitors and all work to enhance the
dil permeated pellet (MUSE) released into the urethra-the
vigor of a man’s erection. Differences exist in chemical
opening in the penis through which men urinate. The penis
structure, onset of action, duration of action and side ef-
swells and becomes rigid shortly after the alprostadil is re-
fect profile. Viagra (sildenafil) and Levitra (vardenafil) have
leased into the spongy erectile tissue of the penis. Men may
a similar chemical structure, onset of activity (30 minutes to
experience a burning pain as the penis becomes erect.
one hour) and duration of effectiveness (4 hours) whereas Cialis (tadalafil) has a different chemical structure, similarly
Penile prostheses are still implanted within the penis every
rapid onset of action but a more extended duration of ef-
year to help men who have not responded to other therapy.
Some penile prostheses are designed so that the penis is in a permanently erect state whereas other newer models are
The term “duration of effectiveness” is often misconstrued
set-up so that a reservoir of fluid flows directly into the pe-
leading some men to believe that after taking any of these
nile tissue to create their erection. Then at the conclusion
PDE-5 inhibitors they will experience an erection that may
of intercourse fluid is redirected from the penis back to the
scrotal reservoir to deactivate the erection allowing the pe-nis to return to its normal flaccid state. Penile prosthesis im-
This is inaccurate. The PDE-5 inhibitors do not cause an
plantation is usually done in the hospital under anesthesia.
erection. They make it possible for a man to have an erection only in the setting of sexual stimulation. The term “duration
Written by Richard F. Spark, MD, FACE
of effectiveness” refers to the time frame after taking one of these pills during which sexual stimulation will allow a man to have an erection-up to 4 hours after taking Viagra and Levitra and up to 36 hours after taking a Cialis tablet.
Side effect profiles differ to some degree among the three medications with facial flushing and headache reported by
DEFIR S.r.l. Revisione n.8 Data revisione 05/10/2011 Stampata il 05/10/2011 BANNER GEL CLORO Scheda Dati di Sicurezza 1. Identificazione della sostanza o della miscela e della società/impresa 1.1. Identificatore del prodotto BANNER GEL CLORO 1.2. Pertinenti usi identificati della sostanza o miscela e usi sconsigliati Detergente igienizzante liquido cloroattivo 1.3. Inf
ROMEO Y JULIETA - Resumen de la obra por actos y escenas Escena I En una plaza de Verona, Benvolio, primo de Romeo y Teobaldo, primo de Julieta se enfrentan en una riña de espadas luego de intentar separar a sus criados que peleaban. La pelea se agranda y llegan los padres de Romeo y los padres de Julieta. Finalmente, llega el príncipe Escalo quien dice estar harto de que la ciudad