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Nonsurgical Treatment of Erectile Dysfunction (cont.)

Yohimbine

Yohimbine, an herbal product, comes from the bark of a West African tree. Its use in treating erectile dysfunction is questionable, and, in studies, yohimbine is only slightly better than placebo (no drug at all).

Nonetheless, yohimbine is considered safe with few known side effects. The usual daily dose is a 5.4-mg tablet taken 3 times a day.

Hormonal Therapy

Men with low sex drive and erectile dysfunction may have low levels of testosterone (the male hormone). As a general guideline, a testosterone level of 300 ng/dL or less is considered low, but this varies depending on the laboratory that does the testing and the time of day the sample is taken.

Hormone replacement may be beneficial, especially when used in combination with other therapies for erectile dysfunction; however, testosterone supplementation alone is not particularly effective in treating erectile dysfunction.

Sexual desire (libido) and an overall sense of well-being are likely to improve when serum testosterone levels (the level of the male hormone in the blood) are restored.

Replacement testosterone is available in the following forms:

  • Injections: Injections are a reliable way to restore testosterone levels, but this therapy requires periodic injections (usually every 2 weeks) to sustain an effective level. It also causes high hormone levels right after the injection and low hormone levels just before the next shot. This is thought to be slightly more risky than other methods that maintain a moderate hormone level throughout the treatment period.
  • Skin patches and gels: Skin patches and gels that are rubbed into the skin deliver a sustained dose and are generally well accepted. A strip that is placed in the mouth on the gums is also available. With the patches and the gels, skin rashes and irritation are the most common problems.
  • Injectable pellets (Testopel) are injected under the skin every 4-6 months. Testosterone levels are maintained at an effective level, but the injection can be uncomfortable and cause bruising.
  • Oral therapy (pills): This is the least effective therapy. Pills are also associated with a small risk of liver problems. Testosterone pills are not recommended.

If your doctor prescribes long-term testosterone replacement therapy, you will have follow-up visits to assess your testosterone levels, to periodically monitor your blood counts, and to undergo regular prostate checks, including digital rectal examinations and prostate specific antigen (PSA) blood tests.

Medically Reviewed by a Doctor on 8/27/2014
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