• What is erectile dysfunction (ED)?
    Erectile dysfunction (ED) happens when it is difficult to get an erection or maintain one firm enough for sex. Many men experience ED occasionally. When a man can’t get or keep erections more than half the time, he has an ED condition. It’s estimated that ED may affect up to 30 million men. Poor ability to maintain a firm erection is often the first symptom of ED and signals the need for a thorough cardiovascular evaluation.
  • How do erections work?
    When a man is sexually aroused, the arteries relax to let more blood flow into the penis while veins close up. Blood flowing to the penis gets trapped in a part called the corpora cavernosa. The trapped blood expands the penis and keeps it erect. The entire erection process that involves increased inflow of blood and decreased outflow is due to relaxation of smooth muscle tissues in the penile arteries (arterial smooth muscle) and the body of penis (trabecular smooth muscle). Once blood stops flowing in, with relaxation of the smooth muscle tissues the veins open again and the penis gets soft.
  • What are the symptoms of ED?
    Symptoms may include: difficulty getting an erection; difficulty keeping an erection; less interest in sex (lower libido); and often, associated early (premature) ejaculation.
  • What are the causes of ED?
    Physical and psychological issues can cause ED or a combination of both. Physical causes include: heart disease, atherosclerosis, high blood pressure, high cholesterol, type 2 diabetes, obesity, metabolic syndrome, Parkinson’s disease, and multiple sclerosis. Alcoholism, substance abuse, and sleep disorders can also cause ED, along with treatments for enlarged prostate and prostate cancer. Psychological causes include: depression, anxiety, other mental health issues, stress, and relationship issues. Some medications, such as certain antidepressants or antihypertensives, can cause ED.
  • How does ED affect a man’s general health?
    ED may indicate underlying health issues such as cardiovascular disease, high blood pressure, or type 2 diabetes. At The Billups Center, we often detect early or undiagnosed diabetes, hypertension, and elevated cholesterol. If we learn a patient may have any of these conditions, we’ll refer him to the right specialist and stay in close contact with his specialist.
  • What are the risk factors for ED?
    Risk factors include: type 2 diabetes, heart disease, obesity, long-term tobacco use that restricts blood flow, heavy alcohol or drug use, obesity, prostate surgery, radiation treatment for cancer, prostate issues, injuries to the nerves or arteries to the penis, certain antidepressants, antihistamines, blood pressure medications, pain medications, stress, anxiety, and depression. Long term bicycling can also cause ED temporarily or permanently and is of special concern, if there is associated numbness of the penis, perineum or scrotum.
  • How is ED diagnosed?
    As the causes of ED can be both physical and psychological, at The Billups Center, we look at all the factors that can impact ED when diagnosing a patient. We consider his medical and sexual histories, family health history, weight issues, nutritional habits, exercise level, alcohol and tobacco use, medications and supplements he’s taking. We perform a physical exam, run appropriate blood, urinary, and other relevant tests, such as Penile Doppler Ultrasound, when indicated. We help our patient get comfortable speaking frankly about his sex life so we can learn if stress, depression or anxiety is affecting him. As ED can also indicate underlying causes such as type 2 diabetes or heart disease, we are always ready to refer patients to the right specialists.
  • How is ED treated?
    At The Billups Center, we take a big-picture view of treating ED and take great pride in a high rate of success for most of our patients. We work with each patient to put together the best treatment plan for him, including steps he can take to improve nutrition, weight control, and exercise. We consider his age, lifestyle, and possible drug-to-drug interactions. While pills to stimulate blood flow are viable for some patients, they may not be right for up to 50% of them. Treatment may also include injections of a vasodilator directly into the penile corporal body or use of an intraurethral suppository vasodilator. Both of these methods stimulate an erection by relaxing the penile smooth muscle tissues and subsequently increasing the inflow of blood, while decreasing the outflow. An external penis pump used with a constriction band, known as a vacuum suction device, is a mechanical option that may be right for some patients. Penile implant surgery is an excellent treatment option for the appropriate patient, after a comprehensive evaluation, education, and adequate trial of other medical therapies. For psychological concerns (chronic stress or anxiety) or relationship issues, we refer our patients to a qualified therapist or counselor with an interest in Sexual Medicine as part of his/her practice. For depression, we refer our patients to a psychiatrist who is familiar with impact of depressive illness on sexual health.
  • Do nutrition and exercise have an impact on ED?
    Yes. Nutrition and exercise impact conditions that affect ED, such as obesity, type 2 diabetes, high blood pressure, and cholesterol levels. Good nutrition and appropriate exercise can also have a positive impact on a man’s overall health and energy level, along with his self- confidence. We believe that poor or inadequate nutrition is a common root cause of many chronic medical conditions and plays a definite role in the development of ED.
  • How common is ED?
    A. It’s estimated that ED may affect up to 30 million men in the US and that ED may affect 50% of men at some time between the ages of 40 and 70. As men age, their risk of ED increases.
  • What is testosterone?
    Testosterone is the main male sex hormone. It is produced by the testicles and responsible for a man’s reproductive development. Testosterone is a key part of a boy’s transition from puberty to sexual reproductive maturity. During puberty, testosterone helps the penis and testicles grow; hair to begin developing on the face, pubic area, and chest; strengthen muscles and bones; deepen the voice; and promote height. After puberty, testosterone helps regulate red blood cell production, bone density, muscular strength and mass, sperm production, distribution of body fat, growth of facial and body hair, and a man’s sex drive.
  • What is low testosterone?
    According to the National Institutes of Health, normal testosterone levels range from 300 to 1,000 nanograms per deciliter. Testosterone levels tend to decrease gradually after age 30. Hypogonadism is a condition that prevents the body from making the normal amount of testosterone. This can be caused by testicular problems (primary hypogonadism) or upstream at the hypothalamus or pituitary gland (secondary hypogonadism) responsible for controlling the testicles. Other conditions, such as type 2 diabetes and obesity, can also lead to lower levels of testosterone, as well as autoimmune diseases, alcohol, and opioids.
  • What are the symptoms of low testosterone?
    Symptoms may include: decreased sex drive (libido), erectile dysfunction (ED) (unable to get or maintain an erection), lower sperm count and infertility, enlarged or tender breasts, less energy, inability to concentrate, irritability, low mood, changes in sleep patterns.
  • How does low testosterone affect a man’s ability to have sex?
    A man may find he has a lower sex drive (libido), suffer from erectile dysfunction (ED) that makes it difficult to get or keep an erection, and have less overall energy.
  • How does low testosterone affect a man’s general health?
    Low testosterone may lead to other health problems such as muscle weakness, bone weakness, and infertility.
  • Are there health risks related to low testosterone?
    Men with low testosterone may be at greater risk for cardiovascular disease, type 2 diabetes, metabolic syndrome, and obesity.
  • How is low testosterone diagnosed?
    As part of your evaluation, your healthcare provider will do a blood test to check the level of “serum testosterone” in your blood. He or she may do this blood test several times to compare levels. For your diagnosis, your provider may consider: sexual problems you may be having, current or past illnesses, your nutrition, medications that could affect your testosterone level, family health history, check if your testicles have been damaged or are shrinking, check if there are recent changes to your breasts, ask about changes in your mood, ability to concentrate, and sleep patterns. At The Billups Center, our routine is to obtain at least two separate early morning fasting blood samples for testosterone testing because there is some evidence that testosterone levels may transiently decrease after eating due to ingestion of glucose (blood sugar).
  • How is low testosterone treated?
    Your physician will work with you to choose the right treatment plan. Your plan may include lifestyle changes for your diet and level of physical activity. It may also include a testosterone replacement in the form of a daily patch or gel on the skin, an injection that can be short-acting (every 1 to 2 weeks) or long-acting (every 10 weeks), or pellets that are placed under the skin and last for up to 4 months. Less commonly used forms of replacement therapy include a tablet that gets placed between your cheek and gum twice daily or a nasal spray used 3 times a day. Instead of testosterone replacement, your treatment plan may include taking pills that can help your body produce more testosterone.
  • Do nutrition and exercise have an impact on testosterone?
    Yes. Obesity, especially abdominal obesity characterized by a waist circumference greater than 40 inches measured at the belly button, can contribute to lowering testosterone. A balanced diet can help reduce weight as can an appropriate amount of exercise. (Be sure to ask your physician what level of exercise is right for you first.) Exercise has also been shown to temporarily boost testosterone levels. Being fitter can also boost your confidence level.
  • How common is low testosterone?
    Low testosterone is a common condition—it’s estimated that 39% of men age 45 or older will have low testosterone levels.
  • Is there a connection between low testosterone and prostate cancer?
    There is no current research evidence that testosterone replacement therapy (TRT) causes prostate cancer. It is important to follow a man’s PSA blood test level both as a baseline before TRT and during TRT. If a man is noted to have a significantly elevated PSA after TRT, he usually needs a prostate biopsy to evaluate for prostate cancer. If he is found to have prostate cancer after starting TRT, he had a pre-existing undetected prostate cancer that must be evaluated and treated accordingly.
  • Can men with a history of prostate cancer be treated with testosterone replacement therapy?
    Men with a history of prostate cancer (previously treated with surgical removal of the prostate or one of the radiation therapy techniques) can be considered for testosterone replacement therapy (TRT) after a comprehensive evaluation. This includes men with prostate cancer under an active surveillance protocol. The decision to use TRT in these populations of men is individualized and takes a number of factors into consideration. At The Billups Center, we often get referrals to see men with prostate cancer or a history of prostate cancer for possible TRT. Each patient must be fully evaluated and educated for informed consent before any individualized treatment decision is made.
  • Is there a connection between low testosterone and cardiovascular risk?
    In November 2013 and January 2014, two studies were published reporting increased cardiovascular risks in men on testosterone replacement therapy (TRT). These studies triggered a flurry of concern in the general public and medical profession, including the FDA. When investigated by multiple sexual medicine societies, both studies were found to have significant flaws in methodology that challenged their conclusions. In addition, there is a body of scientific literature supporting that low testosterone may increase cardiovascular risk and be associated with increased risk of other comorbidities, including obesity and type 2 diabetes. There is also preliminary evidence that, in some hypogonadal men, TRT can improve glucose metabolism and lower overall risk of cardiovascular events. In order to resolve the situation, there needs to be a long-term, randomized, placebo-controlled clinical trial to better assess cardiovascular risk in hypogonadal men undergoing TRT. At The Billups Center, we take the time to educate men about the potential risks and benefits of low testosterone and TRT. While there is no final consensus on cardiovascular risk associated with TRT, we feel that with proper education, evaluation, monitoring and follow up, TRT is an appropriate treatment for many men. Each man is assessed on an individual basis and followed with a treatment plan that is personalized for his medical status.

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1508 Carl Adams Drive, Suite 400, Murfreesboro, TN 37129