Testicular Failure In recent years, there has been increasing interest in the study of aging males. Testicular failure increases with age as serum testosterone levels gradually decline. This process is not universal. When it does occur, there is significant variability in the age at the onset and the degree of the androgen decline associated with age.

Androgen Deficiency The estimated prevalence of androgen deficiency among men 40–70 years of age ranges from 12% to 45%. Approximately 481,000 new cases of androgen deficiency are diagnosed yearly in the USA.

Physiologic levels of testosterone support several critical processes involved in penile erectile response, including the maintenance of libido and energy levels, in addition to the cascade of events mediated by nitric oxide leading to arteriolar dilatation and relaxation. Screening for hypogonadism in men initially presenting with ED can help identify these men. Drug-Induced ED Erectile dysfunction is a common adverse effect of a number of drugs, and it often has a great effect on patient compliance.

This subject as a risk factor is lightly discussed here and further discussed in more detail later in the textbook. It is important to recognize that many of the drugs associated with ED are used to treat conditions that are themselves risk factors for ED, thus the interpretation of ED in the setting of pharmacological therapy is often difficult in the clinical setting.

Perhaps, nothing in life can be more frustrating than a sex life, which is in serious danger of going down the drain. Unfortunately, many couples undergo this trauma when impotence strikes the man out of the blue.

It literally hits the man below the belt and leaves him feeling insecure and powerless. He is often tormented by doubts over his masculinity and the problem consumes a lot of his mental energy as he frets over it.

Costly neglect
Such men tend to emotionally and physically withdraw from their partners thereby straining the relationship. When men intentionally or unintentionally neglect the problem, they only end up harming themselves by decreasing the chances for a positive treatment experience and prolonging recovery.

Instead, it would be more prudent for affected men to tackle the scourge head-on. The first step would be to understand the problem and get to its root.

Know the problem
No doubt, ejaculation is intensely pleasurable for men. But it is regulated by different systems and is as such a complex phenomenon. So, things often can and do go wrong. More than four out of five cases of impotence are the result of a medical problem. Physical impotence can be caused by conditions like diabetes, hypertension, coronary artery disease, hormonal disorders, nerve damage, radiation therapy, injury and substance abuse.

Psychological causes of impotence can include stress-related disorders secondary to depression, addiction or problems caused by work or family.

Counselling and therapy can help if impotence is due to psychological factors. However, if it is due to physical causes, then drug therapy could be the best option besides cutting down on smoking, drinking and substance abuse.

Tried and trusted drug
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Statistics show that more than 80 per cent of men taking Generic Viagra 100 mg could get better erections. Its safety has been demonstrated in over 130 clinical trials involving 1,3,000 men.
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