Dr. Roach: The controversy over estrogen reduction and ED
Dear Dr. Roach: I have a bad case of erectile dysfunction. I am 80 years old and otherwise in good health. I have received an ad in the mail that says it is not a lack of testosterone, but rather too much estrogen in the body. They make a lot of promises, but it scares me to reduce estrogen without further knowledge. What do you know? How can I overcome this problem and enjoy sex again?
Dear Anon.: The effect of estrogen on male sexual function is controversial. While it is true that men with erectile dysfunction are more likely to have high estrogen levels, reducing estrogen with medications (antiestrogens) in men with erectile dysfunction is seldom used as a treatment. The most common drugs, such as sildenafil (Viagra), work mostly on blood vessels but also have effects on raising both testosterone levels and estrogen levels in men.
The vast majority of men with erectile dysfunction, even in their 80s, enjoy success with Viagra and similar drugs. I check testosterone levels and consider testosterone replacement in older men with erectile dysfunction. Antiestrogens are used in men with low libido and low testosterone, often together with testosterone, especially when fertility is a concern — testosterone can dramatically reduce sperm counts, and antiestrogens raise testosterone levels with less effect on sperm count. I would not prescribe an antiestrogen, but would refer a man with poor response to Viagra-type drugs and testosterone to an expert on male sexual function.
Dear Dr. Roach: My husband is one of five brothers, all born in the 1940s. Their father died of Parkinson’s disease. Three of the five brothers have been diagnosed with Parkinson’s and/or Lewy body dementia. All the affected brothers developed symptoms in their late 60s or 70s, and my husband is 80 now (the other brother is 75 — neither he nor my husband have any symptoms). What are the chances that the remaining two brothers will be stricken?
Dear L.E.: Most cases of Parkinson’s disease are sporadic and not familial. However, there are familial cases, and these are more likely when the affected family members are age 50 or less at the time of diagnosis. That being said, I’m compelled to believe there is a family association in your husband’s family, given their history.
I read about many different genes involved in familial Parkinson’s disease, and mutations at some of these genes predispose also to Lewy body disease as well. The mode of inheritance can be recessive, dominant or sex-linked, depending on the gene. Because of the large number of genes, it’s impossible to give precise odds on development of Parkinson’s or Lewy body disease in your husband’s case.
The fact that your husband is older now than any affected family member at the time of diagnosis and has no symptoms is definitely a good sign that he may not develop either of these diseases. Early symptoms can be subtle, and an expert such as a neurologist who specializes in movement disorders could make the diagnosis months or years before symptoms become noticeable to you or your husband, although I am sure you are more adept at noticing them, having had so many family members affected.
There are genetic tests available for many of the identified familial genetic variations; however, their interpretation is difficult. Further, since we don’t have therapies that can stop or slow down the progression of Parkinson’s disease, I do not recommend genetic testing for Parkinson’s disease.
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