The fact that the testosterone level in men decreases with age is completely normal and does not need to be treated. However, if a man has an erectile dysfunction, it may be helpful to correct the testosterone deficiency (hypogonadism). Sometimes this has a positive effect on the potency. Also, the phosphodiesterase-5 inhibitors often work better when taken with hormone therapy. Testosterone can be sprayed at longer intervals or applied as a gel on the skin. This form of therapy has been controversial for a while as it appears to increase the risk of heart attack or prostate cancer. But according to recent studies, this is not the case.
A purely mechanical help with erectile dysfunction is vacuum therapy. Shortly before sexual intercourse, the man places a transparent plastic cylinder on the penis, which is connected to a pump via a hose. He creates a negative pressure, the cavernous bodies are filled with blood, and there is an erection which helps enhance sexual performance. At the root of the penis sits a rubber ring, which prevents the blood from draining off again. At the latest after 30 minutes, this ring must be removed, otherwise it can lead to circulatory disorders, and the penis can be damaged. Men with cardiovascular disease should use this method only after consulting their doctor.
If the medical and mechanical therapy attempts are unsuccessful, there is the possibility, in particularly severe cases of erectile dysfunction, of using penile implants in the penis. Since the corpora cavernosa are partially removed in this procedure, the operation is irreversible and should be well considered. There are currently two variants of artificial erectile tissue:
In the case of the hydraulic penile prosthesis, the man gets a small pump in the scrotum and a reservoir filled with saline solution in the lower abdomen in addition to the implant in the penis. If necessary, he can operate the pump so that water gets into the cavernous prostheses, it creates a hard erection. After intercourse, the water is transported back to the reservoir at the touch of a button, the penis relaxes. It can sometimes come to infections or technical defects.
The second variant is the so-called flexible penile prosthesis. The erectile tissues are replaced by silicone implants. The penis is bent in everyday life down and before sexual pleasure in the desired position. The silicone implants, however, even in the “non-erect” state ensure that the visual impression of an erection arises – which can cause irritation in some situations such as in the swimming pool or the sauna. Possible side effects of the flexible penile prosthesis are infections, swelling and, after prolonged use of the implants, arterial calcification or dying penile tissue.
If the erectile dysfunction has psychological causes, the person concerned should seek the conversation with a sex therapist. Since even a physically induced erectile dysfunction can be a psychological burden for the man, a consultation or psychotherapy is also recommended concomitantly here.