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About Stephen W. Leslie, MD
Expertise
Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience
Full time practicing urologist with 20 years experience. Assistant Clinical Professor of Urology at the Medical College of Ohio. Editor in Chief of eMedicine Urology internet textbook. Author of only book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison

Awards and Honors
Thirlby Award of the American Urological Association.

You are here: Experts > Health/Fitness > Urology > Urology > Erectile Dysfunction

Urology - Erectile Dysfunction

Expert: Stephen W. Leslie, MD - 11/4/2009

Question
Hello, I am a 25 years old male, who is suffering from erectile dysfunction and fatigue/muscle weakness.
I believe this has been going on steadily since last year and my general stamina has also decreased steadily. I am also losing hair and this coincides with decrease in stamina and erection (I think I'm not getting sufficient blood flow to the head, penis, testicles and muscles).
My erection has been steadily getting weaker (on a scale of 0 to 10 with 10 being the strongest), I feel like I am close to 0 or 1 now. I feel extremely tired at the end of every day even though I do not do any exhausting physical activity. I noticed that I am not able to gain muscle as before and since I am tired all the time I have not done any weights for quite a while now and I have lost quite a bit of muscle.
During the day, when I work mostly sitting on the chair, I often feel weakness in muscle and feel very tired. At the end of the day I feel tension headache at the back of head which is relieved when I take a warm bath.

When I felt normal (two years ago), whenever I didnt ejaculate for about a week, I felt this urge to ejaculate and would feel like my testicles are full of sperm. I am not sexually active right now and I haven't masturbated for more than a month now and I feel like my testicles are emtpy. I feel like there is no blood flow to the penis and testicles as they are very cold when I touch them sometimes. Last few times I masturbated this year I noticed my sperm was watery. I don't know what it is but I think somehow my testicles are failing. I feel so weak all the time and I cannot remember the last time I had a strong erection.

I read online about low testosterone symptoms and I have at least 7 or 8 of 10 symptoms listed and I went to see a doctor regarding this problem and he did a blood test on me. He said I have testosterone level of 780 and this is in the high range and everything else was normal. He thinks I am fine and am worrying too much and gave me antidepression medicine (10mg Paxil). I have been on this for about a month and this has not done anything. I honestly feel like I am healthy mentally and something is physically wrong with my body.

To summarize here are my questions:
Do you think I am suffering from hypogonadism or some other urological problem or is it a mental problem?
If so (urological), should I find an urologist instead of going to this primary care physician? This physician did not mention any free testosterone level and I am not 100% sure but I don't think he even asked for free testosterone level in the blood test. Am I right that it is the free testosterone level that defines hypogonadism and can you have low free testosterone level but normal total level?
What other tests are there to see if my testicles are functioning properly and producing sperm other than checking testosterone levels?

Any help would be appreciated as this condition is really making my life difficult.

James

Answer
James:

With a 780 testosterone level you do not have hypogonadism. WHile anything in medicine might be possible, it is extremely unlikely that you would have low free testosterone with a total level as high as yours. You could have some other hormonal problem such as low thyroid or low cortisol. An endocrinologist or internist could look into these possibilities for you.

The testicles have two functions: making sperm and making testosterone. Your symptoms would not suggest a low sperm count but it can be done if you want.

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