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Urology/ED at 23, what is the most likely cause?


QUESTION: Greetings Doctor, I am a 23 year old male with a history of hypertension since 21 and what I am told is an anxiety disorder. Currently I take Losartan 100 HCTZ 25 and toprol xl 12.5 to manage the hypertension. This entire episode began happening presumably 7-8 months ago.  Essentially I began to notice that I no longer have/had morning erections whatsoever. To compound the problem if I do manage to get an erection it is always from laying on my back watching pornography and even then it quickly fades if I stop stimulating myself or if my thoughts begin to drift.   The bottom part of my penis "corpus spongiosum area" used to be something I could control to pump blood into my penis, now it feels weak and only throbs/contracts when I am having an orgasm, occasionally the orgasm feels stifled as if something is blocking the upper portion of the urethra.

My PCP has essentially refused to give me any sort of urological referral and blames the ED on my anxiety.  I plan on becoming a PA in the future and was well aware that ED commonly happens in conjunction with CAD so I demanded an echo stress test which I passed.

Is there anything that sticks out here in terms of diagnosis? Im merely asking you to make an educated guess on the information provided.

Much appreciated, and pardon the alias

ANSWER: Ragnar:

At 23, you already have three problems that can contribute to ED.  Specifically, an anxiety issue, hypertension which suggests arteriolar constriction, and possible medication side effects.  The exact source cannot be determined from the information provided.  The lack of morning erections would tend to suggest one of the latter two etiologies.  If your primary physician will not treat this or refer you, then you may need to do the consult yourself or appeal to your insurance company's medical director if appropriate.

---------- FOLLOW-UP ----------

QUESTION: Thank you doctor for your prompt response.

In thecase of arteriolar constriction, does my clear stress test at least suggest that it is affecting the penis but not necessarilly the coronary arteries? Or can I expect a massive heart attack in 5-10 years?

What would the treatment be? Would it be safe to take cialis/viagra with the medications I am taking? Another possible contributing factor is I ride an exercise bike "flat, square seat" daily for 30 mins- 1 hour.

Is there any way to reverse ED at this age without medication at this young age?



I don't know if you have arteriolar issues or not, but this is a common cause of hypertension and would restrict penile blood flow.  The fact that your stress test was normal only means the coronary arteries are OK.  They didn't test the arteries in the penis which are considerably smaller.  This can be done with penile doppler studies if deemed necessary.

I can't comment on your risk for a heart attack.  I'm not a cardiologist.  You'll need to ask your primary physician about that.

Treatment is relatively simple.  You can try eliminating the medications briefly to see if that has an impact.  If so, then you have an answer. If not, then it's something else.  Only do this with the consent of your physicians.

Standard treatment is Viagra/Levitra/Cialis.  These would appear to be safe with your current meds.  Other options include MUSE, Vacuum devices and intracorporal injections.

Without a clear cause identified, it's not possible to estimate the reversal potential of your ED.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved 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.

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

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.

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. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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