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Urology/Could this toprol xl be causing my ED? Are these doctors correct?


QUESTION: Greetings doctor, im a 24 year old hypertensive male who has had ED for nearly 10 months.

My Medications- Toprol Xl 12.5, HCTZ 25, Losartan 100.

I went to two urologists who refused to prescribe me anything, one asked me to do a stress test and I passed with flying colors. They did a number of blood tests and everything is normal except for slightly elevated VMA "Uro said this was due to anxiety". The doctor also said that my hypertension "which ive had for 2 years" wasn't present long enough to cause erectile problems but that the medication I take might.

I have NO morning erections but if I stimulate myself I can maintain it for some seconds but as soon as I stop stimulating I can actually watch as it deflates within 30 second I am completely flaccid again.

Finally I went to my cardiologist and he was adamant about the fact that my very tiny dose of beta blocker was causing ED. I tried quitting for 5 days and saw no improvement at all, do I need to wait longer?

What is your personal opinion about the advice/reasoning of these two doctors???? My cardiologist is supposed to 3 in the state of New York but I feel im being ignored. Where do I go from here?

Please help Doctor


ANSWER: Ragnar:

I do not understand the issue.  Your blood pressure medicine may or may not be contributing to your ED.  It doesn't really matter.  And your stopping it for 5 days with no noticeable effect is also not conclusive either way.  Lowering blood pressure can certainly affect erection function but your ED problem sounds more severe than just this effect.

One of your urologists should be offering you some help such as Viagra, Cialis or Levitra.  I do not understand the reasoning of not having a definitive cause, which is often hard to find, but still not giving any treatment.  See if one of the urologists or your GP is willing to stop stalling and fussing around trying to find an elusive etiology and just treat your problem.  If not, you should find another physician who will.

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

QUESTION: I could essentially get the same medical advice from any pharmaceutical company rep, or even a spam website from India trying to sell me fake viagra.

I have medicaid and am a student in the state of New York, I have no way of paying for ludicrously expensive ED drugs that i'll build a tolerance to in a year. The urological field to me is still in the dark ages, and is of no use to anyone but a drug company CEO.

Sex is a spontaneous activity, am I supposed to tell a young lady that I need to take a pill like an 80 year old man and she has to wait? Get real, that just isnt going to be attractive or at all accepted by people in my age group.

I'd like to think that the urological field has at least a basic understanding of what the etiology might be in such a young man, but I suppose even that's asking too much.

Whats the point of living with ED at 23? Life is meaningless


ANSWER: Ragnar:

Your attitude is not helping.  The fact that you believe that "life is meaningless" suggests an underlying element of depression which may be contributing to your ED and is certainly likely to interfere with treatment.  While only 5-10% of men with ED have a psychological problem as their primary cause, almost all will have some psychological effect.

First, I do not work for any pharmaceutical company and have no financial interest one way or the other.

Next, we in urology have generally concluded that we cannot permanently fix the vast majority of men with significant ED and that our diagnostic tools which include cavernosography, cavernosometry, penile biothesiometry, spinal evoked potentials, penile arteriography, duplex ultrasound, testosterone and hormone levels, etc. often come back as normal or negative without providing either an etiology or any help with eventual treatment.

For these reasons, we have typically adopted the "patient goal oriented approach" first promoted by a noted urologist, Dr. Tom Lue from UCSF.  This view suggests that we should concentrate on potential therapies and not waste time and money with endless testing that doesn't help much.  

Another way to look at it is this. If there is a major problem with arteries, venous leak, erectile body problems, peyronie's or nerves, there is virtually nothing that will permanently fix or cure that particular problem but we can use Viagra to treat it in the majority of cases.  If you are a student and on Medicaid, chances are that such medications are too expensive.  Alternative treatments include MUSE urethral suppositories, penile injection therapy and external vacuum devices.  Of these, the external vacuum device is overall the least expensive.

Another alternative is a daily cialis.  This is a medication similar to Viagra but is approved to be taken every day which Viagra is not.  With this medication, things should work pretty much normally.  The problem is that this is an expensive treatment which is likely to be out of reach in your situation.

We do not know as much about erection problems and treatments as we do about many other urological problems, but that doesn't mean you have to live without treatment completely.  As far as dealing with sexual opportunities, that will depend on which therapy you use and the quality of your partner.  This is usually more of an issue for the patient and most women are far more understanding and helpful than you would think.

Your alternative is to refuse treatment and live with it the way it is.  Your choice.

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

QUESTION: Thanks for the response Dr.Steve, sorry for my coarse and belligerent response. As you can probably imagine having ED at this age is unbelievably frustrating and troubling.  My suggestion isn't that you are working for a pharmaceutical company, but certainly the treatment approach seems to be lacking, don't men build up a tolerance to these drugs? If you could please indulge me.

If you can comment i'd like your opinion on the recent discovery of sound waves to treat E..D

Does this treatment look promising to you personally?

Again, I apologize for being so rude. I greatly appreciate the fact that you provide this free service and time out of your schedule to adress me concerns. Your explanation makes it somewhat more understandable why seugs are so commonly prescribed.  So just to wrap up.

1. Does the sound wave therapy to ED sound promising? Or is it quackery? Please be honest.

2. Regarding the daily cialis therapy, will I build up a tolerance to it?

3. Is it possible that daily PDE5 inhibitor therapy you suggested could actually improve erectile function indefinitely?

Thanks Doc, forgive my outburst

Sad and 23...with ED < That rhymed


Men do not build up a tolerance to the Viagra type drugs.  However, the underlying problem is likely to tend to get worse and that would explain why the Viagra you took last year no longer works as well this year.

The shock wave treatment is currently still highly investigational.  In my opinion, it is more likely to do harm than good and will need considerable testing before it is ready for routine use.  It's an interesting possibility but it will be years before it becomes available commercially even if it works great.

As far as a tolerance to the dialy cialis, I believe I've answered that already.  You have hypertension at an early age.  This usually suggests limited small artery blood flow which is the likely cause of your ED.

It is possible but not likely that taking a daily PDE5 inhibitor will improve underlying functionality.  This typically only occurs after pelvic radiation, trauma or surgery where a specific injury has occurred and the patient is now in a healing phase.  It does not appear to happen in routine cases of 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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