Recognizing and Treating Low Testosterone
More than 13 million men experience low testosterone, and men with diabetes are twice as likely to be among them. "Especially with type 2 diabetes, men with abdominal fat usually have significantly lower testosterone levels than other men," Campbell says.
About 70% of men who have low testosterone say they also have symptoms of low testosterone, such as erectile dysfunction, and 63% say their sex drive is reduced. Low testosterone can also cause depression or fatigue. Yet it often goes undiagnosed, partly because the symptoms are similar to those of other conditions.
If you have symptoms of low testosterone, a simple blood test will confirm whether it is the cause. Low testosterone is easily treated by prescription skin patch, injection, topical solutions applied to the gums, or gel applied to the skin.
Diabetes and Sex: Treating Erectile Dysfunction
A variety of methods, which are sometimes combined with low testosterone treatments, can improve erections in men with diabetes:
- Oral medications. Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are FDA-approved for treating ED. All of them begin working within a half hour. How long these medications are effective in producing an erection with stimulation varies, from about four hours for Viagra and Levitra to 36 hours for Cialis. They can't be used with some medications, and they can cause side effects -- notably, erections that may last more than four hours. But for up to 60% of men with diabetes, they are effective in treating ED.
- Injections. If oral drugs don't work, the injectable medication alprostadil (Caverject, Edex) may help. Like oral medications, it dilates blood vessels in the penis, encouraging blood flow. You inject this type of medication into the base of the penis. "It sounds painful, but men who use it love it," Campbell says. Erections come fast and may last a couple of hours. Penile injections can only be done three times a week and can cause scarring or prolonged erections. But they are effective in up to 90% of men with diabetes.
- Prostaglandin suppositories. Muse pellets are tiny suppositories, the size of a grain of rice, that are injected into the tip of the penis. They work like other medications, relaxing the muscles and dilating the blood vessels. Suppositories are easy to use and can be used twice a day. But they have downsides, including expense and testicular pain, burning, and dizziness in some cases. They can also cause burning in your partner. They are successful in about 35% of men.
- Devices. Vacuum pumps, constriction bands, and penile support sleeves are other options. Constriction bands keep the blood in the penis once it's erect, so they can be especially useful if you can get an erection but have trouble keeping it. Vacuum pumps are inexpensive, can be purchased at a pharmacy without a prescription, and work to some degree on virtually all men. But they are more complicated to use than constriction bands. "They require a lot of lubrication, a lot of stimulation, and your partner's participation," says Campbell. Penile sleeves or implants can be good choices for men who are physically unable to get an erection.