DEAR DR. ROACH: I have a bad case of erectile dysfunction. I am 80 years old and otherwise in good health. I received an announcement in the mail that said it’s not a lack of testosterone, but rather too much estrogen in the body. They make a lot of promises, but it scares me to reduce estrogen without more knowledge. What do you know? How can I overcome this problem and enjoy sex again? — Anon.
TO RESPOND: The effect of estrogen on male sexual function is controversial. While it is true that men with erectile dysfunction are more likely to have high estrogen levels, reducing estrogen with drugs (anti-estrogens) in men with erectile dysfunction is rarely used as a treatment. The most common drugs, such as sildenafil (Viagra), mainly act on the blood vessels, but also have effects in increasing testosterone and estrogen levels in men.
The vast majority of men with erectile dysfunction, even in their 80s, experience success with Viagra and similar drugs. I check testosterone levels and consider testosterone replacement in older men with erectile dysfunction. Anti-estrogens are used in men with low libido and low testosterone, often in combination with testosterone, particularly when fertility is an issue – testosterone can significantly reduce sperm count and anti-estrogens increase sperm count. testosterone levels with less effect on sperm count. I wouldn’t prescribe an anti-estrogen, but I would refer a man who reacts poorly to Viagra-type drugs and testosterone to an expert in male sexual function.
DEAR DR. ROACH: My husband is one of five brothers, all born in the 1940s. Their father died of Parkinson’s disease. Three of the five brothers have been diagnosed with Parkinson’s disease and/or Lewy body dementia. All affected brothers developed symptoms in their late 60s or 60s, and my husband is now 80 (the other brother is 75 – neither he nor my husband have symptoms). What are the chances that the two remaining brothers will be hit? – THE
TO RESPOND: Most cases of Parkinson’s disease are sporadic and non-familial. However, there are familial cases, and these are more likely when affected family members are aged 50 or younger at the time of diagnosis. That being said, I am bound to believe that there is a family association in your husband’s family, given their history.
I have read about many different genes involved in familial Parkinson’s disease, and mutations in some of these genes also predispose to Lewy body disease. The mode of inheritance can be recessive, dominant or sex-linked, depending on the gene. Due to the large number of genes, it is impossible to give precise ratings for the development of Parkinson’s disease or Lewy body disease in your husband’s case.
The fact that your husband is now older than any affected family member at the time of diagnosis and has no symptoms is certainly a good sign that he will not develop any of these diseases. Early symptoms can be subtle, and an expert such as a movement disorder neurologist could make the diagnosis months or years before the symptoms become noticeable to you or your husband, although I’m sure you are more apt to notice them, having had so many family members affected.
There are genetic tests available for many of the identified familial genetic variations; however, their interpretation is difficult. Also, since we don’t have therapies that can stop or slow the progression of Parkinson’s disease, I don’t recommend genetic testing for Parkinson’s disease.
Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.