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Question:
I'm 60 years old and I've been feeling nervous, irritable, and I'm not sleeping very well lately. My erections come and go when I'm with my wife. My doctor says there's nothing wrong. What's going on?

Answer:
by Richard F. Spark:
(05/26/2004)
When we, as doctors say that "there's nothing wrong," what we are really saying is what we measured when you were in the office - your blood pressure, pulse, breathing and standard lab tests did not reveal anything abnormal This should be reassuring, but if you are still feeling poorly something must be out of kilter. Most commonly middle-aged men with symptoms similar to yours - nervousness, irritability, restless sleep and difficulty maintaining an erection - have one of two problems, either below-normal hormone (thyroid or testosterone) levels or an underlying depression. The only way to know if you have a hormone problem is to ask your doctor to order some specific tests. Most routine blood tests measure blood count, kidney and liver function, as well as cholesterol, but do not routinely measure hormone levels. You have to ask for that test. If either thyroid or testosterone tests reveal lower than normal hormone values - a hormone deficiency - your doctor may prescribe hormone replacement therapy. Then, once hormone levels are normalized you should start to feel better again. If your hormone levels are normal, then hormone therapy is neither warranted nor likely to be effective. Some other factor - possibly a depression - may be what is making you feel poorly. You do have to feel "sad" to be depressed. Often the earliest signs of depression are just what you have been describing - irritability, poor sleeping and sexual problems. Other symptoms may include lack of appetite, weight loss, inability to feel refreshed after a night's sleep, and low self-esteem. Speak to your doctor - he or she may be able to help you directly, or refer you to a specialist to determine if a brief trial of an ant-depressant medication would be helpful. For more information see Chapter 12: Hormones and Sexuality and 17: Psychologic Factors Affecting Potency and Ejaculation in my book Sexual Health for Men: The Complete Guide, 2000, Perseus Press.

Reviewed by Sexual Health Editorial Team

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