Sexual Potency

Testosterone levels can be low in ESRD patients and are usually associated with high levels of prolactin. Besides causing impotence, lack of testosterone can also contribute to bone disease. Both are multicausal problems which need to be sorted out and treated specifically. Instead of the shots, testosterone is now availabe as skinpatches that are applied daily. One has to be cautious with oral testosterone which can lead to liver problems over the long haul. If one is impotent, just taking testosterone may not solve the problem and other causes need to be looked for, such as:

• Depression
• BP medications
• Poor circulation or nerve damage
• Inadequate dialysis causing one "not to feel well"
• Change in relationship between spouses due to ESRD

There are treatments available for almost all causes of impotence. It should also be noted that women with ESRD may have low estrogen levels as well, certainly after menopause. Consideration should be given for replacement for all the reasons estrogen is replaced in non-ESRD women. Testosterone and estrogen as estradiol can easily be measured in the blood.

Impotence Evaluation

Is a Urologist better than an Endocrinologist for impotence?

The urologist may have more interest and skills in the "plumbing" aspects of impotence, those that particularly effect patients with diabetes or athersclerosis. This is not to say that they cannot also have skills with hormonal manipulation.

On the other hand the endocrinologist, particularly one who specializes in this area (ask when making appointment) should be quite skilled in hormone manipulation, replacement and medications.

Peter Lundin, M.D.

Edited by Stephen Z. Fadem, M.D.

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