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I am exploring the possibility that my erectile dysfunction…

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Hi there. I am exploring...
Hi there. I am exploring the possibility that my erectile dysfunction is being caused by neurotransmitter issues in the brain. I've ruled out physical causes through extensive ultra sound and nerve function testing. It's not testosterone because I've been on low t treatment for 2 years and my numbers have been good for some time now. I have smoked/done pot/alcohol for a long time but I've abstained for months from all with no improvement. I've struggled with this since I was 26, for 9 years now, even with good diet and exercise. I'm looking into neurotransmitters as they might be related to stress and maybe a bad anxiety issue. I figure I've got low dopamine fixable by quitting smoking and such for 3 months. How do I know if I have high or low serotonin though? The symptoms of each are almost identical. I have noticed occasional unexplained shivers that might be from high levels, but no sunlight exposure really so it could be low levels?
Submitted: 22 days ago.Category: Urology
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Answered in 2 days by:
6/2/2018
Urologist: Dr Subbanna MD, Neurologist (MD) replied 20 days ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Urology
Satisfied Customers: 6,254
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi Douglas, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions including ED (Erectile dysfunctions), and I am very glad to help you with your health concerns.

I am sorry to hear about your health situation in the form of persistent ED (Erectile dysfunction) as you have described above. I am also sorry for the long delay in getting back to you, please see this is being a 24 X 7 online service so different experts log in to the site at different times or different days, I just logged in to the site and saw your question has still not been answered and I am now replying to you immediately as soon as I have logged in to the site just now. Thank you for your waiting & patience.

Coming to the discussion related to your health concerns;

Yes you are indeed right; ED (Erectile dysfunction) can indeed be caused by neurotransmitter issues in the brain.

And yes, nowadays there are laboratory tests that can tell whether someone is having any deficiency or excess of any of the brain neurotransmitters (or neurochemicals or brain chemicals).

And once again, yes ED can indeed be caused by abnormal levels of various neurotransmitters in the brain which I will discuss now in more detail below here;

Some of the most common neurotransmitters that are related with erectile dysfunction include the following ones;

Dopamine

Serotonin etc

Norepinephrine level too may cause ED.

The abnormal levels of above neurotransmitters in the brain can also cause anxiety and affect your stress level too and this too can cause or contribute to the ED. Of course this is applicable only if you also have some stress or anxiety etc, not otherwise, but the imbalance of the above neurotransmitters in the brain can indeed cause or contribute to ED, with or without other issues such as anxiety or stress etc

So the ED may be caused by the abnormal levels of the neurotransmitters alone, or by the anxiety and stress they mediate alone, or through a combination of all these above factors

Your initial approach is the right one in the form of trying to explore other common possibilities such as issues with testosterone deficiency and looking for other physical issues such as nerve functioning etc and I see the tests have all come fine so such possibilities have already been ruled out and I see you are already on some testosterone supplement and your numbers have been good for some time now.

So you are now doing the right thing by trying to explore other possibilities such as looking for involvement of the brain neurotransmitters in the mediation of ED in you

And you are also right that the dopamine and serotonin are the two commonest culprits in this regard.

Generally it is low dopamine and/or high serotonin that may cause issues with ED, but there are various other factors too come into picture so it is not always straightforward issue to properly assess and manage.

And you are also doing the right thing by quitting smoking and diet and exercises etc but the ED issue in your case is unfortunately still persisting

So we need to explore further to figure out why the ED issue is still persisting

In this regard you are right that serotonin appears the main culprit now – for the reasons you have stated above.

There are tests available now a days that can help to identify the concentration of neurotransmitters and such tests can be used to check the level of serotonin in the brain

However dopamine issue may be still persisting because with quitting smoking etc alone we may not be able to rectify dopamine deficiencies always, so while checking for the serotonin they may check for dopamine deficiency too

There are laboratories that are equipped with state of the art sophisticated testing devices and they also have the technical know-how to help with detecting & evaluating the possible neurotransmitter imbalances through using various specimens such as urine, blood, or saliva samples etc.

For example they can detect the levels of the following neurotransmitters in the brain;

Dopamine

Serotonin

Norepinephrine

Glycine

GABA

Glutamate

Acetylcholine

Histamine etc

But of course you do not need all the above checked, only some of the above are required, for example serotonin and dopamine etc, and norepinephrine too may be checked.

The below site provide information on whom to contact, how to arrange for these tests, and what kind of tests are available, the cost of these tests etc;

https://www.integrativepsychiatry.net/neurotransmitter_tests.html

And as mentioned earlier too, this type of testing can be done with saliva, or blood sample too, but urine test is considered as the most reliable method of testing currently.

To one of your questions, “but no sunlight exposure so it could be low levels of serotonin?” - please see you are making a perfect assessment because sunlight enhances the release of serotonin in the brain, so if you are not exposed to sunlight much so this could be low levels of serotonin in the brain - but there could be multiple other factors that come into play and alter the concentration of various neurotransmitters in our brain- so the actual neurotransmitter level checking through the above mentioned lab testing is the most reliable way of telling which neurotransmitter imbalance is present in the brain, and if any imbalance is found then whether it is in the form of low levels or high levels etc

In addition to the above lab tests, you may also look in to the possibility of undergoing some advanced labs to check your nutritional status, because certain nutritional deficiencies too can cause or contribute to ED

The following is a specialized or advanced lab where they do certain advanced lab tests that are not available at the usual labs and these labs can help you to check your nutritional status and to see whether any underlying nutritional deficiency is the cause for this persisting ED

The following are the links for the advanced labs to determine nutritional deficiencies;

https://www.gdx.net/product/nutreval-nutritional-test-plasma

https://www.gdx.net/tests/alphabetical

And this is a list of various dopamine supplements that either provide dopamine and/or increase dopamine neurotransmission in the brain and this can also help in improving ED;

Tyrosine (or L Tyrosine)

SAMe (S Adenosyl Methionine)

L Theanine

Mucuna Pruriens

CDP Choline (Citicoline)

Phosphatidylserine

Ginkgo Biloba

Bacopa Monnieri

Rhodiola rosea

Panax ginseng

Omega 3 Fatty acids

Vitamin D supplements

Magnesium supplements

Origanum vulgare

Berberine

Resveratrol etc

Wellbutrin (Bupropion) is another dopaminergic agent, which is available as a prescription med and this too can help with improving ED. This med similar to other dopaminergic supplements or meds can help in improving the libido too.

The following are certain additional treatments that can help with ED, if you have not already tried then you may give these a try too.

A) Trying certain OTC (Over the counter) medications or supplements such as the following ones (these help with both libido and ED);

Yohimbine preparation (available as both OTC or Prescription pills)

Libido-max Power extending formula

L Arginine or arginine

Horny Goat Weed

Panax Ginseng (mentioned under dopamine supplements too)

Ginkgo Biloba (mentioned under dopamine supplements too) etc

F) Trying certain Prescription medications such as the following ones;

Tadalafil

Avanafil

Verdenafil

Sildenafil

Yohimbine (both OTC & Prescription as mentioned earlier above)

G) Trying certain Alternative medicine therapies such as the following ones;

Biofeedback

Acupuncture

Hypnotherapy etc

If you have already tried one or more of the above please disregard them and if you see any of the above you have not yet tried then you may consider giving it a try

H) If the above treatment options do not help then certain special treatments or special procedures can be tried such as the following ones;

Vacuum Erection Device (VED)

ICP (intracavernous pharmacotherapy) or penile injection therapy

Penile implant etc

Of course majority of individuals with ED do not require any special procedures or surgeries etc rather one or more of the earlier mentioned non-surgical treatments are sufficient to help with their ED.

Once again to your main question, yes dopamine and serotonin imbalance as a cause or contributing factor to ED needs to be explored, especially considering you have already ruled out physical and testosterone causes, and yes, there are now lab tests available to check the levels of these neurotransmitters as mentioned above, and later if required you may also consider the additional advanced nutritional deficiency lab testing too, and you may also consider exploring the use of the nutritional supplements and the other treatment options to help with ED that are mentioned above - if you have not already tried them.

And also very importantly, please see conditions such as ED can be diagnosed & successfully treated, so please not to be scared or not to lose hopes!

Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & professional effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now will not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Best Regards!

Dr Subbanna MD

For future questions you can follow up either here, or you can reach me directly with "a question for Dr Subbanna MD" through my Just Answer direct link mentioned below here;

http://www.justanswer.com/medical/expert-drsubbannamd

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Urologist: Dr Subbanna MD, Neurologist (MD) replied 19 days ago

Hi Douglas, I see you have not yet rated my answer, is it because you are not satisfied with the above answer, or is it due to some technical glitches? If you are not satisfied and if you are still looking for more information please let me know and I will be very glad to continue assisting you as long as you need my services, and until you are fully satisfied. On the otherhand if rating was not done due to any technical glitches preventing you from rating please let me know and I can bring this to the notice of the company and they can help in fixing this glitch.

Please let me know.

Best Regards!

Dr Subbanna MD

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