# LOW SEX DRIVE, ED and PROSTATE REMOVAL



## sofie

Hi,

I need some input from especially the older guys here.

My husband has ED and last year his prostate was removed.
Due to the ED we already had problems, but after the prostate removal it really got bad, because he doesn't seem to have any sex-drive anymore.
Docters say he can't have Testosterone because of the prostate removal. He shows ALL the signs of low Testosterone levels.
Because he doesn't get really exited, Viagra doesn't do much of course.
Any of you in the same situation and is there ANYthing we can do???
Pump doesn't work well because it sucks up too much skin.
Besides he has to be in the mood to undertake action.


----------



## sofie

Any of you in the same situation????
Any of you any advice???


----------



## MarriedWifeInLove

My husband has ED due to a TBI and also several medications that he takes.

Due to this, we went the prostate stimulation route - problem not solved, but it enables us to have some-type of sex life.

But with his prostate gone also - I'm not sure what to do there.

Have you googled it?

Got to be others on-line somewhere with the same situation.

Now, if he's willing, and your insurance will cover it - they can do a penile implant (my stepfather had one) and it worked great.

Just a thought?


----------



## Anooniemouse

It would be helpful to know why the prostate was removed because its a little different ballgame when its removed due to constant enlargement & inflammation, versus when its removed during cancer treatment (especially if radiation or hormone therapy was used, and/or still in use). 

Before you do something as drastic as a penile implant, he might try something a lot cheaper, and a lot less invasive: High dose Losartan + Aspirin.  

I'm fairly certain that this will still work with the prostate gland removed, and it does work for a large number of men with ED when drugs like viagra fail. There is a growing body of evidence that this combination can help sustain erections _even when there is nerve injury_, and does increase interest (slightly) in men. It also doesn't have the heart attack risks that drugs like viagra have. Benicar, and Losartan generally make it easier for the heart to do its job, rather than the other way around. 

While no drug(s) can replace the smooth muscle tissue lost from removal of the prostate gland, and its not going to change the dry ejaculation issue (thats just physical with the prostate removed), a combination of high dose (100mg to 200mg) losartan (Cozaar is the brand name in the US) split into morning & evening doses, and taken daily, plus 325mg to 1g of aspirin taken an hour or two before sex can significantly help ED. Depending upon the cause, even aspirin alone can help, but the combination is better than either of them apart. Big plus, losartan is now generic. (ARB's are hideously expensive as far as BP drugs go.) It has been expressed to me that some people find an extra 50mg an hour before sex, or timing their medication so that it is taken an hour before sexual activity seems to have an additive benefit for them. 

The harder part is finding a doctor that knows about the off label use of losartan & a few select other ARB's for ED, and making sure it plays nice with any other conditions he may have, or other medications he may be taking (in particular steroids, adrenal/hormone supplements, other blood pressure drugs, drugs for treating bone density, heart medications, and other nsaids). 

What if he doesn't have high blood pressure or pre-hypertension? Wont this lower his blood pressure too much? 

Losartan does have some side effects, but even if his blood pressure is in the normal range it is unlikely to lower it to levels that would be problematic (though it will drop harder the first couple days, and dizziness is a frequent initial side effect the first day or two). If it does drop it too much, try something else. 

What if he does have hypertension?

If he is already on a BP drug, he might get enough relief switching it to losartan; and since quite a few of the other BP drugs contribute to ED problems he might end up with a double benefit from switching if the other drug is contributing to the ED issues. 

Higher doses of Olmesartan (brand name Benicar), another ARB, can also help, but can be a lot more problematic with side effects (extreme sensitivity to light is a fairly common one at high doses). Might be worth investigating if losartan helps, but doesn't help enough. I would put it last on the list to try because of side effects, cost, and the likelihood of having to battle an insurance company to get it covered. This is also a very off label use of an ARB. This works best for ED at dose ranges far exceeding those used for controlling blood pressure, and does not have the same amount of evidence to back up its effectiveness for ED as Losartan does. However it binds more strongly to the things that should help ED than losartan does. Its effect on blood pressure pretty much stops at 40-60mg a day; so taking 40mg every 6 hours doesn't have any additive effect on decreasing BP. To be honest, its just not very impressive as a blood pressure drug; it has a lot of other uses it is quite good for though (such as treating congestive heart failure). Again, works better in combination with aspirin for ED issues. 

Benicar is also hideously expensive at these doses, and no generic on the US market. Insurance companies will likely balk at this, but will gladly cough up $10 a day for other ED treatments. I don't consider $10 a day cheap by any means. I don't make the rules! 

The reason for the higher & every 6 hour dosing of benicar, as opposed to the 20-40mg a day people take for general hypertension treatment has to do with its effects on inflammation at higher doses, its effects on the steroid system at higher doses, and on sex hormones at higher doses. The other effects which are also beneficial for treating ED have a much shorter life (6-8hrs) than the drugs effect on hypertension, and it takes a lot more of the drug to activate those receptors in the body. He might still get a benefit from 40mg taken in the evening an hour or two before sex, but its far less likely to be as helpful. 

(Just like losartan: need to make sure it will play nice with any other medication he is on. In particular other BP meds, heart drugs, NSAIDS, hormone treatments, adrenal supplements...etc)

Notes for both of the above: These also come as a combination drug for blood pressure containing hydrochlorothiazide; you don't want that kind for the high doses used here. Those will be marked drug+HCT, or in the case of losartan/cozaar - the HCT version is hyzaar. 


Any time you combine an ARB with aspirin (or pretty much any NSAID) they have the potential to spike potassium. Its a simple blood test to check electrolytes, and liver function, but it needs to be done if they are used in combination frequently at the higher doses of aspirin (600mg to 1g per day). Electrolytes should also be checked at least once _while concurrently taking both the aspirin & ARB at the time the blood is drawn _ if he requires the full 1g dose of aspirin in concert to make things work for him. Its not likely to be a problem, but it can be serious if he is sensitive to either drug causing elevated potassium. Because of the higher doses of each of these, these effects can happen quicker. First couple months electrolytes need to be monitored. 

One more off label option, and this will get an eyebrow raised from the doc as its very commonly used to treat enlarged prostate problems -- Cardura (drug name Doxazosin). You might also have a fight with insurance over this one because of its chief use if he doesn't have concurrent high blood pressure, or pre-hypertension. This is more likely to work in the lower ranges of 2mg-8mg a day if its going to help. Cardura is in another class of blood pressure drugs called alpha blockers. Not at all ironically, one of the more serious, and thankfully rare side effects of this drug is priapism (an erection lasting for hours that wont go away). This one doesn't play nice with aspirin, and there is no additive benefit from combining them. 

The main way all of these these drugs help is by increasing the amount of blood flow available to the penis to become erect. The penis both needs to be able to get blood flow to become erect, and to be able to retain that blood to stay erect. (The latter is why most blood pressure drugs can cause difficulties maintaining an erection, they take away the ability for the penis to decrease that outward flow of blood.)

Benicar & Losartan also have some effect on the steroid, and hormone systems in the body. They activate (weakly) some of those receptors in ways that make up for some of the lost hormones, either directly, or by the bodies tendency to tightly regulate, and use sex hormones to counter balance steroid metabolism. 

Aspirin primarily reduces inflammation, reduces blood clotting, and thins the blood slightly allowing blood to more easily penetrate into the fine capillaries, and tissues of the penis.

Cardura works for ED by a combination of increasing blood flow available to the penis, and by opening up fine capillaries, and pathways in tissues in the penis to allow increased blood flow. 

There are other options out there yet still ...

As always, the standard legal disclaimer applies. I'm not a doctor, this isn't to be considered medical advice, some results are based on imperfect and/or limited data, knowledge of research that is ongoing, always check with your doctor first, pay your taxes, wear a helmet while riding, and I'm too broke to sue.


----------



## sofie

Anooniemouse said:


> It would be helpful to know why the prostate was removed because its a little different ballgame when its removed due to constant enlargement & inflammation, versus when its removed during cancer treatment (especially if radiation or hormone therapy was used, and/or still in use).
> 
> He had prostate removed on bases of PSA level and biobsies, early stage of fairly agressive cancer. After removal no further treatment needed. His nerves were not damaged. The ED is as good or as bad as it was before surgery. Viagra helps a bit, not much, though lots of flushing and such.
> The desire is gone way down. His mind wants to, but doesn't get his body in the mood. Doctors are very against Testosterone, although that is very likely the reason of no desire; has all the symptoms
> Aside from the prostate removal and the ED he is very healthy, no diabetes and fairly low bloodpressure
> 
> Before you do something as drastic as a penile implant, he might try something a lot cheaper, and a lot less invasive: High dose Losartan + Aspirin.
> 
> I don't know if Losartan or simular won't make him faint or something like that. When he was younger, he used to have low bloodpressure and faint once or twice a year. Now it's normal at about 120/80
> 
> I'm fairly certain that this will still work with the prostate gland removed, and it does work for a large number of men with ED when drugs like viagra fail. There is a growing body of evidence that this combination can help sustain erections _even when there is nerve injury_, and does increase interest (slightly) in men. It also doesn't have the heart attack risks that drugs like viagra have. Benicar, and Losartan generally make it easier for the heart to do its job, rather than the other way around.
> 
> The harder part is finding a doctor that knows about the off label use of losartan & a few select other ARB's for ED, and making sure it plays nice with any other conditions he may have, or other medications he may be taking (in particular steroids, adrenal/hormone supplements, other blood pressure drugs, drugs for treating bone density, heart medications, and other nsaids).
> 
> What if he doesn't have high blood pressure or pre-hypertension? Wont this lower his blood pressure too much?
> Losartan does have some side effects, but even if his blood pressure is in the normal range it is unlikely to lower it to levels that would be problematic (though it will drop harder the first couple days, and dizziness is a frequent initial side effect the first day or two). If it does drop it too much, try something else.
> 
> Benicar is also hideously expensive at these doses, and no generic on the US market. Insurance companies will likely balk at this, but will gladly cough up $10 a day for other ED treatments. I don't consider $10 a day cheap by any means. I don't make the rules!
> Benicar & Losartan also have some effect on the steroid, and hormone systems in the body. They activate (weakly) some of those receptors in ways that make up for some of the lost hormones, either directly, or by the bodies tendency to tightly regulate, and use sex hormones to counter balance steroid metabolism.
> 
> Aspirin primarily reduces inflammation, reduces blood clotting, and thins the blood slightly allowing blood to more easily penetrate into the fine capillaries, and tissues of the penis.
> 
> Cardura works for ED by a combination of increasing blood flow available to the penis, and by opening up fine capillaries, and pathways in tissues in the penis to allow increased blood flow.
> 
> There are other options out there yet still ... If you have some ideas based on the info above: I would be very,very grateful.!
> 
> As always, the standard legal disclaimer applies. I'm not a doctor, this isn't to be considered medical advice, some results are based on imperfect and/or limited data, knowledge of research that is ongoing, always check with your doctor first, pay your taxes, wear a helmet while riding, and I'm too broke to sue.
> 
> Got you and just paid my taxes.


----------



## Deejo

Wish I had something beneficial to contribute, but this is way too close to home for me ... and may very well be me within 10 to 15 years.

Urologist gave me doxazosin for BPH. It had minimal impact on my ability to urinate and many of the potential side effects, I already had in play as a result of suspected low test. I did have killer headaches for the period of time I took it. No benefit to ED in my case.


----------



## Anooniemouse

sofie said:


> Anooniemouse said:
> 
> 
> 
> It would be helpful to know why the prostate was removed because its a little different ballgame when its removed due to constant enlargement & inflammation, versus when its removed during cancer treatment (especially if radiation or hormone therapy was used, and/or still in use).
> 
> He had prostate removed on bases of PSA level and biobsies, early stage of fairly agressive cancer. After removal no further treatment needed. His nerves were not damaged. The ED is as good or as bad as it was before surgery. Viagra helps a bit, not much, though lots of flushing and such.
> The desire is gone way down. His mind wants to, but doesn't get his body in the mood. Doctors are very against Testosterone, although that is very likely the reason of no desire; has all the symptoms
> Aside from the prostate removal and the ED he is very healthy, no diabetes and fairly low bloodpressure
> 
> Before you do something as drastic as a penile implant, he might try something a lot cheaper, and a lot less invasive: High dose Losartan + Aspirin.
> 
> I don't know if Losartan or simular won't make him faint or something like that. When he was younger, he used to have low bloodpressure and faint once or twice a year. Now it's normal at about 120/80
> 
> I'm fairly certain that this will still work with the prostate gland removed, and it does work for a large number of men with ED when drugs like viagra fail. There is a growing body of evidence that this combination can help sustain erections _even when there is nerve injury_, and does increase interest (slightly) in men. It also doesn't have the heart attack risks that drugs like viagra have. Benicar, and Losartan generally make it easier for the heart to do its job, rather than the other way around.
> 
> The harder part is finding a doctor that knows about the off label use of losartan & a few select other ARB's for ED, and making sure it plays nice with any other conditions he may have, or other medications he may be taking (in particular steroids, adrenal/hormone supplements, other blood pressure drugs, drugs for treating bone density, heart medications, and other nsaids).
> 
> What if he doesn't have high blood pressure or pre-hypertension? Wont this lower his blood pressure too much?
> Losartan does have some side effects, but even if his blood pressure is in the normal range it is unlikely to lower it to levels that would be problematic (though it will drop harder the first couple days, and dizziness is a frequent initial side effect the first day or two). If it does drop it too much, try something else.
> 
> Benicar is also hideously expensive at these doses, and no generic on the US market. Insurance companies will likely balk at this, but will gladly cough up $10 a day for other ED treatments. I don't consider $10 a day cheap by any means. I don't make the rules!
> Benicar & Losartan also have some effect on the steroid, and hormone systems in the body. They activate (weakly) some of those receptors in ways that make up for some of the lost hormones, either directly, or by the bodies tendency to tightly regulate, and use sex hormones to counter balance steroid metabolism.
> 
> Aspirin primarily reduces inflammation, reduces blood clotting, and thins the blood slightly allowing blood to more easily penetrate into the fine capillaries, and tissues of the penis.
> 
> Cardura works for ED by a combination of increasing blood flow available to the penis, and by opening up fine capillaries, and pathways in tissues in the penis to allow increased blood flow.
> 
> There are other options out there yet still ... If you have some ideas based on the info above: I would be very,very grateful.!
> 
> As always, the standard legal disclaimer applies. I'm not a doctor, this isn't to be considered medical advice, some results are based on imperfect and/or limited data, knowledge of research that is ongoing, always check with your doctor first, pay your taxes, wear a helmet while riding, and I'm too broke to sue.
> 
> Got you and just paid my taxes.If he truly has issues with low blood pressure the least likely to cause problems would be Benicar. Its not very impressive as a blood pressure drug, maybe 10-14 point drop even in the 40-240mg per day range. That is an average though, and all of these initially cause a larger change than what the sustained effect on blood pressure is. Nice way of saying, the body adapts a bit. This one is actually better just to deal with day 1 being a little dizzy at the full high dose. The postural hypo-tension issue usually goes away within a very short period of time, but there is an adjustment period. It just has to be monitored a bit during.
> 
> However, while Losartan is a much better med the pure purpose of reducing hypertension, it also doesn't have huge effects when given by itself without HCT that sustain past the first few days. Unfortunately its effects on blood pressure aren't as dose limited, and the doses needed here are in the higher range. That being said, the only way to really know with some of these is try it and see.
> 
> The issues with hypotension in the past do make me wonder about some kind or endocrine issue. Has he seen an endocrinologist & had a full work up done?
> 
> Is he averse to needles, and/or giving himself an injection? Not for me, but there are some 2nd line treatments that are injection only that do work. (Just not the highest percentage batters in the bunch.)
> 
> At least we know he didn't sustain damage to other areas from radiation, or down regulation of gene expression from hormone treatment. Any time you cut, there is the potential to do damage to other things, and for the body itself to do a bit of damage in the repair process. Maybe my anti-surgery bias creeping out ...
> 
> I'll have time over the weekend to answer this one more in depth.
Click to expand...


----------



## sofie

Anooniemouse said:


> I'll have time over the weekend to answer this one more in depth.


I would be grateful for that.

And the sad thing is that the drive is gone, and doctors say that he cannot have Testosterone because of the prostate removal. Although they can not tell why not.... there is no prostate anymore that can get cancer???


----------



## Runs like Dog

I would get a second opinion on that. Get another urologist to examine this. You could point him to this

Elsevier

I assume when you mean removal you mean COMPLETE removal?


----------



## sisters359

While you are working on finding therapies or other solutions, you can introduce some toys into your sex life if both of you are willing. Maybe you have, but since it wasn't mentioned, I thought it should be.


----------



## sofie

Runs like Dog said:


> I would get a second opinion on that. Get another urologist to examine this. You could point him to this
> 
> Elsevier
> 
> I assume when you mean removal you mean COMPLETE removal?


Thank you for the link.

Yes, complete removal.

ED is workable but as he has no desire it gets hard to do.
Especially when he wants to have desire, but can't find it.

Plus he had a vasectomy years ago and his libido already went down. I thought back then that it had something to do with that, but every one said it didn't have physical effects. Now I read more and more that it does.


----------



## Runs like Dog

The medical literature does not suggest that testosterone replacement is more dangerous once the entire prostate has been removed. The only statistically significant threat is to the prostate itself, which is no longer there. 

It's unlikely that a vasectomy's effect on one's libido is physical. There may be a drop in libido but it does not appear to be from physical causes. 

The ED issue is a common surgical side effect of removing the prostate. It's nestled in a network of nerves and these nerves can be cut or damaged interfering with the erection mechanism.

I would also suggest that with the loss of the prostate AND a vasectomy your husband can no longer ejaculate any fluids at all. He may not 'feel' the pressure and flow of ejaculation coupled with orgasm in the same way. This may be confusing him what orgasm really is. 

So here is what I would do. I would look for another urologist to confirm what the issue with testosterone is. Then I would experiment with some slow thorough oral sex to climax to see what happens. Ask him (if your mouth's not full!) if he feels any numbness anywhere on or near his penis or near the taint. Get a sense of his physical reactions up to and past the point of climax.


----------



## Breeann

sofie said:


> Any of you in the same situation????
> Any of you any advice???


Yes! I'm in the same situation you are in. My husband had his removed because they told him he had cancer and 2 spots and it was more than likely all over the prostate. After surgery they found only 1 stop and the other was removed by the biopsy. Now he is using the pump and suppository, which burns like heck. They told him he has low T but we have to wait a year for them to give him medicine. THis has been a long road for the both of us bc now he has no sexual feelings at all!


----------



## Breeann

sofie said:


> I would be grateful for that.
> 
> And the sad thing is that the drive is gone, and doctors say that he cannot have Testosterone because of the prostate removal. Although they can not tell why not.... there is no prostate anymore that can get cancer???


I said the same thing and my husbands doctor said giving testosterone could cause cancer again in other parts of the body.They sugguest he waits a year and then they will give it to him.I'm sorry but it's hard for me to believe that!


----------

