I have short penis and ED with history of masturbation. Please suggest medication.

Hello,

Welcome to icliniq.com.

Before jumping to any treatment follow the advice as given below.

You are indeed developing signs of ED (erectile dysfunction). You also seem to have exaggerated guilt of masturbation. Understand that 90% of males start masturbation by the age of 14. Rest 8-9% start after 14. So, virtually every man masturbates. It is a normal male sexual behavior if done in moderation. But excess of everything is bad.

We may need reports of the following tests to rule out the physical causes of erectile dysfunction.

1. CBC (complete blood count).

2. T3, T4, TSH (thyroid-stimulating hormone).

3. HbA1c (glycated hemoglobin).

4. Serum testosterone.

5. Serum prolactin.

To rule out psychological causes, please answer the following questions.

How is your mood? How are your energy levels? How is your appetite? Do you have any sleep disturbances or do you oversleep? Any past history of anxiety or depression? Any family members suffering from anxiety or depression?

Please respond and send me the reports to make a complete assessment.

Hi,

Welcome back to icliniq.com.

We need the reports of the following tests to rule out the physical causes of erectile dysfunction and premature ejaculation.

1. CBC.

2. T3, T4, TSH.

3. HbA1c.

4. Serum testosterone.

5. Serum Prolactin.

I see no attachment to reports of the above suggested tests. Please resend the reports.

Hi,

Welcome back to icliniq.com.

Looking at your reports (attachment removed to protect patient identity), you have a pre-diabetes profile that can lead to ED. Since, your testosterone levels are well within the normal range, dramatic growth will not occur with any medicine. Masturbation is not causing your ED, pre-diabetes is the cause. Managing pre-diabetes primarily involves lifestyle changes.

General and lifestyle measures to boost testosterone and control pre-diabetes.

Diet: Divide your plate into three parts, 1/4 the part should be composed of carbohydrates, 1/4 should be protein and 1/2 (major) part should be fresh fruits and vegetables.

Exercise: preferably play any outdoor sports of your liking or take up dance lessons (if feasible). Moderate intensity exercise should last for at least 30 minutes to 1 hour per day. Start with normal walking if you do not normally do any exercise.

Sleep: seven hours of restful deep sleep boosts testosterone. Sleeping more will not help. Quality of sleep is more important than quantity. Duration should be at least six to seven hours. Have a fixed sleep-wake schedule. Get morning sunlight exposure for 15-20 minutes daily to entrain your biological clock and body's neuro-endocrine systems.

Avoid smoking, drinking, and all harmful substances (if any).

Stress management: follow deep breathing, relaxation exercise. Yoga and meditation can also help with relaxation and stress management. Music is another great way of stress reduction. Offering prayers also help.

Specific treatment:

1. Sildenafil 50 mg two hours before intercourse for short term improvement.

2. Metformin ER 500 mg once a day at night to help with low energy levels, ED, and prediabetes in the longer term.

3. Coenzyme Q 100 mg and anti-oxidant capsule. To boost testosterone hormone naturally for the longer term.

4. Tablet Yohimbine 6 mg twice a day. To boost libido and help in ED directly.

Follow this treatment regimen for the next 30 days and then review.