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T2 and Erectile Dysfunction - Metformin, sulfonylurea, diet, testosterone

J

JayAmerican

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I am treating my T2 with diet alone and it is working, I am positive my next A1C will show me as non-diabetic or borderline pre-diabetic. So I would prefer no meds and want to keep it that way.

However, as I have felt the impact of age the past 2 years (I am in late 40's), I noticed the usual stuff: Gray hairs here & there (mostly in beard, chest, but minor), slightly thinning hair at my scalp line, a little less energy, started needing reading glasses. None of those I consider too huge of a deal but I have noticed around mid-year last year that my, um, ability to be at attention and stay there started to not be great. Have never once had a problem with that. And when I say never, I mean absolutely never. It seems that in the past 2 months it is very noticeable and I am sure performance anxieties may be compounding any physical issues.

I had researched after getting diagnosed with T2 that ED is prevalent. BUT it is not clear in research so far whether it's specifically because of one or more of the following:

- The insulin resistance -- I mean, having a great diet along to bring sugar levels down and put effort to naturally make the body insulin-sensitive is great, but it's not clear whether the resistance itself is core to the problem or not.

- The blood sugar levels. It SEEMS like nephropathy is a factor, so bringing blood sugars down is of great importance. It's not clear, however, whether nephropathy issues "down there" are irreversible. I am fairly certain I only shifted into the diabetic zone sometime in the past 2 years so it's no like my body has been seeing high blood sugars for a long time. I have also read that low testosterone may actually be a trigger to shift men predisposed to T2 into T2, exacerbating the problem.

- Low testosterone. Clearly low testosterone is an issue, and clearly age impacts this, but it's not clear whether this needs to be treated as a separate issue or is caused/exacerbated by T2 or whether low T itself exacerbates T2.

I plan to see a urologist and get some clarity. I the meantime my research shows totally contradictory findings. Examples:

This study says metformin is bad for ED:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296448/

But this says it helps address ED:
https://www.diabetes.co.uk/news/201...help-treat-erectile-dysfunction-94362346.html

So which is it? Also, the first link shows research for metformin vs sulfonylurea and a control group of non-T2 men (taking no meds) and indicates sulfonylurea (the 2nd prescribed med for T2) as being better for testosterone levels (and this, better to address ED) but it increases chance of heart failure by 30%!

Also, in that study, they had no control group of T2 men who took neither med and no lifestyle change, and no control group of T2 men who took neither med but did do lifestyle changes. I guess us men who try to lead a healthy life without meds are not worth studying?

I am sure this topic has been looked into by the men here and wondering what findings or real-world application of solutions has been seen to work the best? I had thought by addressing my blood sugars it would become a non-issue but it seems like the opposite. It also gives me pause to wonder about the medications.
 

Jay, when were you diagnosed? For some, once they have wrestled the beast into a good place, they realise they may have had symptoms for some time. I'm wondering if your ED might have been a symptom for you. Again, many find any issues they have - whether is is related to their vision, nerve issues, or whatever, that those issues appear to get worse, before the turn the corner to get better.

Have you had a chat with your HCPs about this? In UK, it is something HCPs should cover with those who have had a diabetes diagnosis of any kind.

We could all speculate all day, but only when you have eliminated all other potential issues will you know this if this relates to your T2.

I'm sorry if that isn't helpful to you, but someone will post soon with more info, and suggestions, I'm sure.
 
DCUKMod said:
Jay, when were you diagnosed?
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I was diagnosed in October (just under 3 months ago). HBA1C tested a week later, was 9.8% (American numbers, whatever that translates to in the UK). Went to an endocrinologist a week after that then had additional blood tests to rule out MODY, LADA, etc and all tests came back normal (and my body is producing normal levels of insulin, just resistant). I also got an eye test and other than a minor prescription change from last year, all looks normal. I plan to find a urologist or other specialist related to male sexual function to get some kind of evaluation and consultation, plus testosterone and other tests that make sense. Was just hoping for added feedback here as I'm likely to get the best shared experiences to compare to.

Unrelated to the T2 diagnosis specifically, here's the timetable I can recall to understand the timing of the ED impact:

- 2-3 years ago started needing reading glasses (1.25, has not changed to higher).

- 2-3 years ago random gray hairs, but even til now we're talking stray not all over. I can clip the few that have appeared and looks like I have no gray

- 1 Year ago top/front of scalp started slightly thinning. I have kept a full head of hair my whole life other than hair line slightly receding (which barely got any worse after age 27). I used to take finasteride from about age 27 to about 35 but stopped and didn't notice much negative impact after stopping. Finasteride never affected me sexually at all. My libido has been strong since age 16 all the way til last year.

- About 1.5 yrs ago I noticed I was getting up at night to pee at least once. I associated it with aging. A few months ago it became twice a night sometimes. Since getting my blood sugars under control, that has gone away, I now sleep the whole night without needing to wake up and pee.

- About a year ago I noticed that pee stream at end wasn't as strong. I had been working on my house the first few months of the year, likely had muscle strains, and the reason I went to the doc in October wasn't because of anything other than I though I had a hernia as I felt muscle strain in that region and it coincided with pee stream not being as strong. Doctor barely took any interest in that and a ultrasound all around that region showed nothing so it was chalked up to "muscle strain". I wasn't satisfied with the effort to look into things there and this is the type of doctor I went to that I learned doesn't seem to want to do anything other than push drugs as a solution (common among US doctors who are not surgeons or research specialists).

- In the past 1-2 months, I have gained mental energy. My body weight has remained consistent and no adverse affects that I can tell with the diet & exercise changes other than much better blood sugar levels. My body is looking much more physically fit than a year ago. But, in the same time, the ED is more problematic to the point it is affecting my attempts to build new relationships - since I've never had the issue before, I don't know how to navigate around the feelings women may have who see me not performing normally and it's hard to relay that it is not them. I simply can't seem to translate my mental libido into what I am used to. This is not familiar to me at all and it's frustrating. I now don't know how much is mental due to new anxieties vs physical due to T2 or testosterone levels.

- My app is telling me my estimated average A1C for the past 90 days is 6.4% but if I go by just the past month and continue, it will likely be closer to 5.0% going forward. Won't know til I get my next A1C test.
 
Wow so few replies on this. T2 makes men 2 or 3 times more likely to experience ED than non-diabetics and at lest 1/3 of diabetics will experience it at some point, but nobody else seems interested to share experiences here?
 
Dear Jay,

Just saw your post, and I can't comment on those articles but I'm happy to share my experiences.

I was diagnosed with T2DM in April 2019. My HbA1c was 6.8% (51mmol), my weight was 85kg, I was living a high-stress life (my choice!) and stress-eating anything and everything. It has taken me a good 6 months of diet, exercise, intermittently taking metformin and a statin, and intermittent fasting to get the HbA1c down to 5.9% and the weight down to 71kg. Waiting for next HbA1c result tomorrow.

I can relate a lot to what you are experiencing. You are not alone. Grey hairs - I'd say I'm 45-50% grey now, age 45 years. I lost most of my head hairs in my 20s / 30s. A lot less energy. Often I just can't be bothered with the various issues in my life, and I have to focus on what's most important, which is not a bad thing actually.

In terms of ED, I have noticed since 2012 that (1) everything seems smaller down there?! and (2) I have lost interest and ability in flirting, (3) the machinery still seems to work fine though, when needed. I went to see a urologist back then in 2012. My testosterone was borderline low but nothing to worry about. He said it was probably just stress, new job, etc. and I didn't think further about it.

Now looking back, I recognise several things:

1) I had impaired glucose control going back to 2004 at least when I had one random blood sugar level of 13.5 but subsequent testing "ruled out" DM as my fasting sugar was 6.1 and my HbA1c was 6.2% (44.3). In 2012 I had abnormal liver function tests (ALT 94), high cholesterol (7.4), normal fasting blood sugar. This was all put down to "fatty liver" and stress, and neither my GP nor I took it seriously.

2) I feel and look old. A lot older than the 45 which I am. Because of the intentional weight loss I feel and look fragile. I am putting some of this down to "andropause", which is like menopause but for men. It is not a well-recognised situation but you should Google it as it may explain what's happening. I am taking calcium and vitamin D supplements daily to prevent osteoporosis. I take a multi-vitamin every day, as well as iron tablets, as I want to optimise whatever I can and not worry about whether I'm anaemic or low in selenium or whatever. I don't want to go on testosterone supplements as that shuts down your body's natural production and you become dependent on supplementation. I have a friend with DM in a similar situation who tried testosterone supplements. He said he felt amazing for the first month (like a teenager!) but after that his body got used to it and he was back to baseline. I focus on the positives eg. reduced risk of prostate cancer and heart attacks! As long as I can carry on living, working and thinking, I can deal with the rest.

4) Some of my ED-like symptoms may be explained by the DM affecting how sex hormones are produced, transported, stored, and used by the body. The liver has a huge role to play in this, and if the liver is upset enough to affect my cholesterol metabolism and liver function tests, it may explain my testosterone issues too. I'd say I feel 50% better having lost weight, having brought my HbA1c down, and my liver function has normalised. I have not been able to control stress though. I am hoping to get down to 65kg and HbA1c of 5.5% but I've reached a reasonable plateau and it's very difficult to change a lifetime of bad choices. If I ever reach those targets (65kg and HbA1c 5.0-5.5) and come off metformin and the statin, then I will have eliminated the role of DM in my symptoms.

I'm not sure if any of this answers your questions but just intended to say that what you are experiencing is actually quite common but men don't talk about these things unfortunately.
 
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Thanks mm, to work off and compare your experience, I think the "seems smaller" is either just psychological (I think the same way) or that a lack of libido might just make down there less active passively. On comparsison to your number 2) I am a little the opposite - I look younger than I am but body wise could use some muscle toning improvements.

My liver tests and other tests have so far come back fine, so right now only T2 and high cholesterol are my issues. I made an appointment to see a urologist within the next 2 weeks. I'm a little bit anxious as it forces me to put social matters on hold as I am having some performance anxieties. i do feel like my desires are down and am distracted by many stresses lately but I deal with stress differently than most people - I eat it up and spit it out. I actually feel (emotionally) less stressed than in the past but that could be a side effect of lowering my blood sugar.

I wish more guys here would share - I think this is important to anyone experiencing the same things and this, at least for men, is a pretty important psychological need to address.
 
I have just stumbled on your post - I'm happy to share!

I'm 60, diagnosed T2 in May 2019, 51/6.8%, I live on a small island that isn't part of the UK but is near it!

I have with diet and exercise only reduced my A1c to 36/5.4%, lost weight from 14st 6lb to 12st 2lb. I however have suffered with ED for the last two or three years - prior to diagnosis obviously. I suspect I have reactive hypoglycaemia too, but not sure that effects anything. I have used viagra for the last 18 months with reasonable success, my problem is the erection, not the libido, in fact my libido is strong as ever (happily married 35 years) and my sex drive if anything better than 10 years ago. (Don't be afraid to ask your GP about these drugs, once you get past the initial embarrassment it is a positive experience). The problem in my case isn't getting an erection, but is sustaining it. My testosterone level is at the low end of normal range, I have all my own hair but it's a bit thin now up-top but I'm almost 61.

After controlling my blood glucose I do in general feel better, especially since being diagnosed low vitamin D despite taking a general supplement, in fact the T2 was diagnosed while investigating general lethargy and feeling 81 not almost 61! Extra vit D has helped a lot, and maybe just a bit with the ED. I have better weeks and worse weeks, but it is better than it was, the only problem really (hope this isn't too much detail, mods) is the delay in the viagra working - it can spoil the moment rather having to wait an extra 30-45 minutes. I am going to ask to try alternatives next week. We're both busy people, I run a business and my wife is a civil servant and run off her feet, so time is always at a premium!

I don't know how much T2 is linked to the ED, but with control of my BG things have got better - not a cure, but more confidence at least.
 
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They discovered my T2 when I went to the GP about ED.

I say discovered, the person I saw (different every time at my surgery) told me I was already a diabetic from the blood tests I had over the past few years and put me on metformin immediately.

I have always have a very big sex drive and I still have, I still have the urge to really have sex, only trouble is, when it comes to it, it barely works, never really hard, sometimes goes soft halfway through (even though I'm really into it).

Then next time while we're cuddling before hand, while I'm trying not to think about it, in the back of my mind is "I hope he gets hard, oh no, he's still soft...."

Since I was about 14/15 (am now 55) I never ever woke up without morning glory, except in the recent months/years where I've had ED

When the GP diagnosed my T2 he also put me on 50mg of Viagra. It didn't help (and makes me feel weird the next day) , the GP then tried 100mg, Exactly the same (but I feel even worse the next day).

I tried taking Viagra 1/2hr, 1hr, 1.5hr, 2hr before cuddles and it made little difference, I wouldn't say no difference but 9 times out of 10, I still couldn't perform properly, even on the few occasions I can perform, he's still not properly there. Whether I took it 30 mins or 2hrs before cuddles seem to make no difference

The odd thing is, when I take Viagra, even 25mg, while it does little to help, on the morning after I take it, I wake up with an erection just like old days.

I went back to GP asking if there's anything else I could try, they said no, the fact that I wake up with an erection the day after taking viagra, shows my equipment is working fine??????? Then said I need to try things like rings/pumps etc next. Well I can't imagine using a pump. talk about killing the mood, anyway I got a ring (that was a funny hour with my wife and my eyes being opened to the advances in sex toys since our youth, most of the advances causing fits of laughter) , now with Viagra and using the ring, I'm still exactly the same as I was when I first went to the GP, only because I still cant get erect, even when using a **** ring, it makes me kind of feel a bit less of a man.

Even when I can manage to perform, it's rare that I get to climax before he's given up.

My wife just laughs (in a loving jokey way) and says don't worry about it.

I also suffer from CFS/ME, asthma, IBS, cervical lymphadenopathy, migraines, severe joint pain, muscular pain, swallowing problems (food gets stuck lower down in my food pipe), memory issues (caused by cfs) and bad sleep.

currently on the following meds

50 mg Cyclizine Hydrochloride 3 times a day and when needed
Metformin 500g 3 times a day (only taking twice at the moment else I'm on the loo all day)
40 mg Simvastatin once a day
50 micrograms Nasonex nasal spray, twice a day
30mg Lansoprazole if needed
Ventolin/Salbutamol 100 micrograms whenever needed
Fostair 100micrograms/dose / 6 micrograms/dose inhaler. One puff twice a day
Allopurinol 100mg Two once a day
Colchicine 500 micrograms twice a day
Ultrabase cream, use instead of soap
Duloxetine 30MG Three times a day (well 60g in morning and 30g in evening)

The past 8 months, despite my health problems, I'm actually enjoying life for the first time in years, I went through 2 years of hell where the DWP stopped my benefits and it took 2 years to get it overturned at a tribunal, those 2 years were the worst in my life, we had £50 less coming in each month than our bare essentials cost us, and that was before we paid our credit card bills.

In a way, those two years benefited us long term as we had all our debts frozen, they wrote some of mine off due to GP and hospital saying I wont be working again, and the backdated sum for 2 years allowed us to make early final settlements to the rest of our creditors. I then discovered a pension I wasn't aware I had, and as I was 55, took 25% tax free and cleared most of our outstanding mortgage.

This means that apart from a very small (under £6k) mortgage, we don't owe anything to anyone. Which means for the first time in as long as I can remember, even if I have to go through the same hell as before with the DWP next time my medical is due, my wife's earnings more than covers all our bills hence we wont have the stress of creditors phoning us up about 20 times a week etc.

9 months ago I was the most depressed I had ever ever been in my life, my mind was a mess, I was having weird thoughts, today I wouldn't say I was depressed at all.

I had hoped that with this new found stress free life, my ED would disappear, but no, it's exactly the same

As for it getting a bit smaller, I looked at mine a while back and thought he looked much smaller than usual, then decided I was just being stupid. My lovely wife walks in, looks at me and says "he's a bit small today isn't he"
 
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Ojustaboo said:
The odd thing is, when I take Viagra, even 25mg, while it does little to help, on the morning after I take it, I wake up with an erection just like old days.
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Just a thought from someone fully unfamiliar with ED, would your wife be in for a private morning party the day after you take Viagra? It may not be your preferred timing but it sounds like a possibility to me.
 
It's something I've often thought about. The reality is, due to my health problems, my wife is up an hour and a half before me, taking the dogs for a long walk, she definitely isn't in the mood when she comes back. Plus the dogs will be going mad at that point, hence they would bark and wake the neighbours if we closed the bedroom door
 
Blood flow is critical to erections. The arteries expand to increase blood flow to the penis. This blood fills two tubes of spongy tissue which causes them to swell. Meanwhile, the veins narrow, and traps the blood and maintains the erection. After ejaculation, the veins expand and the trapped blood flows back to the body and everything returns to normal.
(P.S. That is why it is dangerous if an erection DOESN'T go away. If it goes on for any length of time, the blood trapped there becomes deprived of oxygen. Oxygen poor blood will begin to damage tissue. They say one that is lasting longer than four hours is an emergency for that reason).

In addition to other causes, things that affect blood flow can affect erections.
High cholesterol, Hypertension, Diabetes all are things that can cause erectile dysfunction.

High cholesterol leads **** building up on the walls of your arteries which, in turn, narrows them. Once upon a time it was thought that this build up restricted blood flow in the penis which caused erectile dysfunction. Now, experts believe that it has to dysfunction of the inner lining of the blood vessels (endothelium) and smooth muscle. Dysfunction of this lining causes impairs blood flow. Impaired blood flow = things don't work right. (Mayo Clinic)

High Blood Pressure can also, over time, damage the lining of your arteries causing the same result. (Mayo Clinic)

Diabetes: Theory is that high blood sugars damage nerves and disrupt their ability to send signals. Without good nerve function erections are more difficult to achieve. High blood sugars can also decreases the elasticity of blood vessels and causes them to narrow, impeding blood flow. Again, poor blood flow = difficulty obtaining desired affect.

I don't think medicine has a definite definitive answer about the relationship to the three things listed above and ED. These are some of the general thoughts on the matter and, of course, you have other causes out there too that are totally unrelated (like hormonal dysfunction).
 
I had my urology visit today, no abnormalities but he did find inflammation right at the point of discomfort I was having on my left side, noted it as epididymitis, so I may have been correct that I must have hurt myself while working on the house earlier last year and this lead to some kind of inflammation with possible bacterial infection coming & going. Gave me an antibiotic. Also prescribed generic Cialis to help in the meantime and prescribed I get an EKG and heart stress test to assess any cardiac disease concerns (since ED is a predictor of this). That will likely turn up nothing, I had an EKG less than 2 years ago at a hospital and 0 issues found, same thing a few years ago.

Also urine test showed ketones at 40 mg/DL. He seemed concerned, also that I am avoiding metformin and focusing on diet change instead, but admitted that he's not a specialist on diabetes. He is the 4th doctor to tell me I should be taking metformin and doesn't understand why I'm not. My average mg/DL for the past month is now 126 (equivalent to 6% A1C) and I started 3 months ago at 9.8%. I would say that's good progress with no serious signs of hitting a wall just yet. My next A1C blood draw is tomorrow.
 
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New Haven Neil said:
I am going to ask to try alternatives next week.
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You can have daily Tadalafil (Cialis) which might be better, or the "as needed" dose which works for a few days after you take it. Just be warned it can give you bad stomach acid - especially after a fatty meal.

I found stopping alcohol & sugar made huge difference - as did core strengthening exercises (Yoga for me).
 


Seeing my (new) GP tomorrow, so we'll see. My previous GP would only prescribe Viagra, at the time saying Cialis was 'for diabetics' - I didn't know then, nor did he, that I was indeed diabetic!

I don't use any sugar and alcohol is maybe three units a week - so not likely an issue. I have tried kegels for some time but not noticed any difference.
 
Ojustaboo, wow that is a long list of meds. Is there any way to manage health problems with fewer meds? It may be a complication with all of that and I would personally prefer to be on the least medications possible to rule out those things as issues.
 

All needed

50 mg Cyclizine Hydrochloride 3 times a day when needed
I really need something even stronger, constantly feel sick, these are anti sickness meds

Metformin 500g 3 times a day (only taking twice at the moment else I'm on the loo all day)
If I can lose weight and get numbers low enough, hopefully GP will get me off this (ED probs before I went on it)

40 mg Simvastatin once a day
will ask to come off when I've finally lost a lot of weight

50 micrograms Nasonex nasal spray, twice a day
Have constant sinus problems, had nose drilled years ago

30mg Lansoprazole if needed
acid reflux problems, been on these (or equivalent) for well over 25 years

Ventolin/Salbutamol 100 micrograms whenever needed
Fostair 100micrograms/dose / 6 micrograms/dose inhaler. One puff twice a day
Suffer from very bad coughing asthma

Allopurinol 100mg Two once a day
Colchicine 500 micrograms twice a day
Suffer from gout, these prevent it

Ultrabase cream, use instead of soap
I can't use normal soap as I come out in rashes

Duloxetine 30MG Three times a day (well 60g in morning and 30g in evening)
I suffer from chronic pain and depression. These address both, not depressed, still in chronic pain, but they take the edge off
 
Follow-up with my primary physician and blood tests came back much better for A1C (6.2) and cholesterol (way lower triglycerides), and the additional tests requested by the urologist (testosterone, sex hormone, antigens, etc.) all came back normal. An EKG also showed totally normal. Which really mostly leaves just this epididymitis which I am about halfway through with the antibiotics for. It does feel a bit better down there but I've not had any convenience yet to "give it a test" until I am back from traveling.

I looked at the PDF for pelvic floor exercises - other than the ED, I don't have any other symptoms listed. The only other slight correlation is that at the end of peeing, the final couple of seconds is a weak dribble. Only in the recent year has that happened - it may be a side effect of the epididymitis but not sure. Not so say I won't try this exercise, just that it seems unrelated.
 
Jumping into this a little late but per Dr. Bernstein who is undoubtedly the best living diabetic and diabetologist in the world, if you have not lost your erection completely for some long time, it gets improved as you control your BG close to normal (83 mg/dl). From his patient's experience, it starts getting back within few weeks of normalizing your BG and can be completely reversed within few months unless you have lived long with high BG and your nerve endings are all dead. The second most important thing is your cardiovascular health. If you are doing regular cardio exercises (5 times a week or 150 min/week) raising your heart rate to 120-130, this should help a lot. If you have read Protein Power by Dr. Michael Eades, it shows that if you are living Palaeolithic lifestyle and your hormonal balance is all right then your protein/fat content of the food will convert mostly to testosterone.
 
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