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March 2023 Advice to Be Well From Dr. Mark Bornstein and Dr. Paul Benson

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I’m a 40 year old male living with HIV since 2002.  I have been doing very well with that and taking my medications daily.  I also have hypertension and diabetes.  As I am getting older I am having more and more difficulty with my erections, especially when using condoms.  My cardiologist says I should not be taking erectile medications because of an interaction with my heart medications.  The inability to have a satisfying erection is becoming more and more depressing.  What can I do?   Brian

Dear Brian,

I understand your frustrations.  Erectile dysfunction (ED) is actually more common than one may think, especially as one gets older.  There is a revolutionary new treatment that might be of benefit for you.  It’s called low intensity shock wave therapy (LISWT).  This innovative technology is clinically proven to improve blood flow and restore sexual performance.  This procedure is painless and easy to perform.  It works best for those mild to moderately affected. It requires two 10-15 minute treatments a week for 3 weeks.  It’s not for everyone.  It would be nice for many to avoid taking ED medications.  Some underlying causes of ED such as low testosterone or mental health issues, will probably not be amenable to LISWT. 

The gold standard equipment for this procedure is the Alma-Duo.  Staying physically active, controlling your blood pressure and sugar, and staying well hydrated are other things you can do to help yourself.  The Be Well Medical Center providers are experts in Sexual Health.  We are completing our training to be able to offer this therapy in the next few weeks with the Alma Duo.  We will take a detailed sexual medical history to determine if this procedure might be right for you.  More information will be coming soon on our website.  Additionally you can Google Alma Duo to learn more about it.  

Hi doc. I am a trans female and had bottom surgery 10 years ago. Sometimes I will go months without taking my estrogen as I am happy and comfortable with my transition. Is this bad? Do I have to worry about anything?

Hi there! First, one of the most important parts of transitioning is how YOU feel. Our goal will always be making sure you feel great and are happy with the current state of your transition. That being said, another important part of your transition is making sure we do it safely. From the doctor’s perspective, having had an orchiectomy (removal of testes) and not being on any estrogen does put you at an increased risk of suffering a bone fracture. This is because not having an adequate amount of testosterone or estrogen in your body puts you at an increased risk of a disease called osteoporosis.

Osteoporosis is when an individual has decreased bone mineral density. That means that the bones are not as strong and can fracture much easier. This is something that every individual should be screened for as they age. Factors that put an individual at increased risk of osteoporosis are age over 50, low BMI, history of smoking, history of steroid exposure, alcohol use, and parents having had a hip fracture. Even without any of these risk factors, cis women should still be screened for osteoporosis at 65 years old with a DEXA scan. This is the preferred imaging modality to test for osteoporosis.

To go back to your question, it is very important to continue taking some form of estrogen after an orchiectomy as testosterone and estrogen play a pivotal role in bone formation and remodeling. Having low testosterone and low estrogen will make bones weak and increase your risk for fracture. This is also extremely important for intersex individuals not on hormone therapy.

The good news is that we have a DEXA scan at Be Well! We will be able to measure your bone mineral density at a separate visit and it will very likely be covered by your insurance. This is an important part of your health and we need to be thinking about it just as we think about other health screenings such as colorectal cancer screening or breast cancer screening. Please reach out if you have any questions or want to schedule your DEXA scan.

Since 1980 Dr. Paul Benson’s Be Well Medical Center has been an inclusive medical center celebrating diversity. Do you have a health related question for Dr. Paul Benson and Dr. Mark Bornstein? Submit your questions to [email protected]. This article is a sponsored editorial produced in collaboration with Be Well Medical Center. Between The Lines’s journalism is made possible with the support and partnership of advertisers like Be Well. Learn more about Be Well here.

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