Men’s Health

I have worked with thousands of men requiring specialized treatment for conditions affecting sexual performance as well as androgen (testosterone) deficiency. I employ an individualized treatment approach that is tailored to fit the needs of each individual. Every man is different and and requires customized treatment that is not based on a generic one-size-fits-all approach to care. Contact us today to request an appointment.

Conditions and Treatments
Sexual dysfunction
Testosterone optimization therapy

Michael Zappulla
Certified Nurse Practitioner

Sexual dysfunction

Sexual dysfunction is a common condition experienced by men. Sexual dysfunction includes erectile dysfunction, decreased libido or sex drive and abnormal or premature ejaculation. Erectile dysfunction is the most common form of sexual dysfunction and is described as difficulty achieving and/or maintaining an erection. Over 50 % of men between the ages of 40 – 70 will experience symptoms of erectile dysfunction.

Normal sexual function is dependent on complex interactions between the vascular, neurological, hormonal, and psychological systems.

  • Neurological Disorder: Erections rely on strong nerve impulses sent to the penis. The nerves can become damaged from trauma resulting in nerve injury or due to certain medical conditions such stroke or diabetes.
  • Vascular Disease: Abnormal blood flow is the most common cause of erectile dysfunction. Narrowing of the arteries (atherosclerosis) causes a decrease in blood flow to the penis. The veins also play an important role in erections. Men who experience trouble maintaining a firm erection may have a condition called venous leak.
  • Psychological disorders: Often overlooked, men under a lot of stress or suffering from depression may experience erectile dysfunction. Some antidepressants can contribute to erectile failure. Men may also develop performance anxiety or become frustrated when they notice changes in sexual function which only makes the problem worse.
  • Hormone-induced: Men with low testosterone may experience several a combination of symptoms such as: changes in sexual desire, low energy levels, trouble concentrating, difficulty sleeping, fatigue and erectile dysfunction. Men with too much or too little thyroid hormone, increased prolactin levels, or on hormones prescribed for prostate cancer may also contribute to erectile dysfunction.

Treatment for erectile dysfunction is determined based on age and medical history, the severity of the disease, previous treatment attempts, and your personal preference.

Oral medications such as Sildenafil, Tadalafil or Vardenafil may be prescribed for treatment.Men who are taking medications such as nitrates, such as nitroglycerin, should avoid using these medication as it may cause a potentially dangerous drop in blood pressure.

Men with low testosterone levels may be prescribed testosterone replacement therapy to improve energy, mood, lean muscle mass and increase sexual interest and libido. Testosterone replacement therapy may not be enough on its own and the combination of testosterone with medication such as Sildenafil, Tadalafil or Vardenafil may be required.

Additional treatment options may be used for men who have are on nitrates, have had treatment failure with the Sildenafil, Tadalafil or Vardenafil in the past or have had a history of prostate cancer.

While certain medication conditions that contribute to erectile dysfunction may not be avoidable, to help reduce or avoid situations in which erectile problems occur:

  • Be sure to get plenty of rest
  • Eat a healthy diet and exercises regularly to keep good blood circulation.
  • Maintain a healthy weight for your height.
  • Avoid alcohol before intimacy (and no more than 2 drinks per day).
  • Cut back, preferably quit, smoking.
  • For diabetics, keep blood sugar well-controlled.
  • Talk openly with your partner about your relationship and sex life

Testosterone optimization therapy

Testosterone is the primary sex hormone for men. It is responsible for the growth and development of many key male features and characteristics.

Testosterone is the key hormone that makes a man feel like a “a man”. In men, testosterone helps:

  • Keep bones and muscles strong
  • Maintain sex drive and erections
  • Make sperm
  • Determine hair growth and where fat is store on the body
  • Make red blood cells
  • Boost energy and mood

As the man continues to age, the amount of testosterone body gradually turns out to drop. Around the age of 30, most men will begin to have a gradual (about 1% per year) decrease in testosterone. A “normal” testosterone level falls between 250 to 1,000 nanograms per deciliter (ng/dL). Around 40% of men over age 45 will have levels that come in below that range. While a gradual decline in testosterone is a normal part of the aging process, there are several other ailments that can contribute to this such as:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Alcohol abuse
  • Obesity and being overweight
  • HIV / AIDS
  • Long-term use of some medications, like opioids

Low testosterone may also be referred to as low-t, andropause, androgen deficiency, male menopause, androgen deficiency in the aging male. When testosterone symptoms are too low it may cause very mild to very noticeable symptoms. As every man that experiences low testosterone is different, the number of symptoms and severity of these symptoms will be different. Levels of testosterone, as well as age, also contribute to the symptoms of low testosterone. The most common symptoms of low testosterone include:

  • Lower sex drive or desire
  • Lower quality and frequency of erections
  • Difficulty in concentration and memory
  • Reduced muscle mass and strength
  • Increased body fat
  • Low energy/fatigue
  • Moodiness and irritability
  • Depressed feelings

In order to measure your testoerone levels, basic blood test are done. The results of this blood test will indicate the testosterone level. If a combination of a low testosterone level along with symptoms associated with low testosterone are present, testosterone optimization (replacement) therapy may be recommended.

Most men will begin to experience results in as little as a few weeks, however, the this may vary depending on the number of symptoms being treated. For example, if you are trying to improve sex drive, results may take anywhere from 3 – 6 months.

But overall, you should experience a gradual increase in lean muscle mass, increase libido, increased energy, improved mental clarity and reduced body fat.

There is no way that the natural decline in testosterone levels associated with aging can be prevented, however, anything that affects overall health affects testosterone. A healthy diet, losing weight, exercise, reducing alcohol intake, and smoking cessation can help maintain healthy testoerone levels. Reducing stress and getting a good night’s sleep can also be helpful.


Sexual dysfunction

American Urological Association website. What is erectile dysfunction? urologic-conditions/erectile-dysfunction(ed). Updated June 2018.

Burnett AL, Ramasamy R. Evaluation and management of erectile dysfunction. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 69.

Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. PMID: 29746858

Testosterone optimization therapy

Allan CA, McLachlin RI. Androgen deficiency disorders. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 139.

Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental concepts regarding testosterone deficiency and treatment: international expert consensus resolutions. Mayo Clin Proc. 2016;91(7):881-896. PMID: 27313122

U.S. Food and Drug Administration website. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Updated February 26, 2018. Accessed July 6, 2021.