Men's Health: Fertility, Sexual Wellness & Hormonal Well-being

Common causes of erectile dysfunction in men

Erectile dysfunction (ED) — the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity — affects an estimated 1 in 5 men above the age of 40, with prevalence rising steeply with age. Far from being merely a sexual problem, ED is increasingly recognised as an early warning sign of underlying cardiovascular disease, diabetes, and hormonal imbalance. In Dr. Utture's experience treating men across Mumbai, ED is a condition that is almost always treatable once the root cause is identified.

• Vascular disease (most common) — The penis requires robust arterial blood flow to achieve erection. Atherosclerosis, hypertension, and high cholesterol narrow penile arteries, often years before cardiac symptoms appear. ED in a man under 50 should prompt cardiovascular risk assessment.
• Diabetes mellitus — Both type 1 and type 2 diabetes damage nerves and blood vessels supplying the penis. Up to 75% of diabetic men experience ED at some point. Poor glycaemic control accelerates this progression significantly.
• Low testosterone (hypogonadism) — Testosterone drives libido and supports the neurological pathways involved in erection. Low levels reduce sexual desire and impair erection quality, often in combination with other causes.
• Psychological and relationship factors — Performance anxiety, depression, chronic stress, relationship conflict, and pornography-induced desensitisation are significant contributors, particularly in younger men. These causes are often overlooked in routine medical consultations.
• Medications — Antihypertensives (especially beta-blockers), antidepressants (SSRIs), antiandrogens, and some diuretics are well-established causes. Never stop a prescribed medication without consulting your doctor, but do discuss ED as a side effect.
• Neurological conditions — Multiple sclerosis, Parkinson's disease, spinal cord injury, and nerve damage from pelvic surgery (prostatectomy, bowel surgery) can interrupt the nerve signals needed for erection.
• Lifestyle factors — Smoking damages penile vasculature directly; obesity raises oestrogen and lowers testosterone; excessive alcohol suppresses the central nervous system; and physical inactivity impairs endothelial function. All are modifiable.
• Peyronie's disease — Scar tissue inside the penis causes curved, painful erections and can make intercourse difficult or impossible. It is more common than most men realise and is treatable.

A thorough evaluation includes fasting blood glucose, lipid profile, total and free testosterone, prolactin, thyroid function, and — in selected cases — penile duplex Doppler ultrasound to directly assess arterial blood flow. Treatment is then matched to the underlying cause rather than applied as a one-size-fits-all approach.

Male infertility: symptoms, diagnosis & treatment

Male factors contribute to infertility in approximately 40–50% of all couples struggling to conceive, yet male investigation is often delayed while the female partner undergoes multiple tests. Infertility is defined as the inability to achieve pregnancy after 12 months of regular unprotected intercourse. If the female partner is over 35, evaluation is recommended after 6 months. A male assessment — beginning with a semen analysis — is simple, non-invasive, and should be performed early.

Treatable causes of male infertility include varicocele, hormonal deficiencies, infections (treated with antibiotics), obstructions in the reproductive tract, and lifestyle factors. For men with untreatable azoospermia, donor sperm or adoption remain options that Dr. Utture discusses openly and compassionately with couples.

Low testosterone: signs every man should know

Testosterone is the primary male sex hormone, essential for libido, erectile function, muscle mass, bone density, mood, energy, and cognitive function. Levels peak in early adulthood and decline by approximately 1–2% per year after age 30. When levels fall below the clinical threshold — a condition called hypogonadism or testosterone deficiency syndrome (TDS) — symptoms emerge that are often misattributed to stress or normal ageing.

• Reduced sex drive (low libido) — One of the earliest and most consistent signs. Men often describe a gradual fading of sexual interest rather than a sudden change, making it easy to dismiss.
• Erectile dysfunction — Low testosterone impairs both desire and the neurological-vascular mechanisms of erection. ED that does not respond to PDE-5 inhibitors alone should prompt testosterone testing.
• Persistent fatigue and low energy — A pervasive tiredness that sleep does not relieve, often accompanied by reduced motivation and drive, is among the most commonly reported symptoms of testosterone deficiency.
• Loss of muscle mass and strength — Testosterone is anabolic. Men with low levels notice progressive muscle loss and difficulty building strength despite regular exercise.
• Increased body fat, especially abdominal — Low testosterone promotes fat accumulation and reduces lean mass. Central obesity in turn further suppresses testosterone, creating a worsening cycle.
• Mood changes — depression, irritability, poor concentration — Testosterone has neuroactive effects. Deficiency is associated with depressive symptoms, reduced sense of well-being, and cognitive slowing — often diagnosed as depression when testosterone is the underlying issue.
• Reduced bone density — Testosterone maintains bone mineralisation. Long-standing deficiency increases fracture risk, particularly at the hip and spine, in a manner analogous to post-menopausal osteoporosis in women.

Testosterone replacement therapy (TRT) — available as injections, gels, or patches — can reverse most symptoms of confirmed deficiency. However, TRT is not appropriate for all men: it suppresses sperm production and is contraindicated in men with prostate cancer or those wishing to father children. A specialist evaluation is essential before starting treatment.

Lifestyle habits that affect men's health

The lifestyle choices men make on a daily basis have a profound and measurable impact on testosterone levels, sperm quality, erectile function, and overall well-being. The good news: most of these factors are within your control, and even modest improvements produce significant benefits. Dr. Anand Utture integrates lifestyle counselling into every men's health consultation, because medication alone rarely addresses the root cause.

Myths and facts about erectile dysfunction

Erectile dysfunction carries significant stigma in India, and as a result, many men delay seeking help for years — or never seek it at all. Much of this reluctance is driven by misinformation. Below, Dr. Anand Utture addresses the most pervasive myths about ED with the evidence-based facts that every man deserves to know.