When masculinity falters
Sexual dysfunction is a collective term for disorders of sexual function in men. This includes problems with erection, sexual desire (libido), ejaculation, or orgasm. Many men experience such problems at least once in their lives, and in about one in three men over 40, they occur persistently. The causes are complex and range from psychological stress and physical illnesses to hormonal imbalances.
Despite its prevalence, sexual dysfunction often remains a taboo subject due to shame, ignorance, or insecurity. However, it is not just a sexual problem, but a potential early indicator of serious health issues , such as cardiovascular disease, diabetes, or testosterone deficiency.
What exactly constitutes sexual dysfunction?
- Erectile dysfunction (ED): Inability to achieve or maintain an erection
- Low libido: loss of sexual desire
- Ejaculatio praecox: Premature ejaculation
- Anorgasmia: Inability to achieve orgasm despite sexual stimulation
- Ejaculation disorder: Delayed or absent ejaculation
The symptoms can occur individually or in combination and may vary in severity at each stage of life.
Causes: Why sexual function can be impaired
Sexual dysfunction is rarely purely physical or purely psychological in origin. In most cases, several factors interact: hormones, blood flow, mental health, metabolism, and lifestyle.
Common physical triggers:
- Vascular diseases , e.g. arteriosclerosis
- High blood pressure , diabetes mellitus, lipid metabolism disorder
- Hormonal disorders , especially testosterone deficiency, elevated prolactin levels
- Medication side effects , for example from beta-blockers, antidepressants
- Hypothyroidism or hyperprolactinemia
- Obesity , lack of exercise, nicotine
Psychological & social factors:
- Stress and mental load , especially at work or in a relationship.
- Fear of failure (performance pressure)
- Depressive moods , sleep problems
- Low self-esteem or body image problems
A vicious cycle often develops: Fear of sexual failure creates tension, which intensifies the problem, resulting in growing insecurity and withdrawal.
The role of testosterone and hormones
Testosterone is the most important biochemical driver of male sexuality. A deficiency can manifest itself in various ways:
- Reduced libido
- Fewer spontaneous erections (especially at night)
- Delayed ejaculation
- Emotional flatness, declining energy
- Decline in morning erections
A persistently low testosterone level (especially free testosterone) in combination with elevated SHBG, low DHEA or disturbed estradiol balance can lead to functional sexual dysfunction, even in the absence of organic damage.
Diagnostics: What should be checked out?
A consultation with a doctor specializing in men's health is the first step. It's important to talk openly about any complaints, without shame or guilt.
Key components of diagnostics:
- Medical history (duration, extent, living conditions, medication use)
- Hormone status , including testosterone, SHBG, DHEA, estradiol, prolactin
- Vascular check (e.g. Doppler ultrasound of the penile arteries in cases of ED)
- Blood tests for metabolism (blood sugar, LDL/HDL, liver values)
- Thyroid values (TSH, fT3, fT4)
- If necessary, accompanying psychological diagnostics , especially in cases of stress, depression or anxiety disorder.
Treatment options
Treatment depends on the cause, age and health condition and must be individually tailored.
Medication:
- PDE-5 inhibitors (e.g., sildenafil) for ED
- Possibly hormone replacement therapy (TRT) in case of testosterone deficiency
- Adjustment of other medications that affect sexual function
Non-medicinal:
- Lifestyle changes (exercise, diet, stress management)
- Targeted strength training → improves libido, testosterone & blood circulation
- Behavioral therapy or sex counseling
- Couples therapy for relationship stress
- Mindfulness, breathing exercises, relaxation training
Conclusion
Sexual dysfunction is not a flaw, but a medically serious signal , often with underlying causes. Especially for men over 35, a comprehensive examination of hormone levels, lifestyle, vascular health, and mental stress is worthwhile.
The earlier the causes are identified, the better the symptoms can be treated, often even without medication. Targeted diagnostics, such as the premium hormone analysis from Adon Health , can be the first step towards gaining clarity.
