Gout Patients Should Be Screened for Erectile Dysfunction

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Erectile dysfunction (ED) is common and often severe in men suffering from gout, according to the results of a cross-sectional survey of men who presented to a rheumatology clinic.

“These results strongly support the proposal to screen all men with gout for the presence of ED. Increasing awareness should in turn lead to earlier medical attention and treatment for this distressing condition,” said lead author Naomi Schlesinger, MD, chief, Division of Rheumatology, and professor of medicine at Rutgers–Robert Wood Johnson Medical School, in New Brunswick, New Jersey.

The results of the study were presented here at the European League Against Rheumatism (EULAR) Congress 2014.

The most common inflammatory arthritis in men older than 40 years, gout is caused by deposits of urate crystals in the joints and is associated with uricemia. The crystals cause inflammation, pain, and swelling, and the inflammatory component of the disease is linked to risk factors for cardiovascular disease and coronary artery disease.

The cross-sectional study included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013. Of these, 83 had gout.

Participants filled out a Sexual Health Inventory in Men (SHIM) questionnaire, which evaluates the ability to have an erection, the firmness of the erection, the ability to penetrate sufficiently for sexual intercourse, and sexual satisfaction. A score of ≤21 indicates ED; a score of ≤10 indicates severe ED.

“Men don’t usually volunteer sexual complaints,” said Dr. Schlesinger. “The gout patients in our study were generally delighted and grateful that someone finally asked them about ED.”

The mean SHIM score for all participants was 16.88. Patients with gout had a mean SHIM score of 14.38 compared with 18.53 in patients without gout (P < .0001).

A significantly greater percentage of patients with gout had ED compared with patients without gout (76% vs 52%, P = .0007). Also, significantly more men with gout had severe ED vs men without gout (43% vs 30%, P = .007).

The presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout (P = .0001), and was significantly more likely to be severe (P = .0002).

A multivariate analysis adjusted for age, hypertension, low-density cholesterol level, glomerular filtration rate, obesity, and depression found that the association between gout and ED was statistically significant (P = .0096).

Silent Coronary Artery Disease

 “It is estimated that 1 in 5 men who present with ED have silent coronary artery disease. A man with ED, even with no cardiac symptoms, is a cardiac patient until proven otherwise,” said Dr. Schlesinger. “Perhaps we could say that the 3 ‘EDs’ are related: endothelial dysfunction leads to erectile dysfunction leads to early death.

“Gout patients who present with ED have an increased rate of cardiovascular risk factors and concomitant silent coronary artery disease and should be evaluated,” she added.

 Maya Buch, MD, from the Leeds Institute of Rheumatology and Musculoskeletal Medicine, at the University of Leeds, United Kingdom, praised the authors of this study for providing new information on these conditions with overlapping risk factor — gout and cardiovascular disease.
 “These patients are at risk for cardiomyopathies, and there is no literature on ED and gout. We know that patients with gout have multiple comorbidities, and it’s clear that rheumatologists need to address that,” she explained.

“I was surprised at how many patients with gout have ED. In addition to treating hyperuricemia in our patients with gout, we need to pay attention to cardiovascular risk factors. I hope that this study makes doctors more receptive to evaluating patients for ED,” she added.

Dr. Schlesinger has disclosed no relevant financial relationships. Dr. Buch has received honoraria and consulting fees from AbbVie, Bristol-Myers Squibb, and Roche-Chugai and has a research grant from Pfizer, Inc.

 European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.

Written By: Alice Goodman

Article Source: http://www.medscape.com/viewarticle/826773

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Testosterone Deficiency in Men

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It is not normal to wake up feeling tired all of the time, nor is it written in stone that the body has to break down as you age. Do not let any person or doctor tell you that lack of energy, weight gain, decreased sex drive, and loss of muscle are a fact of life. They are not! Why is it that some people manage to stay looking young and fit throughout their lives when others show the signs of aging in their early years? Testosterone deficiency may be to blame.

If the only thing you have ever thought testosterone was good for was building muscles, or increasing a man’s love drive, you are very mistaken. These are only two of the many functions testosterone has in the body. While often referred to as the male sex hormone, testosterone is beneficial to everyone, male and female, alike.

Yes, you are getting older – we all are! That does not mean that you have to hang up your running shoes, put away your golf clubs, or cancel your gym membership. Once you understand the signs and symptoms of testosterone deficiency in men, you will be able to determine if the time has come to reach out to a specialist for help.

Testosterone Deficiency in Men

Here are the top warning signs that you might have testosterone deficiency:

  • You are always tired – in the morning when you wake up, in the afternoon after eating lunch, at night after work
  • You have gained weight – unless you have changed your eating habits and are now consuming mass quantities of food or alcohol beverages, abdominal weight gain is often a sign of hormonal imbalance
  • Your sex drive is missing from action – there is no action here when your libido has disappeared, and you find it takes a long time to feel even the slightest bit aroused
  • You can no longer achieve or maintain a powerful erection – erectile dysfunction is an immediate sign that something is wrong, and this can be as simple as fewer morning erections all the way to not being able to achieve an erection or orgasm
  • You are shrinking – loss of height has everything to do with decreased bone density – a serious issue when Low T is present
  • Your muscle size has decreased – testosterone helps to maintain muscle structure and strength, and if your workouts are no longer producing the desired effect, testosterone deficiency could be the problem
  • You are feeling depressed – depression, mood changes, anxiety, aggression, lack of motivation, decreased drive, frustration – these are all signs of testosterone deficiency
  • You forget things – memory failure, trouble with mental calculations, difficulty learning new things or committing new facts to memory, and poor focus are all associated with Low T
  • Hair loss – balding or thinning hair on the head, and excess hair growth on the body may all signal low testosterone
  • You have other health problems – if you have any of the following conditions you may also have testosterone deficiency: heart disease, diabetes, obesity, thyroid issues, osteoporosis, sleep apnea, Alzheimer’s disease, dementia, high blood pressure, osteoarthritis, or prostate problems

It is also not uncommon for a man with Low T to experience hot flashes and night sweats much the same way as a woman dealing with menopause. In fact, the term applied to Low T is andropause. The good news is that there is a way to improve these symptoms, you just need to know where to look and who to turn to for help.

Which Doctor Will Help to Reveal Testosterone Deficiency

The right doctor will help you determine if your symptoms are associated with testosterone deficiency. Blood testing will reveal if testosterone or any other hormone levels are below their normal range. Some of these hormones impact one another, causing a spiraling effect of deficiencies. The doctor that you want to contact at this time is a hormone replacement therapy specialist – HRT for short. These practitioners work with men and women over the age of thirty who are experiencing changes in their bodies due to hormonal imbalances.

An HRT specialist will not brush off your symptoms as signs of aging. These doctors know that testosterone deficiency can create havoc in the body, and lead to serious illness if not caught and treated. A proper diagnosis will provide patient-targeted treatment that will bring stellar results.

You do not need to live with the symptoms outlined above. There is help, and a hormone replacement specialist can provide what you need to feel like yourself again. Vitality, libido, passion, and excitement can and should be a part of your life. Testosterone therapy can make it happen.

Article Source: http://positivemed.com/2016/06/21/testosterone-deficiency/

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Biking and Erectile Dysfunction: A Real Risk?

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Some experts say ED may be an unwelcome side effect of bicycle riding.

For men, the health benefits of bicycling may involve a troublesome trade-off. While riding a bicycle burns calories and improves cardiovascular fitness, too many hours on a bicycle saddle can compress the artery and vital nerves leading to the penis.

The result? A risk of numbness, pain, and erectile dysfunction.

A male cyclist can place a significant percentage of his weight on his perineum, an area between the scrotum and the anus where the nerves and arteries to the penis pass. This pressure — and a narrow saddle seat — can injure the arteries and nerves.

“The earliest warning sign is numbness or tingling,” says Irwin Goldstein, MD, director of San Diego Sexual Medicine.

Even a young man may lose the ability to achieve an erection, says Goldstein, who pioneered an operation that restores blood flow and sexual potency in 65%-75% of cases.
How much riding does it take to put a man at risk? The Massachusetts Male Aging Study found that the risk was highest among men who cycled more than three hours a week.

The ‘No-Nose’ Seat

Goldstein encourages men to sit upright when they ride and replace the traditional bicycle saddle with a “no-nose” seat that redistributes a man’s weight to the sit bones of the buttocks.

Serious cyclists who lean forward in a racing position when they ride claim they need the nose to achieve more power and control.

“I don’t think you can be a competitive rider and be protected from erectile dysfunction,” says Goldstein. “They need that nose between their thighs, and that produces nerve and artery compression.”

The evidence that riding a bicycle can be harmful to men is very persuasive, but it should be kept in perspective, says John M. Martinez, MD.

“If someone comes in and says, ‘Should I not cycle because of the danger of erectile dysfunction?’ I say, ‘You have a 50% chance of developing and dying from heart disease, so your primary focus should be exercise and diet — the two main components of fighting heart disease and ED,'” says Martinez, a primary care sports medicine physician and the medical director at Coastal Sports and Wellness Center, San Diego.

“I wouldn’t tell anyone to give up cycling because of fear of ED. If there is ED from cycling, it’s almost always temporary and reversible. Other causes of ED, such as hypertension and diabetes — the No. 1and No. 2 causes of ED — tend to be fairly permanent. If there are problems, they’re usually treatable with proper bike fit and bike seat selection.”

A proper-fitting bicycle can help prevent these injuries; appropriate frame size, handlebar height, and seat position are all important. A rider may consider changing the angle of the seat, which should be angled parallel to the ground or slightly forward, to help alleviate pressure on the perineum. Wider seats or those designed with a central cutout also help reduce perineal pressure and can help redistribute weight.

A change in riding style may also help reduce pressure. Standing on the pedals during long rides can prevent pressure and help re-establish blood flow.

Police Bike Patrol Study

Some new saddle designs take the weight off the perineum, according to Steven Schrader, PhD, of the National Institute for Occupational Safety & Health (NIOSH). Schrader triggered an explosion of research on the link between cycling and ED in 2002 when he published a study involving members of a police bicycle patrol. He found that the more hours the officers spent in the saddle, the more likely they were to experience a decrease in the quality of nighttime erections.

All this research spurred the development of several no-nose bicycle seats, and Schrader has tested several.

“We recruited police officers and gave them no-nose seats to use for six months,” Schrader says. “We’re still doing data analysis, but the striking thing is that of the 91 men who completed the study, only three had returned to a traditional saddle. When we went back and found those three guys, two of them said their saddle had broken and they wanted a new one. Only one said he didn’t like it.”

No-nose seats have a wide rear that distributes the rider’s weight on his sit bones on the buttocks. One study in Germany found that oxygen levels in blood flow to the penis dropped by only about 20% when riders were on a no-nose seat. A traditional bicycle saddle reduces oxygen in blood flow by around 80%.

The Grooved Seat

Bike saddles that feature a groove down the middle or holes in the center to alleviate pressure can actually make the problem worse by increasing pressure on either side of the groove.

“They feel better,” Schrader said of the grooved seats. “With the traditional saddle you’re sitting on your internal penis. You can feel it. When it drops into the groove it feels better, but if you’re increasing the pressure on either side, you’re still compressing the artery and the nerves. The wider the seat, the farther back you sit, the better off you’re going to be.”

The problem affects women too, although not as conspicuously. Schrader recently participated in a study that found the genitalia of competitive female cyclists were desensitized by long hours of riding.

“Some gynecologists say it doesn’t hurt their sex life so who cares,” Schrader says, “but I say if they’re causing physiologic damage, that should be a concern.”

Cycling has been commonplace for well over a century. Yet the relationship to ED wasn’t widely noticed until 1997 when Ed Pavelka, former executive editor of Bicycling magazine, acknowledged his own erectile difficulties after a year of high-mileage cycling.

Historical Perspective

Why did it take so long for this problem to come to light?

Actually, it didn’t. “Cyclists were talking about numbness in the groin as far back as the 1890s,” says Schrader. “Ads used to say that this bicycle saddle is the only one that doesn’t cause permanent damage. This has been known about for a long time.”

After Pavelka brought the problem to public attention, research has consistently supported the connection between cycling and ED. Yet despite ample research showing that a traditional bike seat and improper cycling position can reduce blood flow and compress nerves, some cycling enthusiasts continue to argue that the health benefits of bike riding outweigh the dangers of ED.

But Schrader contends that evidence to the contrary is overwhelming. True, not every man who rides a bicycle will experience a problem. “One would not expect that every bicyclist would suffer from ED any more than one would expect every smoker would get lung cancer,” he wrote in a recent editorial in The Journal of Sexual Medicine. Nevertheless, the time has come to develop effective strategies to reduce this danger. “The health benefits from having unrestricted vascular flow to and from the penis are self-evident,” he says.

By
WebMD Feature
Article Source: http://www.webmd.com/men/features/biking-and-erectile-dysfunction-a-real-risk?page=1

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PDE5 inhibitors – Another reason to love them

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Boston Testosterone Partners – Testosterone Replacement Therapy for Men with adjunct therapies in PDE5 inhibitors such as tadalafil (Cialis) and Sildenafil (Viagra).  Here is another reason why many of our patients love to include tadalafil troches into their therapy protocols.

Researchers from the University of Bonn treated mice with Viagra and made an amazing discovery: The drug converts undesirable white fat cells and could thus potentially melt the unwelcome “spare tire” around the midriff. In addition, the substance also decreases the risk of other complications caused by obesity. The results are now published in “The Journal of the Federation of American Societies for Experimental Biology” (FASEB).

Sildenafil – better known as Viagra – is used to treat erectile dysfunction. This substance prevents degradation of cyclic guanosine mono-phosphate (cGMP), which then ensures blood supply for an erection. However, another effect of Viagra has been noticed quite some time ago – mice given sildenafil over longer periods of time were resistant to obesity when fed with high-fat diet. However, the cause for this reduced weight gain had been unclear. Researchers from the University of Bonn have been able to shed some light on this sildenafil effect. “We have been researching the effect of cGMP on fat cells for quite some time now,” reports Prof. Dr. Alexander Pfeifer, Director of the Institute for Pharmacology and Toxicology at the University of Bonn. “This is why sildenafil was a potentially interesting candidate for us.”

Viagra converts undesirable white fat cells into beige ones

Together with the PharmaCenter of the University of Bonn, the German Federal Institute for Drugs and Medical Devices (BfArM), and the Max Planck Institute for Heart and Lung Research, the team around Prof. Pfeifer studied the effect of sildenafil on fat cells in mice. The researchers administered the potency drug to the rodents for seven days. “The effects were quite amazing,” says Dr. Ana Kilic, one of Prof. Pfeifer’s colleagues. Sildenafil increased the conversion of white fat cells, which are found in human ‘problem areas’, into beige ones in the animals. “Beige fat cells burn the energy from ingested food and convert it to heat, says Prof. Pfeifer. Because the beige fat cells can “melt the fat” and thus fight obesity, researchers are very hopeful for their potential.

Positive effect on inflammation responses

In addition, the researchers observed something else of interest. If white fat cells are further “stuffed”/accumulating lipids, they are increasing in size and can synthesize and release hormones which in turn cause inflammation thus increasing the persons risk for chronic diseases. Such inflammatory responses may then lead to, e.g., cardio-vascular diseases resulting in heart attacks and strokes, as well as cancer and diabetes. “It seems that sildenafil prevented the fat cells in these mice from getting onto that slippery slope,” reports Prof. Pfeifer. Overall, the development of white cells seems to be healthier.

More than half a billion overweight people worldwide

Globally, over half a billion people are overweight. Present study has resulted in interesting starting points for further research on this mechanism. “Sildenafil is not only able to minimize erectile problems, but it can also reduce the risks of gaining excessive weight,” says Prof. Pfeifer. The researchers may have found a mechanism that allows converting the undesirable white fat cells into the “good” beige (brown-like) fat cells that “melt” away excess pounds. In addition, it might be possible to decrease complications related with obesity. “But this will need to be proven in additional studies,” adds Dr. Kilic.

Caution against premature application

Despite promising data, researchers caution the public against the fallacy of thinking that popping some sildenafil will work to quickly lose the extra pounds accumulated over the holidays. “We are currently in the basic research stage, and all the studies have been exclusively performed on mice,” stresses Prof. Pfeifer. It will be a long way until potentially suitable drugs for decreasing white fat cells in humans will be found.

Boston Testosterone Partners

Boston Testosterone Partners – At our National Men’s Testosterone Replacement Therapy Clinic in Boston, Massachusetts, many of our patients are treated with Tadalafil (Cialis) sublingual troches 6.25mg daily that work amazing to increase blood flow for ED. However, most everyone finds a great benefit while weight training as blood flow to the muscle is increased as well resulting in a “muscle pump”.

Coupled with our testosterone replacement therapy, the protocols work wonders for men.

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Low testosterone may cause health problems that lead to erectile dysfunction

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Men with erectile dysfunction should be examined for testosterone deficiency and the metabolic syndrome, because these conditions commonly occur together, a new study shows. The results will be presented at The Endocrine Society’s 90th Annual Meeting in San Francisco.

“Erectile dysfunction is a portal into men’s health,” said the study’s senior author, Aksam Yassin, MD, PhD, of the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany. “It is becoming clear that obesity, diabetes, high blood pressure, cholesterol problems and erectile difficulties are intertwined, and a common denominator is testosterone deficiency.”

Yassin’s research, performed with scientists from The Netherlands, Germany and the United Arab Emirates, aimed to determine in men with erectile dysfunction (ED) the prevalence of hypogonadism, the scientific term for testosterone deficiency.

Over a two-year period the investigators studied 771 patients who sought treatment for ED. Their average age was 56. The patients received a comprehensive screening for low testosterone and indicators of the metabolic syndrome, a cluster of risk factors that increase the chances of developing heart and vascular disease and type 2 diabetes. Having three of the following five risk factors establishes the diagnosis of this syndrome: increased waist circumference (abdominal fat), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure, and high blood sugar.

Among the 771 men, 18.3 percent of the men (141 men) had testosterone deficiency, which had previously been undetected, the authors found. The prevalence of hypogonadism in the general population of men age 45 and older is about 12 percent, Yassin said.

Of all the men in the study, 270 (35 percent) had type 1 or type 2 diabetes; in eight of the men, diabetes was a new diagnosis, according to study data. High blood pressure was found in 239 men (31 percent), and 12 of these men had been unaware of it. Among the 162 men (21 percent) who had dyslipidemia–abnormal cholesterol or triglycerides–nine of them had not previously been diagnosed. And 108 men, or 14 percent, had varying degrees of coronary heart disease. Five of them received this diagnosis for the first time, Yassin said.

Men with ED–especially older men–should therefore receive evaluation not only for ED but also for testosterone deficiency and any underlying signs of the metabolic syndrome, he advised.

Article Source: http://www.eurekalert.org/pub_releases/2008-06/tes-ltm061408.php

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Five common causes of erectile dysfunction

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You’ve seen the late night commercial come across your screen. An older man is on a date with a beautiful woman in a romantic setting. They hold hands as they walk around or eat a nice meal. A big smile stretches across his face as he looks in her eyes, but something is secretly bothering him. Cue the voiceover about erectile dysfunction.

Also known as ED or impotence, erectile dysfunction occurs when a man is unable to get or keep an erection firm enough to engage in sexual intercourse. While these commercials spur jokes and laughs among most, erectile dysfunction could indicate a serious health issue.

The likelihood of erectile dysfunction does increase with age (22 percent of men over the age of 60 and 30 percent of men over the age of 70 suffer from impotence), but it’s not an inevitable part of growing older. Instead, the cause is more likely related to an underlying physical or psychological condition.

1. Medical Conditions

Serious medical conditions, such as heart disease, could be the origin of your erectile dysfunction. In fact, causes of heart disease and erectile dysfunction are very similar. ED symptoms may occur earlier than those of heart disease due to cardiovascular issues like atherosclerosis. Atherosclerosis, the narrowing of blood vessels throughout parts of the body, is believed to be the most common cause of erectile dysfunction and a warning sign of a future heart attack or stroke. Other medical conditions that put men at risk for erectile dysfunction are diabetes, chronic kidney disease, multiple sclerosis and Peyronie’s disease.

2. Medications

Are you taking any prescribed or over-the-counter drugs on a regular basis? Certain medications may make it difficult for you to get or keep an erection, like antidepressants, antihistamines or blood pressure medications. While these drugs may treat a condition, they can also affect hormones, nerves, or blood circulation, which can all increase the risk of erectile dysfunction. If you think your ED may be the result of a medication, it’s best to consult your physician.

3. Emotional Distress

Have you been fighting with your partner? Relationship problems causing stress can lead to struggling in the bedroom. Depression, anxiety, low self-esteem, guilt, and fear of sexual failure are other contributing factors.

4. Lifestyle Choices

Making poor health decisions on a daily basis may affect your ability to get an erection. Men who are overweight, habitual smokers, alcoholics, or substance abusers are more prone to experiencing erectile dysfunction. Eating foods high in flavonoids, like blueberries, help reduce the risk of erectile dysfunction. Increased flavonoid intake also helped men smoke less, drink less and exercise more.

5. Physical Injury

While exercise is great for your health, be cautious of any physical activity that could injure your lower half, as injuries to these areas of the body can cause erectile dysfunction. With the increasing popularity of cycling, men have expressed concern about whether this exercise contributes to ED. A recent study published in the Journal of Men’s Health concluded that there was no relationship between prolonged cycling and erectile dysfunction.

With 30 million Americans currently suffering from erectile dysfunction, a number estimated to rise to 320 million worldwide by 2025, it’s important to be active in your health care. Talk to your health care provider if you’re experiencing impotence and share your concerns about any underlying causes.


Story Source:

The above post is reprinted from materials provided by Texas A&M University. Note: Materials may be edited for content and length.

Texas A&M University. “Five common causes of erectile dysfunction.” ScienceDaily. ScienceDaily, 8 February 2016. <www.sciencedaily.com/releases/2016/02/160208183449.htm>.

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Does a Lack of Morning Wood Suggest Erectile Dysfunction?

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Morning erection may be a very common experience for almost every man. While others choose to ignore the reason behind the morning erection, most assume that morning erection is caused due to the delay in passing urine.

Research suggest that during the REM (Rapid Eye Movement) sleep, the body’s systems are tested, including the function of the erectile tissue within the penis. While this sleep occurs, the parasympathetic nerves trigger the tissues in the penis to become engorged with blood, and then firm. Therefore, the last REM period often occurs right upon awakening, when men will most often wake up with an erection.

Yes, a lack of morning wood may also be a sign of erectile dysfunction (ED) or impotence.However, there are various causes of erectile dysfunction. Generally, erectile dysfunction can be related to physiological or psychological status of a man. However, a lack of morning wood may help to differentiate between these two causes.

Physiological Causes of Erectile Dysfunction:

Physiological causes of impotence relate to an underlying inability to fill the penis with blood to make it erect. This often has a vascular cause, meaning that it relates to dysfunction of the blood vessels. It may also occur as a side effect to medications, most commonly antidepressants. Men with a physiological cause of impotence will not have morning erection.

Psychological Causes of Erectile Dysfunction:

Alternatively, some men are not able to have an erection due to psychological difficulty. A lack of sexual arousal or responsiveness may lead to impotence. This can also occur because of anxiety. Men with this condition will have morning erections, since they are physically capable of having them. Therefore, men who suffer from periods of impotence who still have morning erection likely have a psychological cause for their erectile dysfunction.

Source: http://www.curejoy.com/content/lack-morning-wood-suggest-erectile-dysfunction

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