Controversy over estrogen reduction

DEAR DR. ROACH » I have a bad case of erectile dysfunction. I am 80 years old and otherwise in good health. I saw an ad that says it is not lack of testosterone, but rather too much estrogen. It scares me to reduce estrogen without further knowledge. How can I overcome this problem?

— Anon.

DEAR READER » The effect of estrogen on male sexual function is controversial. While it is true that men with erectile dysfunction are more likely to have high estrogen levels, reducing estrogen with medications (antiestrogens) in men with erectile dysfunction is seldom used as a treatment. The most common drugs, such as sildenafil (Viagra), work on blood vessels.

The majority of men with erectile dysfunction, even in their 80s, enjoy success with Viagra and similar drugs. I check testosterone levels and consider testosterone replacement in older men with erectile dysfunction. Antiestrogens are used in men with low libido and low testosterone, often together with testosterone, especially when fertility is a concern — testosterone can dramatically reduce sperm counts, and antiestrogens raise testosterone levels with less effect on sperm count. I would refer a man with poor response to Viagra-type drugs and testosterone to an expert on male sexual function.

DEAR DR. ROACH » My husband is one of five brothers, all born in the 1940s. Their father died of Parkinson’s disease. Three of the five brothers have been diagnosed with Parkinson’s and/or Lewy body dementia. All the affected brothers developed symptoms in their late 60s or 70s, and my husband is 80 now (the other brother is 75 — neither he nor my husband have any symptoms). What are the chances that the remaining two brothers will be stricken?

— L.E.

DEAR READER » Most cases of Parkinson’s disease are sporadic and not familial. However, there are familial cases, and these are more likely when the affected family members are age 50 or less at the time of diagnosis. I’m compelled to believe there is a family association in your husband’s family, given their history.

There are genetic tests available for many of the identified familial genetic variations; however, their interpretation is difficult. Further, since we don’t have therapies that can stop or slow down the progression of Parkinson’s disease, I do not recommend genetic testing for Parkinson’s disease.