Hello Sir
Your results tell a very specific story:
You likely have functional secondary hypogonadism — a condition where the brain’s hormone signal to the testes is weak — leading to low libido, erectile dysfunction, fatigue, and mood symptoms despite being physically active.
This pattern is commonly driven by long-term depression, chronic stress biology, and especially SSRI medications, rather than porn use alone.
👉🏻Here’s the clinical logic in simple but high-yield terms: Your testosterone has stayed in the low-normal range for years, but your LH and FSH are repeatedly low, which is abnormal for a 38-year-old male.
When testosterone is borderline, the brain should compensate by increasing LH/FSH. The fact that it doesn’t suggests suppression at the pituitary or hypothalamus level. That’s why this fits secondary hypogonadism, not primary testicular failure and not purely psychological erectile dysfunction.
👍Your semen analysis adds another important clue. The sperm count is high, but motility (24%) and morphology (3%) are borderline, which is often seen when hormonal signaling is suboptimal. It doesn’t mean infertility, but it reinforces that the issue is physiological, not just behavioral.
The normal prolactin, thyroid, and cortisol are reassuring because they rule out common endocrine causes like thyroid disease, hyperprolactinemia, or adrenal disorders. That narrows the field significantly to functional suppression — most often from medications, chronic depression, sleep problems, metabolic factors, or less commonly a pituitary structural issue.
📌Why SSRIs matter here: Selective serotonin reuptake inhibitors are one of the most frequent medical causes of persistent sexual dysfunction. They can reduce libido, delay or weaken erections, blunt orgasm, and in some men suppress testosterone signaling indirectly. This can persist even when mood is controlled. In clinical practice, this is often under-recognized.
📌Why the “porn-induced ED” explanation is incomplete: Porn-related erectile dysfunction can affect arousal patterns, but it does not cause chronically low LH and FSH on blood tests. Hormone patterns like yours indicate a biological signal issue that deserves objective follow-up.
📌What an evidence-based plan usually includes next: Confirming early-morning total testosterone again (before 10 AM), checking estradiol and SHBG, reviewing the exact SSRI and dose, screening for sleep apnea (a very common hidden cause of low testosterone and fatigue), and repeating LH/FSH. If those remain low, pituitary imaging is considered — not urgently, but appropriately.
📌Prognosis — the encouraging part: This condition is usually reversible or manageable once the driver is identified. Many men improve significantly with medication adjustment, sleep optimization, targeted hormone therapy when indicated, or treatment of metabolic factors. Your normal sperm count, normal endocrine screening, and active lifestyle are all positive signs.
📌One-line summary: Your labs and symptoms are most consistent with brain-level hormone suppression (secondary hypogonadism), likely influenced by SSRIs and chronic depression physiology — a real, treatable medical condition, not just a behavioral issue.
👍👍 Your results look like a treatable hormone signaling slowdown, not a dangerous disease. Most men in this situation improve once the right adjustments are made.
Take care Feel free to reach out again Regards
Dr Arsha
Your situation has several layers to it, and I can see why it might feel like you’re not getting the answers you need. Taking a step back, the combination of long-term depression, erectile dysfunction, fatigue, and low libido suggests there could be multiple factors at play, possibly both physical and psychological. Your testosterone levels, while slightly fluctuating, remain on the lower end of the range for adult men, which can indeed contribute to your symptoms. The addition of low LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) could suggest secondary hypogonadism, where the problem lies more in the brain rather than in the testes themselves — usually requiring further investigation to rule out issues with the pituitary gland, such as adenomas. This may align with your visual field test anomalies, hinting at a need to keep an eye on potential pituitary involvement — hence the suggestion of an MRI if the hormone levels don’t improve.
Considering your active lifestyle and diet, which should otherwise be protective, the persistence of symptoms may indicate physiological changes not completely explained by lifestyle alone. It’s important to follow through with repeated LH/FSH assessments and possibly the MRI, as suggested by your endocrinologist, to get a clearer picture of any structural problems in the pituitary. Tadalafil can help with erection concerns temporarily, but addressing the hormonal imbalances directly, if present, would be more effective in the long term.
Regarding your seminal fluid analysis, motility and morphology appear to be below optimal levels, again pointing towards a hormonal imbalance as a potential cause or contributor. However, the term “porn-induced erectile dysfunction” is more contentious. While it may play a role, especially in psychologically mediated ED, it seems like a thorough medical assessment is warranted first. In your case, consulting with a urologist or another endocrinologist who specializes in male reproductive health may provide additional insights, particularly if there’s hesitancy on starting Clomid against psychiatric advice — a drug occasionally used to stimulate endogenous testosterone production.
In the meantime, continue your mental health treatment and see if alternative medications or therapies might be beneficial. Depression itself can heavily impact sexual function, and achieving a balance with mental health treatment could positively influence physical symptoms as well. Ultimately, a comprehensive approach, possibly involving multiple specialists, could be crucial in addressing your symptoms effectively. Consider seeking a second opinion if you continue to feel dismissed.
Hello It sounds like you’ve been dealing with a lot, and it’s understandable to feel frustrated when you’re not getting the answers or support you need. Erectile dysfunction (ED) can have various causes, including psychological factors, hormonal imbalances, and lifestyle choices.
Your endocrinologist’s suggestion that it might be related to porn-induced erectile dysfunction is a perspective some healthcare providers hold, especially if they believe that the issue may be more psychological than physiological. However, it’s also important to consider hormonal evaluations, especially since you’ve mentioned low libido and fatigue.
Here are a few steps you might consider:
1. Hormonal Testing: If you haven’t already, getting your testosterone levels checked along with LH and FSH can provide insight into any hormonal imbalances. Low testosterone can contribute to ED and low libido.
2. Mental Health Support: Since you’ve been dealing with depression for a long time, it might be beneficial to continue working with a mental health professional. Sometimes, addressing underlying mental health issues can improve sexual function.
3. Lifestyle Factors: While you mentioned that you maintain a healthy diet and exercise regularly, consider evaluating other lifestyle factors such as sleep quality, stress levels, and any medications you may be taking that could affect sexual function.
4. Second Opinion: If you feel that your concerns are not being addressed adequately, seeking a second opinion from another healthcare provider, such as a urologist who specializes in sexual health, might be helpful. They can provide a more comprehensive evaluation and discuss potential treatment options.
5. Tadalafil: Using Tadalafil as prescribed can help with erections, but it’s also important to address the underlying causes of your ED for long-term improvement.
It’s essential to advocate for your health and seek the support you need. You’re not alone in this, and there are professionals who can help you navigate these challenges.
Thank you
Your history and reports suggest that your symptoms are not just “porn-induced ED”—there is a clear possibility of a hormonal component along with medication-related and psychological factors. Your testosterone levels (around 2.4–2.8 ng/ml) are on the lower side for a 38-year-old, and more importantly, your LH and FSH are low or low-normal, which points toward a pattern consistent with secondary hypogonadism (where the brain is not stimulating the testes पर्याप्त रूप से). This can contribute to low libido, fatigue, and poor erection quality. At the same time, the use of SSRIs is very commonly associated with erectile dysfunction, delayed ejaculation, low libido, and emotional blunting—so your medication is likely playing a significant role as well.
Your semen analysis shows good sperm count but low motility and borderline morphology, which again can be influenced by hormonal imbalance and chronic stress or medication effects. Thyroid and prolactin look normal, which is reassuring, but the consistently low LH trend is something that should not be ignored.
In practical terms, your management should be more structured: you need a repeat early morning total testosterone (8 AM), free testosterone, LH, FSH, and ideally estradiol. If LH/FSH remain low with low testosterone, then an evaluation of the pituitary (including MRI if indicated) is reasonable—not excessive. Treatment options in such cases may include medications like Clomiphene (which stimulates natural testosterone production and preserves fertility) rather than jumping directly to testosterone therapy.
At the same time, your psychiatrist should review your antidepressant—sometimes switching to a more sexual-friendly option like Bupropion or adjusting the dose can significantly improve libido and erections. For symptom relief, drugs like Tadalafil can help erections, but taking “5 tablets at once” is not standard practice; usually 5–10 mg is taken once before intercourse or as a low daily dose.
Hello dear Please be aware See following medications can be taken in case if preventive therapy is not successful
Sildenafil empty stomach to be taken Tadalafil Accordingly if recommended by gynacolologist Vardenafil Levitra or Staxyn in case if allergic to Sildenafil Avanafil accordingly if recommended In addition please take the following precautions Avoid heavy meals and alcohol Take ashwagandha or triphala once a day for 2 months Do meditation Do physical exercises atleast for half an hour Especially kegel exercises Take shilajeet for 1 month once a day In case of no improvement in 1 month, kindly consult gynaecologist for further clarification Hopefully you recover soon Regards
Dr. Nikhil Chauhan (Urologist) here. Here’s what’s likely causing your ED, fatigue & low libido – point by point:
· Low LH + low-normal testosterone → Secondary hypogonadism Your 2026 LH (0.86) is very low while T is low-normal. This points to a pituitary/hypothalamus issue – not “porn-induced ED.” · Abnormal visual field (right eye) + low LH/FSH → Rule out pituitary tumor (microadenoma). MRI brain (pituitary protocol) is essential, not optional. Your endo’s 6‑month wait is risky. · SSRIs worsen all three – ED, fatigue, low libido. They lower dopamine & can suppress gonadotropins. Discuss switching to bupropion (less sexual side effects) with your psychiatrist. · Clomid was the right idea – but your psychiatrist wrongly dismissed it. Clomid raises LH → then T, without affecting fertility. If MRI is normal, restart Clomid or try HCG/enclomiphene. · Your semen analysis shows low motility/morphology despite high count – consistent with hormonal imbalance, not porn use. · Tadalafil treats symptom, not cause – fine for occasional sex, but you need to fix the underlying low LH/T.
Bottom line: Get a pituitary MRI + repeat morning LH, FSH, total/free T, prolactin, IGF‑1. Then treat the root cause – not just the erection.
You deserve better than being brushed off. Find a reproductive urologist or neuroendocrinologist.
— Dr. Nikhil Chauhan, Urologist
