What is causing my erectile dysfunction, fatigue, and low libido after years of depression and hormonal issues?

Question #29637

2 hours ago

What is causing my erectile dysfunction, fatigue, and low libido after years of depression and hormonal issues? - #29637

Client_c51ac0

I'm a 38 year old male. I have been suffering from erectile dysfunction, fatigue, low libido for around 5 years now and depression for more than 10 years which is clinically treated with drugs till this date. To get and erections I have to manually stroke the penis and it doesn't last long. I'm an active male who hits gym 4 days per week and follows a fairly healthy diet. Initially I thought this is related some sort of hormonal imbalance and took some hormonal screening in 2023,2024 & 2026 and results are as follows. 2023 2nd generation Testosterone - 2.635 ng/ml 2024 2nd generation Testosterone - 2.490 ng/ml Luteinizing hormone - 2.27 miu/ml FSH - 1.47 - miu/ml SHBG - 17.9 Albumin 44.8 Free Testosterone - 2.57 % Bioavailable testosterone - 1.56 ng/ml Doctor prescribed Clomid 25mg daily for 3 months which I couldn't follow - my psychiatrist asked not to and he just brushed it off. 2026 2nd generation Testosterone - 2.796 ng/ml prolactin - 7.81 ng/ml FSH - 1.57 miu/ml Luteinizing hormone - 0.86 miu/ml 3rd Generation T.S.H. 0.938 MicroIu/ml Cortisol - 14.58 ug/dl Free Thyroxine( F.T4) - 1.200 ng/dl Seminal Fluid Analysis Volume 3.0 ml Appearance - Normal Viscosity / Liquification -Normal Sperm concentration - 153.5 millions/ml Motility ( a + B ) - 24% Rapid Progressive motility (a) - 18% Non progressive motility (b) - 06% Immotility - 76% Morphology (% Normal Forms ) - 03% Total Sperm number - 460.5 millions *motile sperm (a+b)- 110.1 millions *Total progressive motile sperm (a) - 84.9 millions *Total functional sperm - 6.6 millions Sperm motility index (SMI) 114 Motile sperm concentration (MSC) 36.7 millions/ml Progressive motile sperm concentration (a) 28.3 millions/ml Functional sperm concentration (FSC) - 2.2 millions/ml Velocity ( Average path velocity - VAP - 36 mic/sec Pus cells - Occasional / H.P.F. RED cells 1-2/H.P.F. Summary of seminal fluid analysis Sperm concentration = > 20 mil/ml Rapid Progressive motility (a) = > 25% Morphology (% Normal Forms ) = (3.0 -4.0)% Total Sperm number = > 40 millions Sperm motility index (SMI) = > 80. Progressive motile sperm concentration (a) = > 10 mil/ml Functional sperm concentration - = >7 mil/ml. Velocity = > 5 mic/sec. Visual Perimetry 30-2 test results My right eye came up with borderline GHT and outside normal limits. Despite all these results in place. My endocrinologist brushed this off stating that this is porn induced erectile dysfunction and asked not to watch porn and asked me to take Tadalafil 10mg 5 tables 1 hour before a sexual intercourse. And told me that we shouldn't try to find out illnesses that don't exist. And then told me to do a LH and FSH in another 6 months and if the levels are still low then proceed with a MRI.I really don't feel the doctor did the justice. I need your expert opinion on this.

How long have you been experiencing erectile dysfunction and low libido?:

- 3-5 years

How would you describe the frequency of your erectile dysfunction?:

- Always

Have you noticed any specific triggers that worsen your symptoms?:

- Stress or anxiety

What medications are you currently taking for depression?:

- SSRIs

How would you rate your overall energy levels during the day?:

- Low

Have you experienced any other symptoms besides erectile dysfunction and fatigue?:

- Mood changes

How often do you engage in sexual activity?:

- Rarely or never

Have you previously sought treatment for erectile dysfunction?:

- No, this is my first time

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Doctors' responses

Dr. Nirav Jain

I am a qualified medical doctor with MBBS and DNB Diploma in Family Medicine from NBEMS, and my work has always been centered on treating patients in a complete, not just symptom based way. During my DNB training I rotated through almost every core department—Internal medicine, Pediatrics, Obstetrics & Gynecology, Surgery, Orthopedics, ENT, Dermatology, Psychiatry, Emergency medicine. That mix gave me the skill to manage acute illness, long term disease and preventive care together, something I find very important in family practice. In psychiatry I worked closely with patients who struggled with depression, anxiety, stress related problems, insomnia or substance use. I learned not just about medication but also about simple psychotherapy tools, psycho education and how to talk openly without judgement. I still use that exp in family medicine, specially when chronic disease patients also face mental health issues. My time in General surgery included assisting in minor and major procedures, managing wounds, abscess, sutures and emergencies. While I am not a surgeon, this gave me confidence to recognize surgical cases early, provide first line care and refer fast when needed, which makes a big difference in online or OPD settings. Now I work as a consultant in General medicine and Family practice, with focus on both in-person and online consultation. I treat conditions like fever, infections, gastrointestinal complaints, respiratory illness, and also manage diabetes, hypertension, thyroid disorders, and lifestyle related chronic diseases. I see women for PCOS, contraception counseling, menstrual health, and children for common pediatric issues. I also dedicate time to preventive health, lifestyle counseling and diet-sleep-exercise advice, since these small changes affect long term wellness more than we often realize. My key skills include holistic diagnosis, evidence based treatment, chronic disease management, mental health support, preventive medicine and telemedicine communiation. At the center of all this is one thing—patients should feel heard, safe, and guided with care that is both professional and personal.

1 hour ago

Hi, Thank you for sharing your reports. This is not something to dismiss casually, and your concern is valid. Your symptoms are likely multifactorial, meaning more than one cause together. You are on SSRIs, These are one of the most common causes of Erectile dysfunction, Delayed erection, Low libido & Reduced orgasm. This alone can explain a large part of your symptoms. Based on your reports, you have Secondary hypogonadism. Psychological+ performance component can further contribute to erectile dysfunction. Based on your semen analysis, your fertility is not optimal but not severely impaired. Your endocrinologist is partially right but incomplete. Tadalafil can help symptoms. Repeat LH/FSH is reasonable But Ignoring persistent low LH/FSH pattern is not ideal. What should be done next is-
1. Repeat hormonal evaluation (properly)- Morning (8–10 AM) sample for Total testosterone, Free testosterone, LH, FSH, Prolactin.
2. Consider MRI if persistently low LH/FSH to rule out pituitary causes (as your doctor mentioned).
3. Review antidepressant with psychiatrist. You need dose adjustment OR a switch to Bupropion (which less sexual side effects). Discuss the same with your Psychiatrist.
4. Symptomatic treatment- Tadalafil. Helps erection. Safe if no contraindications.
5. Consider hormonal therapy (only if confirmed), discuss this with your endocrinologist. This stimulates natural testosterone production. Good option in secondary hypogonadism. This is not just “in your head”. There is a real biological + psychological overlap. Your issues are due to likely combination of SSRI side effects, Secondary hypogonadism & Psychological factors. Your concern about hormones is valid and should be evaluated properly. Condition is treatable with the right multi-step approach.
Feel free to reach out again.
Regards,
Dr. Nirav Jain
MBBS, D.Fam.Medicine

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Dr. Prasannajeet Singh Shekhawat

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

52 minutes ago

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

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