No erection No sex feel Testicles shrinking

Professional Assessment: The presenting symptoms strongly suggest hypogonadism (low testosterone) as a primary differential diagnosis, with potential secondary considerations including depression, cardiovascular disease, and medication side effects. The pathophysiological mechanism likely involves disruption of the hypothalamic-pituitary-gonadal axis, leading to decreased testosterone production, which explains the constellation of symptoms including erectile dysfunction, decreased libido, and testicular atrophy. For a 50-year-old male, key risk factors include obesity, type 2 diabetes, chronic stress, sleep disorders, and certain medications (particularly antidepressants and opioids). Essential diagnostic testing should include comprehensive hormone panel (total and free testosterone, LH, FSH, prolactin), metabolic workup, thyroid function tests, and potentially pituitary imaging to rule out structural abnormalities.

Treatment recommendation: Start with Testosterone Replacement Therapy (TRT) to address the hormonal imbalance causing these symptoms, which can be administered through injections, gels, or patches. Combine this with PDE5 inhibitors (such as sildenafil or tadalafil) to improve erectile function and sexual response. Additionally, incorporate lifestyle modifications including regular exercise, particularly strength training, and ensure adequate zinc and vitamin D supplementation through diet or supplements to support natural testosterone production. For additional treatment recommendations, ask in the chat.