Blood Work for Erectile Dysfunction: Why Every Patient Needs It | Dr. Anne Truong MD

You ever wonder what type of blood work you need to be getting when you have ed? Well, I'll deep dive into that in this episode. What type of blood work do you need to have for evaluation for erectile dysfunction? We're going to discuss about that today because I get this questioned a lot, and why do I do it for every patient that I see for ed? So I want to show you why. Because it's so important to know that the normal sexual function or how you get an erection is that it starts in the brain. The brain is a larger sexual organ. It starts in the brain, and then you get messages from your senses, your five senses. What you see, what you smell, what you taste, what you hear, and what you touch that feed into your brain like the picture I show. And then it mixed with your emotions, how you feeling, you're feeling depressed, you're feeling fatigue, you're feeling anxious, or you're distracted. And then that messages get filtered, then goes to the hormone, the glands in the pituitary and the hypopituitary, and that get. The hormones get released from that gland that's like right in your midbrain right here. And then that message gets sent to the nerve in the back of your head here. And the nerve sends messages down to the heart, and then the heart increases heart rate and it goes to the blood vessel, the blood vessel open up or dilate, and then more blood flows in and then it goes to the muscles of the penis. So in order for you to get an erection, our 6 system has to. To work in harmony and in balance. And it starts in the brain. So, guys, the erection starts in your brain. It doesn't start in your penis. And in order for you to get an erection, your brain and your penis have to both be relaxed. Yes, relax. So an erection is actually a relaxation state for the penis muscle. And that when you're not erect and is actually a contracted state. All right, and the reason why I bring this up is that when we do blood work, we evaluate the whole six system. Not so much emotion, but we can look at inflammatory factors. And so this is the blood work that I used to evaluate. Now I want to show you this because if you are going to see a doctor for ED or even for hormone, make sure you get this done. So what I see a lot in patients that come to see me is that they went to another clinic and the only thing that was done is just testosterone only and nothing else. And sometimes not even a cbc. Let's dive in into comprehensive blood work. You need to be getting when you have ED is first start off with a cbc. A CBC is blood work that look at how much red blood cells you have in your your body, all right? And it's important to know because you can be anemic or you can have too much red blood cell. And if you're already taking testosterone already, either as an injectable form or as a pellet, you need to get monitored because one of the side effects of testosterone is that it raises red blood cell in your body called erythrocytosis. And when the red blood cell is higher, you're more prone to developing clots. So if you're on testosterone replacement therapy, you got to make sure that you get your CBC check on a regular basis. I check this almost every four months when my patients are on testosterone pellet. The number one thing you should have is the CBC. And that's the reason why hemoglobin A1C. Hemoglobin A1C is a blood work that look at see if you have diabetes, all right? And anything over 7 is diabetic, anything between over 6.1 to 7 pre diabetic range. Diabetes means that you have high blood sugar in your blood more than normal, and that the insulin that is supposed to be secreted in your bloodstream that bring down the blood sugar is not working as well as it should. So it's a good marker to see if you have diabetes, and if you have diabetes, a good marker to see if where you are in your blood sugar management oftentimes. Actually, what I see a lot in my patient is that they come in for ED first and ED will present first. And then the blood work revealed that they actually have diabetes. So interestingly, men that has ED should be screened for diabetes and that if you have diabetes, you're three times more prone to getting edited. So the next blood work is the lipid panel where you look at a cholesterol or your cholesterol level, your LDL level and your HDL level. So the total cholesterol is a measure of the fat, and then the LDL is the bad fat, or the LDL is affected by sugar, how much sugar you take is affected contribute to the LDL factor. And really, guys, the thing you need to worry about is the sugar that's causing the inflammatory state, not so much the fat, but you also should also decrease your red meat intake as well. So you want your cholesterol to be lower, the top number to be lower than 200 at the time. Then you also want to look at thyroid hormone panel, where you look at TSH T3, T4 and reverse T3. That's called the complete panel because thyroid and I'll talk about it in future episodes, can also either hypothyroid or hyperthyroid can contribute to ED as well too, because your body is the balance of other hormones interplaying with each other.

All right, and then homocysteine.

The reason homocysteine, a reason why we check that is some people, they may have a high level homocysteine, which is prone to developing clot, or low level homocysteine, which is due to nutritional deficit. So you gotta check that because you want to avoid hormone replacement therapy in patients that are prone to getting clot. Or high level homo 16 can also contribute to cardiovascular disease as well. And you want to check the insulin level, which is the next one to assess to see if you're insulin resistant. If you're insulin resistant, that goes with the diabetes. You want to check the level. Then you want to check vitamin D. Now, very important, you want to do vitamin D25 hydroxy, that's the vitamin D3 that is in your blood. And vitamin D3, it's almost considered as a hormone itself. It's an essential vitamin, but it is essential in our hormone function. And almost 99% of people that I look at are low in vitamin D. So am I. I'm low in vitamin D because the only way you could take vitamin D is through taking at least five portions of vegetables a day. Eat tons of oysters as well, because oysters have vitam. But the thing, most of the time, we also need the sun to convert your body to have vitamin D. But the good part, you can supplement the vitamin D. However, I measure that for evaluation of ed, because low vitamin D can contribute to ED as well, because the hormone needs that to function. Then you want to look the next blood work. Is testosterone free and total? The total is the total testosterone, but Most testosterone, about 90% of it, is actually bound to protein. All right, it bound to a protein, albumin, and also the sex hormone binding globulin protein and the free hormone, the one that's active, that works on the cell. And you want to look at both the total and the free, because the total may be normal. The free will be low because if somebody has high sex hormone binding globulin, it binds to the testosterone and the testosterone cannot get free to be active on your cells. You gotta measure both of it. And you gotta measure the sex hormone binding globulin as well. Sex binding hormone globulin varies with other states as well. When you're stressed, it increases. When you have hypo or hyperthyroid, it also increases as well. So when SHBG or sex hormone binding globulin is high, it decreases the testosterone. The next hormone you want to look at is estradiol. Estradiol is the female hormone and estradiol come from testosterone. Now when you have too much testosterone, that gets converted by aromatase to become estradiol. And when a man needs estradiol as well, when estradiol become too much like may say you're over 45 or so, it start to take away your total testosterone that you need. So you got to measure that. What I usually see, estradiol conversion is usually related to a poor diet that's high in carb when you're not exercising. And in men that has like love handles or a belly like that, that's called visceral fat. And those fat store estradiol. What it does is that when you have a belly or love handle, it actually will usurp your testosterone. And then in the belly it makes more estradiol. So it's good to exercise and to keep the size of your waist to below 40 inches because the more belly fat you have, there's a chance that you may be converting it to your testosterone to estradiol. The next one is dihydrotestosterone right here. Dihydrotestosterone is dht, which testosterone can be converted by an enzyme that converted to dht. And DHT is responsible for hair loss. And when you have too much dht, that means that you have less testosterone because testosterone being converted to DHT. The next one is IGF, that's growth hormone. IGF1 and IGF TB3 is growth hormone. So we want to check to make sure that the growth hormone that is released in the brain is being monitored. Is it too high or too low? That will affect your testosterone level as well. And the next one is actually fsh, follicle stimulating hormone, not fsg, fsh. You want to measure diabetes and lh, Those are the hormones being released in the pituitary. And that what's control the testosterone? Mainly LH control testosterone and FSH control more of estrogen in a female. And then you want to look at prolactin. Prolactin is a hormone that is released in the pituitary as well. And whether prolactin is high or low, because when you have high, high level prolactin that could represent a pituitary tumor as well. And you want to make sure you measure that. So you have to really look at all the hormone, the gland functioning from the brain, and how it talks to your testicle, because your testicle is what produces testosterone, but is being regulated by the pituitary and the brain. You also want to check C reactive protein because that's an inflammatory marker. So if your body's inflamed, that will rise up and that looks at to see if endothelium, how's endothelium doing? Because if the endothelium is inflamed, so then you're not going to produce enough nitrous oxide. You're not going to be able to open up that blood vessel. All right. And another inflammatory marker is thyroid peroxidase antibody and thyroglobulin antibody. That looked at when that usually elevated inflammation and that is an antibody where your body actually attack the thyroid hormone, the thyroid hormones right here and attack it and it prevent the thyroid from producing the thyroid hormone that you need. So you want to look at that. And the next one is psa, the prostate hormone, prosthetic stimulating hormone. And make sure you get checked for total as well as reflex to free PSA. If the PSA is over 4, then the lab will kind of assess how many percentage of that is free psa. And for men, that's important to follow, especially if you're getting testosterone hormone replacement therapy. Testosterone does not cause prostate cancer, but prostate cancer sometime may be inflamed. And DHT actually contribute to more of prostate irritation and dysfunction even more than testosterone. But DHT come from testosterone as well. So that need to be follow up. And then the last One is factor 5 LIDDA mutation. That's the most common clotting disorder. And we check that to make sure that the patient doesn't have any type of clotting disorder that may cause side effect with the hormone replacement therapy. Another one I didn't put on there is dhea. DHEA is really at the top of the ladder of all the hormones where it's kind of like the father of progesterone and testosterone. And DA level could be up or down and that could be easily supplemented as well. So the reason why I mentioned about this is that hormone is an interplay of other glands interacting with one another. And you need to assess from the pituitary in your brain all the way to the testicles and see what's going on, whether it's an imbalance in it or not. And this is the total panel you should be getting when you have ED and or you're on testosterone replacement therapy. This is the first blood work I will get then subsequent blood work I usually get around every four months if they're on testosterone replacement therapy and I wouldn't do the whole thing with the follow up. I would definitely. If you're on testosterone hormone replacement therapy for follow up blood work you should have at least a CBC to have CMP on here. In fact, it's actually not on here. CMP 414 complete metabolic panel. You should have that as well. Complete metabolic panel 14 that looks at the liver function. Look at your kidneys as well because kidney and liver function can also affect testosterone level as well. Should have your lipid panel looked at on follow up. Vitamin D measure every time as well as testosterone free and total sex hormone binding, globulin, estradiol, dht, LH level and PSA at least once a year if you're over 50. And so those should be checked out on follow up hormone at this point. So I hope this is helpful. I love to hear from you and I would appreciate it if you like subscribe and comment and I will see you in the next episode. Hello there.

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