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ED and corticosteroid

User
Posted 16 Sep 2023 at 18:07

This is a fairly niche medication question, but I thought I'd see if anyone has any ideas.

I have some quite bad tinnitus, linked to a few episodes of sudden hearing loss (not total hearing loss, but in my last test I'd lost about 15db at the top range, and that's quite a lot). It's especially in my left ear. This seems to have been caused by PDE5 inhibitors, which I started after my prostatectomy but which I can now no longer take due to the hearing issue. At the end of this week, I had the sensation that I had some further hearing loss and a bit more tinnitus. It came on very rapidly. Apparently, this can sometimes be reversed with high dose corticosteroids, provided they are started within 72 hours. I contacted my GP, who called the ENT rapid treatment centre at UCLH to see what could be done. Since it was Friday afternoon, they said that they wouldn't be able to see me until next week. However, they told my GP that he could go ahead and write out the prescription for the meds and I could start taking them in the meantime and then they'd assess me at some point in the coming week. It's a bit annoying, because I've recently had a cold, and it could just be caused by some lingering congestion that's blocking up the ear, or it could be more sudden hearing loss — I can't tell because both things feel the same. In the past, I've done nothing and the hearing loss and tinnitus have been permanent, so this time I thought I'd not leave it to chance and try to nip it in the bud.

Anyway, I started taking the meds this morning. It's Prednisolone and the dose is really high: 60mg a day for seven days. So far, I feel completely fine. However, I noticed that I seem to have even less erectile function than usual, and a bit of googling suggests that this might be an effect of the meds (though it's not one that's mentioned in the leaflet), since they disrupt hormones in various ways. If so, that's really worrying to me, as my main priority is to regain erectile function and it's already an uphill battle without the PDE5s. I have no idea whether these drugs can cause lasting damage to erectile function/libido, even if just taken for a short time. If so, that might be enough to finish my erections off forever. There's plenty of info online about anabolic steroids in this regard, but not so much about catabolic/corticosteroids. It would be really gutting if, in trying to treat the tinnitus/hearing loss caused by the drugs that I originally took to try to treat the ED, I just ended up making the ED worse or making it permanent. I'd rather just stop taking the steroids and accept the hearing loss. The thing that I really, quite obsessively want above all else is to regain my erectile function. That's definitely the top priority. Of course it could also be that it's not having an effect, since my erectile function is a bit up and down — so to speak — anyway.

So, not sure what to do. As usual, it's the weekend and there's nobody to call... If anyone knows anything relevant, please do let me know.

User
Posted 16 Sep 2023 at 18:07

This is a fairly niche medication question, but I thought I'd see if anyone has any ideas.

I have some quite bad tinnitus, linked to a few episodes of sudden hearing loss (not total hearing loss, but in my last test I'd lost about 15db at the top range, and that's quite a lot). It's especially in my left ear. This seems to have been caused by PDE5 inhibitors, which I started after my prostatectomy but which I can now no longer take due to the hearing issue. At the end of this week, I had the sensation that I had some further hearing loss and a bit more tinnitus. It came on very rapidly. Apparently, this can sometimes be reversed with high dose corticosteroids, provided they are started within 72 hours. I contacted my GP, who called the ENT rapid treatment centre at UCLH to see what could be done. Since it was Friday afternoon, they said that they wouldn't be able to see me until next week. However, they told my GP that he could go ahead and write out the prescription for the meds and I could start taking them in the meantime and then they'd assess me at some point in the coming week. It's a bit annoying, because I've recently had a cold, and it could just be caused by some lingering congestion that's blocking up the ear, or it could be more sudden hearing loss — I can't tell because both things feel the same. In the past, I've done nothing and the hearing loss and tinnitus have been permanent, so this time I thought I'd not leave it to chance and try to nip it in the bud.

Anyway, I started taking the meds this morning. It's Prednisolone and the dose is really high: 60mg a day for seven days. So far, I feel completely fine. However, I noticed that I seem to have even less erectile function than usual, and a bit of googling suggests that this might be an effect of the meds (though it's not one that's mentioned in the leaflet), since they disrupt hormones in various ways. If so, that's really worrying to me, as my main priority is to regain erectile function and it's already an uphill battle without the PDE5s. I have no idea whether these drugs can cause lasting damage to erectile function/libido, even if just taken for a short time. If so, that might be enough to finish my erections off forever. There's plenty of info online about anabolic steroids in this regard, but not so much about catabolic/corticosteroids. It would be really gutting if, in trying to treat the tinnitus/hearing loss caused by the drugs that I originally took to try to treat the ED, I just ended up making the ED worse or making it permanent. I'd rather just stop taking the steroids and accept the hearing loss. The thing that I really, quite obsessively want above all else is to regain my erectile function. That's definitely the top priority. Of course it could also be that it's not having an effect, since my erectile function is a bit up and down — so to speak — anyway.

So, not sure what to do. As usual, it's the weekend and there's nobody to call... If anyone knows anything relevant, please do let me know.

User
Posted 16 Sep 2023 at 23:59

Interesting post, sorry I can't give you any answers, but I can give you my experience. Supposedly non nerve sparring nine and a half years ago, some intermittent recovery. Fast forward to this year I started bicalutamide in June and this year I have had twice had my knee with ,depo modrol. Night time knee pain is pretty bad and supposedly related to cortisol production.

My normal routine is to get up and shower, since June I have had a very solid semi erection. The ability to orgasm takes more effort and frequently fails. My hearing is slightly impaired but I can't say I have noticed a difference. 

Thanks Chris 

User
Posted 17 Sep 2023 at 09:29
Yes, Prednisone can have a negative effect on erections and can interfere with the production of testosterone. It is definitely not a drug to be taken long term and is normally restricted to 7 days. If you take it for any longer then it should be reduced slowly, not stopped suddenly. 80mg is the max daily dose. You can become addicted quickly to it, encounter states of euphoria and suffer a significant 'down' when you stop it - but those symptoms are usually with longer term use/abuse.

Your erections however should return to normal when your course of treatment ends.

User
Posted 17 Sep 2023 at 09:54

In the absence of PDE5 inhibitors, I would suggest you make daily use of a pump for penile physio, which might help provide some mitigation.

User
Posted 17 Sep 2023 at 14:28

A cock ring might help with manual erections, as it slows the rate blood leaves the erectile tissue. This is not a pump constriction ring (which would probably stop blood getting in too), but something more gentle such as a Durex pleasure ring. Larger ones which include the penis and scrotum and press on the perineum can work well too.

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User
Posted 16 Sep 2023 at 23:59

Interesting post, sorry I can't give you any answers, but I can give you my experience. Supposedly non nerve sparring nine and a half years ago, some intermittent recovery. Fast forward to this year I started bicalutamide in June and this year I have had twice had my knee with ,depo modrol. Night time knee pain is pretty bad and supposedly related to cortisol production.

My normal routine is to get up and shower, since June I have had a very solid semi erection. The ability to orgasm takes more effort and frequently fails. My hearing is slightly impaired but I can't say I have noticed a difference. 

Thanks Chris 

User
Posted 17 Sep 2023 at 09:29
Yes, Prednisone can have a negative effect on erections and can interfere with the production of testosterone. It is definitely not a drug to be taken long term and is normally restricted to 7 days. If you take it for any longer then it should be reduced slowly, not stopped suddenly. 80mg is the max daily dose. You can become addicted quickly to it, encounter states of euphoria and suffer a significant 'down' when you stop it - but those symptoms are usually with longer term use/abuse.

Your erections however should return to normal when your course of treatment ends.

User
Posted 17 Sep 2023 at 09:54

In the absence of PDE5 inhibitors, I would suggest you make daily use of a pump for penile physio, which might help provide some mitigation.

User
Posted 17 Sep 2023 at 12:03

Thanks all for the replies. Chris, it sounds like it has been a tough few years. Great progress since June though, and hopefully more to come.

Steve, thank you, that's exactly the detailed info I was looking for. I've actually reduced the dose a bit today as had a lot of trouble sleeping last night. Despite having taken the Prednisone in the morning I felt pretty wired all night (and still this morning!). Clearly a strong drug and not one to be taken lightly. Hopefully I can talk to the ENT tomorrow. I would like to stop the meds as soon as possible really.

Andy, yes, I do use the pump every day. In addition, I use Invicorp now and then and am trying to be more regular with it. I can also get an erection through physical stimulation (though it takes some time and it rapidly starts subsiding literally the second that stimulation stops) so I try to have one natural erection per day. Hopefully these things combined are enough to keep the tissue healthy and perhaps encourage the nerves (which were spared on both sides) to heal. 

User
Posted 17 Sep 2023 at 14:28

A cock ring might help with manual erections, as it slows the rate blood leaves the erectile tissue. This is not a pump constriction ring (which would probably stop blood getting in too), but something more gentle such as a Durex pleasure ring. Larger ones which include the penis and scrotum and press on the perineum can work well too.

User
Posted 17 Sep 2023 at 23:50
Thanks Andy, sounds like it would be worth a try.
 
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