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Guide to Andropause


Guide to Andropause


by Dr. Tatiana Fleischman, MD

Although men do not experience such an abrupt and complete cessation of their reproductive function as women do, normal aging process leads to a decrease in hormonal levels. That decrease primarily involves testosterone that starts as early as in your late 20’s and early 30’s and then accelerate when you hit your 40’s and 50’s. Eventually other hormones get out of balance. For example, the levels of estrogen, a female sex hormone, can go up in your body.

These hormonal changes often lead to a clear set of symptoms that are considered male menopause or andropause. Click on the symptoms below to learn more.

Muscle Loss: What is it?

Standing in front of the mirror, have you ever wondered why your biceps no longer seem as pronounced, no matter how much you flex them? Have you ever silently complained how your body seems flabbier and saggier – a far cry from how you looked twenty or even ten years ago?

It is normal for men to lose muscle strength and muscle mass as they age, and this usually indicates the onset of andropause. As early as your twenties, you may already start to experience sarcopenia (the medical term for muscle loss with aging), although it becomes more apparent after you reach 60. With advanced age comes decreased activity. As a result, your muscle cells eventually decrease and begin turning muscle fibers into fat.

What Causes Muscle Loss?

Male muscle loss is positively correlated to lower testosterone levels, which is another side effect of andropause. Testosterone is a hormone that aids in muscle creation by attaching to receptors in muscles, sending them signals to contract and grow.

Couch potatoes be warned: your muscles will naturally shrink (and eventually disappear) if you lead a largely sedentary lifestyle. From age 25 to 60, men who don’t exercise regularly will lose muscle strength and muscle mass at a rate of 0.5% each year. While it may not seem alarming at first glance, this figure doubles to around 1% every year after age 60. In another decade, muscle mass and muscle strength is expected to degrade by 2% every year. This doubling trend continues every decade until death.

Another contributor to muscle loss in men is poor nutrition. Protein, as Biology class taught us, is the building block of muscle. A diet low in protein (and high in sugar) will naturally result in muscle loss, owing to the muscles not having enough fuel for growth.

The causal relationship may not be evident, but weight gain in males and hormonal imbalances brought on by andropause seem to share a strong connection. Body fat appears to increase while muscle mass decreases with a decline in testosterone and an upsurge in cortisol. The hormonal imbalance is further compounded by the increase in body fat by turning testosterone into estrogen. Fatigue and low energy levels are not far behind with weight gain and muscle loss, as these put undue burden on the body to carry more weight with less muscle.

Specific Hormonal Causes or Contributors to Male Weight Gain

So how are hormones responsible for weight gain in men? Stress is primarily the culprit – specifically, the hormones our body produces in response to stress: cortisol. When cortisol levels rise in response to stress, our body goes into “survival mode.” In this mode, the body stocks up on fuel by producing a surplus of fat cells while slowing down metabolism.

Ever notice how you feel extra hungry when you are under stress? This increase in appetite is actually your body’s way of preparing itself for the energy it expects to burn when you go into “fight or flight” mode. Naturally, this will lead to weight gain.

But the effects of excess cortisol on the body do not end there. While testosterone levels normally decrease during andropause, high cortisol levels will bring these down even more. It isn’t unusual to feel fatigued or for your energy levels to go down as a result of having low testosterone levels.

Other causes of weight gain include disorders that decrease the body’s metabolic rate. These include thyroid disorders, in particular hypothyroidism, as well as having low levels of the human growth hormone (HGH).

The Solution: Male Weight Loss

Given that hormonal imbalance is one of the common culprits of weight gain in men, logically we expect that bringing balance to the body’s hormone levels will help achieve weight loss. In particular, we can bring to more optimal levels your testosterone, cortisol, estrogen, HGH and thyroid hormones, to name a few, with the aid of bioidentical hormones. Achieving this balance will set the stage for you to attain weight loss.

With andropause comes hormonal imbalance, and with it fatigue in men. If you’ve been feeling worn out and tired for some time, even after getting a full night’s rest, chances are you’re experiencing fatigue. Fatigue may also manifest in feeling not being up to the tasks that you used to do every day (whether at work or at home), and a general decline in efficiency and sense of achievement.

What Causes Fatigue in Men?

A key component of energy production is testosterone. When andropause strikes, reduced testosterone levels become one of the leading causes of insomnia or sleep apnea, two contributors to fatigue in men. Aside from this, other symptoms of andropause—night sweats, irritability, depression, weight gain, and stress, to name a few—may also lead to sleep interruption in men.

Men with fatigue find that experiencing night sweats further worsens insomnia and fatigue as the discomfort gets in the way of getting quality sleep. Fatigue often develops from experiencing extended periods of sleep deprivation.
Negative feelings brought about by irritability and depression, which normally come with andropause, can also lead to tiredness and exhaustion. This feeling of sluggishness and tiredness could also be a result of gaining weight and losing muscle mass during andropause. Additionally, energy levels may be depleted by stress and high cortisol, which produce feelings of frustration and worry. And don’t forget that poor dietary choices can also lead to low energy supply.

Is it a good idea to combat fatigue with exercise? While working out will of course use up your energy stores, the endorphins released post-exercise will often lead to an energy boost. Though not everyone enjoys exercise, what’s sure is that not having enough of it can worsen male fatigue.

The Solution: Treatment for Fatigue in Men

The Chinese principle of Yin and Yang also applies to treating fatigue: Restoring hormonal balance in the body will help relieve or alleviate the more negative effects of andropause. This is most often achieved through natural bioidentical hormone replacement therapy, which balances your testosterone and cortisol levels. Stabilizing your hormone levels will bring about a positive domino effect: once the symptoms of andropause lessen or disappear, you get a boost in your energy levels as well as in your mood, which then leads to reduced or eliminated fatigue.

While both sexes are equally susceptible to insomnia, the causes of this sleep disorder in men vastly differ from those in women. In men, andropause or male menopause is usually marked by a drop in testosterone. This in turn can contribute to sleep apnea, leading to insomnia or sleeplessness.

Has your spouse or partner complained that you snore loudly in your sleep? Chances are, you are among the 9% of adult males that have sleep apnea – the interruption of or difficulty breathing during sleep. This sleep disruption is commonly marked by a temporary, longer than usual pause in breathing and loud snoring. While you may not be aware of these disruptions, unfortunately your bedside companion may be all too aware and, as a consequence, they may suffer from sleep interruption as well.

Can something be done about this disorder? Fortunately, testosterone therapy has shown promise in alleviating sleep apnea and its symptoms. One reason sleep apnea keeps you from getting a good night’s rest is that, with the frequent sleep disruptions, your sleep is kept only at the light or shallow state. Optimizing your testosterone levels makes it easy for you to transition from light to slow wave or deep sleep.

Just how serious is this condition? As you may already know, sleeping allows the body to repair itseIf. Therefore, when low testosterone and sleep apnea leads to insomnia, your health naturally suffers. This can easily snowball into a host of problems: fatigue, lowered insulin sensitivity, subpar human growth hormone levels, and increased cortisol levels.

There are several reasons prolonged insomnia is bad news for your health. For one, the stress brought about by not getting quality sleep increases your body’s cortisol levels. Testosterone levels can further be depleted with cortisol at constantly high levels. This creates a vicious cycle where high cortisol and low testosterone levels lead to adrenal fatigue; this further exacerbates feelings of fatigue and feeds insomnia.

The first one and a half hours of sleep is crucial in the production of human growth hormone. Frequent sleep disruptions impede growth hormone production, leading to reduced testosterone levels and lower lean muscle mass.
Another reason sleep is crucial is because it keeps insulin sensitivity and glucose in check. During sleep, your body keeps blood sugar at stable levels with the help of insulin. If you suffer from sleep disruptions, your body will need increasing amounts of insulin to control blood sugar. One side effect of this is weight gain. Overtime, if left unchecked, this can even lead to diabetes.

Obstructive Sleep Apnea vs. Central Sleep Apnea

There are basically two types of apnea: the silent kind (Central Sleep Apnea) and the noisy kind (Obstructive Sleep Apnea).
Central Sleep Apnea (CSA) is a sleep disorder that originates in the central nervous system. Breathing temporarily stops due to delayed brain signals. Often CSA develops when trauma or disease affects the brain stem.

Obstructive Sleep Apnea (OSA) is mainly due to obstruction in the airways: this could be from having excess tissue (in the case of obese people), or it could be caused by poor throat muscle tone (as is usually the case with those who have low testosterone). Whatever the cause may be, when air flow to the mouth and nose is inhibited during sleep, oxygen supply to your blood suffers. Because of this, men who have Obstructive Sleep Apnea find that they rarely get quality sleep from waking repeatedly at night. Most cases of sleep apnea caused by low testosterone is obstructive sleep apnea.

What is Gynecomastia?

Gynecomastia is a hormonal abnormality in men that results in enlarged breast tissue in either or both breasts. It usually starts as a small lump underneath the nipple, which results in irregular swelling.

Enlargement of the breast in males is quite common and may appear during the first few weeks of birth or during puberty. In newborns, aside from swelling, the nipples may even secrete small amounts of milk (galactorrhea), which subsides after several weeks. Gynecomastia may also appear at the onset of puberty, lasting a couple of months.

What Causes Gynecomastia?

Hormonal imbalance is largely at the root of enlarged male breasts. This is the reason why gynecomastia often appears at birth or during puberty. Gynecomastia in newborns results from the newborn absorbing most of the mother’s estrogen. Eventually the condition goes away as the estrogen is excreted from the newborn’s system.

The Testosterone and Male Estrogen Balance

Breast enlargement in men specifically happens due to a drastic imbalance between the body’s testosterone and male estrogen. (While estrogen is chiefly regarded as a female hormone, men’s bodies contain minimal amounts of estrogen, which helps regulate sperm production, bone density, and mood.)

After puberty, breast enlargement in men often reappears during andropause, typically after the age of 50. Andropause causes a drop in testosterone levels in men, creating an imbalance between the male hormone and the female hormone, estrogen.

Other Causes

Other causes of gynecomastia include severe hyperthyroidism as well as the overproduction of estrogen in the body. Additionally, obese men are more likely to get enlarged breasts. It isn’t unusual for men to be both overweight and have gynecomastia, since weight gain also happens to be one of the side effects of andropause.

External factors may also explain why men have swollen breasts. For instance, having a poor diet, taking herbal products that contain estrogen—even taking recreational drugs (amphetamines, marijuana, and heroin) and alcohol—can affect your hormone levels in your body, making you susceptible to gynecomastia.

Be careful with household products you use too: Some soaps, shampoos, and body lotions may contain low levels of plant estrogen (such as those found in lavender and tea tree oils). Excessive use of these estrogen-containing products—especially if you already have low testosterone levels due to andropause—can cause breast enlargement.

Hot flashes are sudden strong sensations of heat radiating from different parts of the body—usually the face, neck, and upper body—and which result in cold, clammy sweats and a general feeling of discomfort. While these are usually associated with menopause, men also experience hot flashes during andropause.

In essence, male hot flashes are not any different from female hot flashes, except for the cause. Male hot flashes may occur as frequently as six to ten times a day; as to duration, they can last anywhere from several minutes to an hour. Hot flashes may be accompanied by feelings of anxiety, an increase in heart rate, irritability, and nausea.

The Cause: Hot Flashes during Andropause

While women more commonly experience hot flashes during menopause, men are just as susceptible to it too. In men, hot flashes may appear during andropause, as a result of being severely deficient in testosterone. It may also occur in men who have prostate cancer, as a side effect of undergoing androgen-deprivation therapy.

Hot flashes in men are the body’s internal mechanism to guard against overheating. During andropause, when men experience a reduction in testosterone levels, the hypothalamus (the part of your brain that regulates body temperature) takes this dip to mean that your body is overheated. It then fires off signals to dilate blood vessels in the skin to release what it perceives is excess heat.

Hot flashes are also one of the side effects of androgen-deprivation therapy, a treatment for prostate cancer that induces andropause by suppressing testosterone production. While this treatment method is effective in keeping prostate cancer cells from growing, it can result in hot flashes 80% of the time.

The Solution

Bioidentical testosterone replacement therapy delivers effective results in treating and relieving hot flashes during andropause. However, as treatment success hinges on correctly identifying the cause, it is recommended that you undergo hormone testing with an expert hormone specialist. Schedule a free consultation with us today!

A more severe form of hot flashes experienced by men are night sweats. It isn’t uncommon for a man experiencing night sweats to wake up completely drenched in sweat, sometimes even soaking the sheets. That said, men experiencing this hyperactivity of the sweat glands often find their sleep frequently interrupted by the intense heat (this feeling may even be accompanied by a slight chill).

What Causes Night Sweats in Men?

The warm weather or your room temperature has nothing to do with the nighttime sweats you experience. Rather, it is the result of an internal bodily process. Specifically, it is the hypothalamus—the part of your brain that regulates body temperature—reacting to hormonal imbalance. When the hypothalamus detects that your testosterone levels are insufficient, it interprets this to mean that your body is overheating. It then acts quickly to get rid of this excess heat, hence the occurrence of night sweats.

Aside from having low testosterone, men may be more susceptible to experiencing night sweats if they are undergoing excessive stress (leading to elevated cortisol levels), have an unhealthy or nutritionally deficient diet, and do not exercise regularly.

The Solution

Addressing night sweats in men requires addressing its root cause, which is the imbalance of testosterone and cortisol levels in the body. The use of natural bioidentical hormones has shown promise in restoring balance to your hormone levels. Availing of bioidentical hormone replacement therapy with CT Hormone Therapy is a recommended treatment not only for hormonal balance restoration, but also for the relief of night sweats.

Men currently in the middle of andropause most often complain of having reduced libido or a low sex drive. In the same way that erectile function is affected by low levels of testosterone, a man’s sex drive is strongly influenced by testosterone.
Sex begins primarily in the brain. Specifically, it starts in the nerves that stimulate testosterone production. When testosterone is released in a man’s system, the brain’s receptors in turn signal the release of nitric oxide. Nitric oxide acts as a muscle relaxant, facilitating blood flow that then results in penile erection.

During andropause, reduced testosterone production means there is less of the hormone available to fire up the nerves in the brain that induce sexual desire and bring forth erectile function. In a nutshell, if man’s body does not have enough testosterone levels, his sex drive wanes.

Other Causes of Low Libido in Men

Lifestyle, in particular physical health and nutrition, plays a crucial role in sustaining (or decreasing) a man’s sex drive. Unhealthy habits such as smoking and alcohol consumption are especially notorious for negatively affecting men’s libido. Improving lifestyle choices such as eating healthier and being physically active will help improve blood flow (and, by extension, sexual function), as well as increase energy levels and provide an overall feeling of wellness—key ingredients that enhance sex drive.

If high testosterone is responsible for improving male sexual desire, having increased estrogen levels negatively affects it. (On a side note, aside from keeping your bodily function at optimal levels, it needs no mentioning that sexual drive is also dependent on cultivating a healthy and happy relationship with your partner or spouse.)

The Solution

Natural bioidentical testosterone replacement therapy is especially effective in treating low sex drive in men by addressing problems with hormone levels, specifically testosterone deficiencies caused by andropause.

The beginning of andropause brings about a host of physiological and behavioral changes in men, including mood swings. Men between the ages of 40 and 60 will likely experience irritability and rapid mood shifts, a consequence of hormonal imbalance.

Irritable Male Syndrome

Irritable Men Syndrome or Irritable Male Syndrome (IMS) refers to the mood swings men experience during andropause. The co-occurrence of high cortisol and low testosterone levels, which is common during andropause, results to irritability in men. In some men, this manifests in sudden outburst, while in others this can be a catalyst for depression.

The following are observable behaviors in men that are consistent with irritable syndrome:

  • Anger
  • Sarcasm
  • Tension
  • Being combative or argumentative
  • Frustration
  • Being demanding
  • Sadness
  • Impatience
  • Anxiety

  • Hostility
  • Being unloving
  • Appearing withdrawn
  • Defensiveness
  • Dissatisfaction
  • High stress or low testosterone (or both) are the primary culprits behind Irritable Male Syndrome; however, studies also point to high estrogen levels as being another cause of irritability in men. Andropause and aging usually brings forth hormonal imbalance, particularly a decrease in testosterone.

    Aside from testosterone and cortisol, another hormone that contributes to mood swings during andropause is estrogen. Estrogen are created from testosterone by fat cells produced in turn during weight gain. High estrogen co-occurring with low testosterone levels are a precursor to male irritability; the greater the disparity between estrogen and testosterone levels in the body, the higher the probability of irritability in men. The presence of high cortisol levels is particularly problematic, as it increases the incidence of mood swings in men by disrupting the production of testosterone. If you are taking medication, check with your doctor if it causes hormonal imbalance.

    Treatment for Irritable Male Syndrome

    Irritable Male Syndrome, while common, often goes undiagnosed and untreated. Culturally, hormonal problems and the effects associated with them, especially mood swings, are all too often dismissed as women’s issues. This being the case, a paradigm shift is necessary in order to find relief from this condition. Instead of denying and fault-finding, the key is to accept and acknowledge that the problem exists. Doing so will allow you to acknowledge that a solution exists, and it is within you.

    The first step to arriving at a solution to male irritability is checking your hormone levels via male hormone testing. Many men have found relief from their mood swings by undergoing bioidentical hormone therapy in conjunction with a personalized nutrition and fitness program.

    Can Hormones Cause Andropause Depression?

    Andropause brings about fluctuations in hormone levels, which in turn results in a host of mostly unwelcome changes to a man’s physiology and disposition. From among the various andropause-related symptoms, perhaps the most serious is depression.

    Depression associated with male menopause normally arises from insufficient amounts of testosterone. Testosterone is a key ingredient in many bodily processes and functions. Men who are deficient in testosterone may experience hypogonadism, defined as an overall sense of ill-being. Testosterone is a vital hormone in men; as a matter of fact, men diagnosed with having low testosterone levels have been shown to increase their likelihood of being diagnosed with depression by 400%.

    Another factor that may contribute to depression in men is hypothyroidism, or having low thyroid levels. Specifically, reduced levels of the thyroid hormone T3 are responsible for the decrease in the neurotransmitter serotonin (the “happy chemical”), which is crucial in regulating mood and behavior.

    In addition, some studies show that men with higher levels of B-12 and folic acid respond better to the treatment of depression.

    Can hormones cause depression?

    The short answer is yes: Our sleep, mood—as well as a host of other factors critical for maintaining our quality of life—are dependent on our hormones. While we can point to numerous emotional and psychological factors as likely causes of depression, we cannot understate the role hormones play too. Hormonal imbalances are likely to cause depression, especially in men going through andropause; essentially, depression can either be caused by or made worse by hormones. As regards andropause, its various symptoms—erectile dysfunction, loss of muscle mass, weight gain, and hair loss, among others—may take such an emotional toll in men, leading to depression.

    Treatment for Male Menopause Depression

    Given the strong link between hormones and depression, it makes sense to look to treatments that help manage and restore balance to hormone levels in the body. One such treatment that has been effective in managing and treating male menopause depression is natural bioidentical hormone replacement therapy. Count on CT Hormone Therapy to bring optimal balance to your body’s testosterone levels.

    The condition of your hair says a lot about the state of your health. Unless you’re genetically predisposed to hair loss, why when you experience hair loss, you can pretty much trace it to several factors—including sickness, nutrient deficiency, hormonal imbalances, and even stress. Finding a solution for thinning hair or baldness is contingent on identifying its root cause and, from there, deciding on the best course of treatment.

    Alopecia—the medical term for hair loss—has two main types: telogen effluvium and alopecia areata. Telogen effluvium, the more common but less severe type, is when the hair falls out several months after the hair follicles stop growing and lie dormant. The good news is that this condition is only temporary: hair will typically grow back in 6 to 9 months.

    The other type, alopecia areata, occurs when your immune system attacks your own hair follicles, causing you to lose hair in patches. Unlike telogen effluvium, hair loss due to alopecia areata is irreversible most of the time and so may require treatment.

    Hair Loss and Hormones

    There is a strong link between hormones and hair loss in men. Just like menopausal women, men undergo hormonal changes and declines during andropause, or what is termed “the male menopause.” These hormones are responsible for regulating almost all bodily functions, including the growth of our hair. Stress and poor diet can negatively impact testosterone levels in men, impairing the mechanism responsible for follicular regeneration.

    Low testosterone and hair loss are linked by the testosterone derivative dihydrotestosterone (DHT). This male sex hormone can cause premature balding by shrinking hair follicles, therefore keeping healthy hair from surviving. In particular, DHT reduces the hair growth cycle and increases its resting cycle. Eventually, hair in regions affected by DHT will take longer to grow than hair in other unaffected areas, until it altogether becomes a bald spot.

    Hair follicles in front of and at the crown of the head are especially susceptible to this hormone because of genetics. In addition, when there is a surplus of testosterone in the system, DHT levels also rise, leading to an increased tendency for hair loss, even baldness. Aside from hair loss, teenage and adult acne may be attributed to DHT, likewise for enlargement of the prostate in older men.

    Stress and Hair Loss

    Your hair is especially vulnerable when you are under stress. During stressful episodes, the stress hormone cortisol is produced in copious amounts by your adrenal glands. High levels of this hormone can have a detrimental effect on your body, including but not limited to reducing collagen, counteracting insulin, making your bones brittle, and of course, making you lose more hair than average. Prolonged stress in men causes the adrenal glands to go on overdrive as your body demands a constant supply of cortisol. This results in the overproduction of testosterone and adrenaline. With the surplus of testosterone comes an increase in DHT, which leads to hair loss.

    Hair Loss and Thyroid Imbalance

    Thyroid problems are also marked by loss of hair. Thyroid disorders almost always result in hormonal imbalance; hormones in your body—as well as hormone-dependent bodily processes—will be affected by an improperly functioning thyroid.

    Changes in your hair’s appearance and texture (for instance, from smooth and shiny to dry, coarse, and frizzy) usually signal impending thyroid-related hair loss. Thyroid imbalance can also be detected by sudden loss or thinning of facial and body hair. In fact, the thinning of the outer corners of the eyebrows is a sign of an underactive thyroid gland.

    Nutrition Deficiencies and Hair Loss

    We all know that keeping our body functioning at optimal levels is contingent on getting balanced nutrition. To keep our organs, tissues, and cells working properly, we need to make sure that we are supplying our body with the necessary minerals and nutrients. Not getting enough protein, iron, zinc, and biotin results in hair loss in men. In some cases, however, excessive amounts of certain nutrients, such as vitamin A or carotenes, can lead to premature male pattern baldness.

    Hair Loss Due to Medication

    Some medications often include hair thinning or hair loss as one of their side effects. These include anticoagulants (blood-thinning medications), antidepressants, beta blockers, NSAIDS, and retinoids or Vitamin A–based drugs. Patients undergoing chemotherapy normally lose their hair in the process of the treatment. However, as with chemotherapy, hair loss following the use of medication is only temporary; hair will grow back as soon as the medication is discontinued or stopped.

    What exactly is Erectile Dysfunction?

    Erectile dysfunction refers to a man’s inability to hold an erection for the duration of sexual intercourse or activity. ED can mean the full failure to reach erection, an inconsistency in doing so, or the inability to sustain it for an extended time. Erectile dysfunction in men has several causes, in part due to hormones.

    Hormones and Erectile Dysfunction

    Hormones serve to regulate your bodily functions. Hormones normally work alongside other hormones to keep your body functioning normally. A shortage or oversupply of one hormone will create a ripple effect and affect other hormones as well as some bodily processes.

    Andropause is a period in a man’s life marked by low testosterone levels, leading to a chain effect that gives rise to several symptoms, such as erectile dysfunction. For one, men with low testosterone levels will find their ability to produce erections hampered. Low testosterone negatively impacts a man’s libido or sexual drive; this can then affect his ability to develop and sustain an erection.

    Some men find their sexual desire largely unchanged; however, even if this were the case, they may find they are unable to produce an erection. Erection begins with the brain signaling the release of nitric oxide, which the muscles in the penis need in order to relax. If nitric oxide is not released, such as when there is too much plaque in the arteries that house nitric oxide, man will find it difficult to achieve or sustain an erection.

    Stress, in particular elevated levels of the stress hormone cortisol, can adversely impact testosterone. The secretion of prolactin by the brain’s pituitary gland is another possible cause of erectile dysfunction. Specifically, testosterone levels can decrease with an increase in levels of prolactin.

    An overactive thyroid gland, or hypothyroidism, is also responsible for producing prolactin and, conversely, reducing testosterone levels. Subpar levels of testosterone could also be caused by hypogonadism or testicular failure. Erectile dysfunction may develop from this testicular abnormality that creates a higher-than-usual testosterone deficiency.

    Erectile dysfunction may also be a side effect of liver and kidney disease, which cause hormone imbalances. For instance, liver disease in men can elevate estrogen levels, which leads to ED. Other leading causes of erectile dysfunction include the contraction of the veins, diabetes, as well as taking medication for hypertension.