According to the American Diabetes Association, more than 113,000 individuals in Hawaii have diabetes, with men having a higher prevalence of this disease than women.

Since November is American Diabetes Month, this is an opportune time to talk about a hidden and rarely discussed epidemic among diabetic men: erectile dysfunction.

Men with diabetes suffer from erectile dysfunction at startlingly high rates, developing this disorder 10 to 15 years earlier than males without diabetes. And as they age, erectile dysfunction becomes even more common.

Over the age of 50, the likelihood of having difficulty with erectile dysfunction occurs in as many as 50 percent to 60 percent of men with diabetes. Over age 70, this increases to 95 percent.

Erectile dysfunction can be caused by nerve damage and poor circulation, which are associated with diabetes, but what many people might not know is that low testosterone levels can also contribute to erectile dysfunction.

Up to 50 percent of men with diabetes have co-existing low testosterone levels.

Testosterone helps the body’s tissues take up blood sugar in response to insulin, a hormone secreted by the pancreas that regulates glucose (sugar) levels.

Men with low testosterone often experience insulin resistance and need to produce more insulin to keep blood sugars in a normal range.

Symptoms of low testosterone may include fatigue, decreased sex drive, difficulty concentrating, hot flashes, decrease in muscle mass, development of breast tissue, erectile dysfunction, infertility and decrease in facial or body hair.

The good news is that low testosterone levels can be diagnosed with a simple blood test drawn early in the morning. When levels are found to be below the normal adult male range, treatment can begin, if appropriate, with testosterone replacement therapy.

Testosterone replacement therapy can restore sexual function and muscle strength.

In addition, men receiving testosterone often experience an increase in energy, sex drive and sense of well-being.

There are also many ways to prevent and treat erectile dysfunction. Good blood sugar control can prevent nerve damage to the penis and also help blood flow. Stopping smoking and drinking only a moderate level of alcohol can also help erectile dysfunction.

If those things are not enough to improve the problem, then oral medications such as Viagra, Cialis or Levitra can be tried. If pills are not a good option, then doctors may prescribe a tiny suppository to place in the penis before sex, a vacuum pump or even penile implants.

Despite the high number of diabetic patients who have erectile dysfunction and low testosterone, many men still suffer in silence, assuming they are alone in experiencing male sexual dysfunction.

It’s important for them to know that erectile dysfunction is much more common than one might think, and that the benefit of speaking to a doctor about one’s experiences outweighs the temporary awkwardness of having the conversation.

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Dr. Jennifer Loh is chief of endocrinology at Kaiser Permanente Hawaii.