Erectile dysfunction is when a man loses his ability to initiate and sustain an erection during sexual activity. It is not the same as premature ejaculation, which is when a man releases semen before climaxing (having an orgasm), shortly after engaging in sexual intercourse, causing him to lose his erection.
ED and premature ejaculation may coexist in some men. It’s advised to treat the erectile dysfunction first since it usually corrects the premature ejaculation issues in the process.
The physiological mechanisms that underpin ED are fairly intricate since the central nervous system (i.e. the brain and spinal cord), cardiovascular system, and reproductive system all play into the equation.
Neurotransmitters in the brain (e.g., epinephrine, dopamine, acetylcholine) are the primary chemical messengers that initiate an erection. Psychological and/or physical sexual stimulation causes nerves to transmit electrical impulses to the vascular system, which subsequently directs blood flow towards the penis. There are two arteries in the penis that supply oxygen-rich blood to the corpora cavernosa and erectile tissue, causing the penis to expand as a result of greater blood flow and an increase in pressure.
Erectile dysfunction is when a man loses his ability to initiate and sustain an erection during sexual activity.
Since blood must remain in the penis to maintain rigidity and size during an erection, erectile tissue surrounded by fibrous elastic sheathes (tunicae) that clamp and restrict blood from flowing away from the penis. After ejaculation, or when stimulation ceases, pressure in the penis drops, blood flows away, and the penis returns to the flaccid state.
ED is often treated with medications that target chemicals in the body that modulate these mechanisms. For example, sildenafil (Viagra) and tadalafil (Cialis) encourage blood flow to the penis by inhibiting phosphodiesterase-5 (PDE5) enzymes.
These PDE5 inhibitors preserve the activity of intracellular messengers known cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) in the corpus cavernosum, thereby relaxing blood vessels in the penis and increasing blood flow.
Men often presume that ED is merely a ramification of ageing, but that’s not necessarily the truth. While aging and the associated reduction in testosterone is a major can lead to erectile dysfunction, a myriad of other factors need to be taken into consideration.
For example, the prevalence of ED among those men with type-2 diabetes and hypertension is significantly greater than healthy men.1 This makes sense given that hypertension and type-2 diabetes can hinder cardiovascular function and make it harder for blood to flow to the penis and produce an erection.
But erectile dysfunction is a complex condition that can stem from a wide range of psychological and/or physiological issues. In fact, emotional wellness and mental health are strongly correlated with erectile dysfunction, especially in younger males.(2) This is sometimes referred to as psychogenic erectile dysfunction.
Naturally, treating ED is a matter of pinpointing the root cause and then correcting it.
In fact, emotional wellness and mental health are strongly correlated with erectile dysfunction, especially in younger males. This is sometimes referred to as psychogenic erectile dysfunction.
Testosterone is the quintessential “man” hormone and its androgenic properties have strong effects on libido and erectile function, directly and indirectly. While ED can be brought on by several health conditions, androgen deficiency (low testosterone) is a major risk factor.
Testosterone is a ubiquitous hormone in both males and females, affecting virtually every tissue and organ in the body (whether directly or indirectly). Low testosterone is essentially the starting point for a subsequent vicious cycle of debilitating health conditions that all feed into each other.
Research shows that low T increases the risk of metabolic syndrome, endothelial dysfunction, cardiovascular disease, type-2 diabetes, and anemia, all of which significantly impact the physiology of erectile function.(6)
In addition, low T is associated with a greater risk of depression and mood disorders, which are well-known to impact libido and erectile quality.(7) In this regard, TRT can help treat ED by establishing healthy mental wellness and confidence in men suffering from low T.
In other words, a man with low T should address his testosterone deficiency first and foremost as part of a long-term resolution for erectile dysfunction. One study even found that low testosterone negatively impacted endothelial function and flow-mediated vasodilation independently of other risk factors, such as hypertension, chronic smoking, and type-2 diabetes.(8)
Men suffering from low T and erectile dysfunction most always respond positively to TRT as it can restore both sex drive and erectile quality through both physiological and psychological changes.
Viagra and Cialis are non-habit forming medications and their effects have a rapid onset, usually lasting up to 4 hours and 36 hours, respectively.
If oral PDE5 inhibitors don’t help with erectile dysfunction, injectable medications such as P-shot and Trimix may be prescribed. These medications are self-administered by injection into the intracavernosal space of the penis, thereby bypassing the gastrointestinal tract and rapidly producing an erection.
TRIMIX FOR ERECTILE DYSFUNCTION
Trimix contains three different compounds, papaverine, phentolamine and alprostadil, that help expand and relax the blood vessels in the penis. It is premixed and must be kept cool to maintain potency.
Advantages of injectable ED medication is that they don’t readily interact with alcohol, food, and other medications like PDE5 inhibitors may. Injectable ED medications also are considered safe for men who suffer from cardiovascular issues and diabetes.
P-SHOT® FOR TREATING ERECTILE DYSFUNCTION
Another injectable option for erectile dysfunction is the Priapus Shot® (P-Shot®). This one-time procedure involves several injections of platelet-rich plasma (PRP) into the penis in order to stimulate new tissue growth and promote stronger erections. The P-Shot® is said to be synergistic with TRT and reportedly increases sexual stamina. The procedure is virtually painless under anesthesia and takes less than 30 minutes. Results may be noticeable immediately in some patients, but can take up to three months for maximum benefit.
As always, consulting with a licensed physician that specializes in men’s health is imperative for determining which Erectile Dysfunction treatment is best for you and your specific needs.
Men who suffer from ED rarely suspect that low testosterone could be the culprit. While Viagra and Cialis are unequivocally effective for treating erectile dysfunction, they won’t correct low T. Having healthy testosterone levels is an integral component of long-term health, wellness, and sexual function.
TRT is simply meant to “replace” testosterone to a normal, healthy range under the guidance of a licensed physician. GameDay Men’s Health uses only bioidentical testosterone, which is much safer since it is the same as the natural testosterone produced by the body.
In healthy, TRT doses of testosterone, the side effects are much more manageable than the side effects people often experience when using testosterone for illicit purposes (i.e. for “performance-enhancement”). Hence, TRT is not the same as using testosterone for athletic performance enhancement.
Remember, testosterone is a natural hormone and necessary for all humans. When a man’s body doesn’t produce enough of it, his health and quality of life will slowly deteriorate.
TRT is simply meant to “replace” testosterone to a normal, healthy range under the guidance of a licensed physician.
Here are some of the most common questions and concerns we receive from prospective TRT candidates with erectile dysfunction:
The reality is that many of the purported risks of TRT, such as an increased risk of prostate cancer and cardiovascular disease, are based on results from poorly designed studies and flawed clinical trials.
In fact, several studies suggest that TRT is actually beneficial for cardiovascular function and metabolic health, which thereby promotes better erectile quality. Likewise, men with low T are the ones that have a greater risk of prostate issues than men with normal T levels.
What many people don’t know is that the amount of testosterone used for “performance enhancement” is drastically more than a proper TRT dose. A normal weekly dose of testosterone on TRT is anywhere from 100-200 mg.
There are a few side effects of TRT that some men with ED may experience, such as night sweating, oily skin, and acne (particularly on the shoulders or upper back). Thankfully, these side effects are easy to manage, if not avoid, by monitoring blood levels of various biomarkers and adjusting the TRT dose accordingly.
Any initial side effects of TRT generally subside after the body acclimates to having a normal, healthy level of testosterone again.
As part of our ED San Clemente Treatment, GameDay Men’s Health will ensure you get the best results possible while controlling any side effects.
PDE5 inhibitors like Viagra, Cialis, and Stendra are well-tolerated by most men and produce beneficial actions on erectile function quickly. For men with low T, these medications serve as great adjuncts to TRT for treating erectile dysfunction. Injectable medications, like the P-Shot and Trimix, are also safe and effective options when PDE5 inhibitors don’t produce the desired results.
If you’re experiencing ED or any other symptoms of low T, don’t hesitate to schedule a complimentary consultation with one of our hormone specialists by
or calling us at 858-252-9202
We’ve helped countless men regain their confidence and sexual vitality.
1. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the US. The American journal of medicine, 120(2), 151-157.
2. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: prevalence and predictors. Jama, 281(6), 537-544.
3. Park, B., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., … & Doan, A. (2016). Is Internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences, 6(3), 17.
4. Hald, G. M. (2015). Comment on: Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?. The journal of sexual medicine, 12(5), 1140-1141.
5. Prause, N., & Pfaus, J. (2015). Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction. Sexual medicine, 3(2), 90-98.
6. Traish, A. M., Guay, A., Feeley, R., & Saad, F. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of andrology, 30(1), 10-22.
7. Zarrouf, F. A., Artz, S., Griffith, J., Sirbu, C., & Kommor, M. (2009). Testosterone and depression: systematic review and meta-analysis. Journal of Psychiatric Practice®, 15(4), 289-305.
8. Akishita, M., Hashimoto, M., Ohike, Y., Ogawa, S., Iijima, K., Eto, M., & Ouchi, Y. (2007). Low testosterone level is an independent determinant of endothelial dysfunction in men. Hypertension Research, 30(11), 1029.
9. Corona, G., Rastrelli, G., Vignozzi, L., Mannucci, E., & Maggi, M. (2011). Testosterone, cardiovascular disease, and the metabolic syndrome. Best practice & research Clinical endocrinology & metabolism, 25(2), 337-353.
10. Kloner, R. A., Carson, C., Dobs, A., Kopecky, S., & Mohler, E. R. (2016). Testosterone and cardiovascular disease. Journal of the American College of Cardiology, 67(5), 545-557.
11. Morgentaler, A. (2006). Testosterone replacement therapy and prostate risks: where’s the beef?. Canadian Journal of Urology, 13, 40.
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