Erectile Dysfunction
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Erectile Dysfunction Clinic San Diego

Erectile dysfunction, also known as impotence or ED, affects an estimated 1 out of 5 men over 20 years of age in the United States.(1) ED can be caused by a multitude of factors, whether psychological or physiological. The condition is fairly misunderstood among the general population since those who suffer from it may not be comfortable talking about it.

However, erectile dysfunction is readily treatable in many cases through the use of certain medications that help make achieving and maintaining an erection easier. The first step is to find a physician trained in men’s health and communicate any erectile issues you may be experiencing. Lifestyle and dietary changes can also help promote healthy erectile function.

The vast majority of men who seek treatment for ED find that any prior performance anxiety they may have had ceases and their sex life improves significantly.

The vast majority of men who seek treatment for ED find that any prior performance anxiety they may have had ceases and their sex life improves significantly.

WHAT IS

Erectile Dysfunction?

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.

WHAT CAUSES

Erectile Dysfunction?

Men often presume that ED is merely a ramification of aging, 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.

Low T and ED

What’s the Connection?

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.

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.

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.

Treatment for


Erectile Dysfunction

In addition to TRT (if necessary), a range of medications may be used to treat erectile dysfunction. Depending on the cause of ED, PDE5 inhibitors such as Viagra and Cialis are usually the medications of choice since they are easy to take and very effective.

PDE5 Inhibitors (Pill-Form)

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. As such, Cialis may be thought of as “long-acting” Viagra.

A second generation PDE5 inhibitor known as avanafil (Stendra) may be used if either Cialis and Viagra are not well-tolerated. Stendra has an even quicker onset of action than Cialis and Viagra, reaching maximum concentration within roughly 30 minutes of ingestion; its effects last roughly 2 hours.

Some men may experience nausea, headaches, or blurred vision after taking a PDE5 inhibitor, but these symptoms generally subside shortly after the drug wears off. However, if one of the PDE5 medications produces side effects, it’s prudent to try a different option since they have distinct selectivity for PDE enzymes throughout the body. Some men tolerate Cialis better than Viagra and Stendra and vice versa.

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.

Injectable ED Medications

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.

How does
TRT Work for Erectile Dysfunction?

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.

Is TRT Safe for

Erectile Dysfunction

Here are some of the most common questions and concerns we receive from prospective TRT candidates with erectile dysfunction:

Will TRT harm increase my risk of cardiovascular complications?

Will testosterone make me more aggressive and moody?

Will taking testosterone cause the prostate gland to hypertrophy?

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.

Side Effects of TRT for

Erectile Dysfunction

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.

ED San Diego Treatment

As part of our ED San Diego 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.

References

 
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.

Frequently Asked Questions

In contrast to many male health clinics, we offer a complimentary consultation that includes a blood test through our on-site laboratory. We will have your lab results ready within 15 minutes - no running around from building to building. In addition, we accept PPO health insurance plans and Tricare military insurance to make your out-of-pocket costs much more affordable. Our expert, licensed staff specializes in treating male health and wellness. We are dedicated to providing you with the most professional care in a comforting, modern “man-cave” environment. To ensure optimal efficacy and safety, we use only the highest-quality medications, including bioidentical hormones that are the molecular equivalent of what your body naturally produces.
  1.  On-site lab /get your results in 15 minutes/ No runaround/ free consultation
  2. Insurance Accepted / affordable
  3. Expert, licensed staff
  4. Comfortable 'man-cave environment'
  5.  Highest quality medication
Testosterone replacement therapy (TRT) is a form of medical treatment that helps restore testosterone levels to a healthy level by providing prescription testosterone. In most cases, injectable testosterone is administered either weekly or bi-weekly. This results in a steady supply of testosterone in the blood and, eventually, the reversal of low T symptoms. Hence, the goal of TRT is to re-establish and maintain proper testosterone levels. After being on TRT for a few weeks, many men notice they are able to sleep better, their sex drive is higher, they have more confidence and motivation, they have an easier time building muscle and losing fat, and their energy levels are greater. Adult males with low T are the ideal candidates for TRT since testosterone levels tend to fade as we age past our 20s. However, some younger males may be candidates for TRT if they have primary or secondary hypogonadism since these signify a dysfunction either in the testes or the brain, respectively. Regardless of what age you are, low T is not something to be taken lightly and TRT is the most effective way to treat this condition.

A: We accept most major PPO plans and Tricare military insurance. You can use our Insurance Verification Form to see if your insurance qualifies.

A: We have an on-site laboratory that will perform any labs our physicians order for you. If you haven’t been to Gameday Men’s Health before, we offer a free consultation to new patients. You can book an appointment online by clicking here.

Sexual dysfunction related to low T is best remedied through TRT. Many men who have low T notice that they lose interest in sex and subsequently have a harder time achieving (and maintaining) an erection. Once testosterone levels are brought back to a healthy range, libido and erectile quality tend to improve. [We offer PDE5 inhibitors, like sildenafil and tadalafil, if erectile dysfunction persists despite having healthy testosterone levels.]
Absolutely. Testosterone has extensive benefits when used in conjunction with a proper diet and diligent exercise regimen. Most men find that they are able to build more muscle and gain strength quicker when they are consistent with their nutrition plan and gym routine while on TRT. As such, it’s essential to realize that TRT is not intended to replace a healthy lifestyle. There is simply no drug, supplement, or medication that can make up for a poor diet and lack of exercise.