ED, PE, and Low Testosterone: How TRT improves Sexual Dysfunction

When men suffer from low testosterone, sexual issues become even more uncomfortable and harder to battle in the bedroom. Most men will experience ED or PE at some point in their lives and while most men will move passed the episode with ease, men with low testosterone have a continuous battle at a deeper physiological level when critical triggers to launch an erection are not firing as they should due to underperforming bodily functions that rely on normal levels of testosterone. Reference

The National Institute of Health (NIH) defines ED as the “inability to achieve or maintain an erection that is satisfactory for sexual performance…”

Testosterone plays a direct and indirect role in erectile dysfunction and premature ejaculation. In ED, testosterone asks the body to release nitric oxide, which the most critical part of a healthy erection.

Low testosterone levels play a role in erectile dysfunction (ED) somewhat indirectly meaning that without proper levels of testosterone functions that trigger an erection are broken. Ouch, choice words. Not literally broken.

Common issues like high blood pressure, high cholesterol, sleep issues, obesity, diabetes, etc. are related to low levels of testosterone. These ailments impact liver function, blood vessel health, and chronic inflammation, which directly impact performance in the pants.

We will get into the details later on in this article.

Low testosterone levels play a larger role in premature ejaculation (PE) as most PE issues are psychological. Stress, anxiety, and depression can impact your time under the sheets.

As we cover in our article about how TRT helps with cognitive health, testosterone helps the body destress and function properly in all three of these brain regions. If testosterone levels are off, stress and cortisol throw off the hypothalamus-pituitary axis leading to anxiety. Some men do not even know that they are suffering from stress or anxiety as the feeling begins to feel “normal” after coping with the feeling at work and pushing it aside.

Most research out there concludes that ED and testosterone are totally independent operations in the body to a certain degree, which is very true but taking a closer look at how a normal male body should be performing tells a different story. Men from 18 to 70 without low testosterone can suffer from ED or PE in the same manner as men 40+ would suffer from ED or PE suffering from low T.

Some men with low testosterone can have normal erections, but every man is different. The crux of this article shows how sexual dysfunction and low testosterone impact a man’s life. Reference, Reference

Healthy erections do need testosterone and research shows that men with low testosterone have less frequency, amplitude, and rigidity of erections.

At a structural level, testosterone is critical in the maintenance of the pelvic ganglion neurons aka the structure and function of the penis nerve network. Testosterone keeps the pipes and muscles running smoothly when carrying sperm through the vas deferens, which is the duct that moves sperm from the testicle to the urethra. If testosterone levels are low, this function can be held back leading to erectile dysfunction. Testosterone helps the spinal cord coordinate the erectile response of the cavernous nerve, which are nerves that facilitate an erection.

Nitric Oxide and Testosterone

When men suffer from erectile dysfunction, PDE-5 Inhibitors is prescribed. PDE-5 or phosphodiesterase type 5 inhibitor (PDE-5) medications like Viagra, Cialis, and are commonly combined with testosterone replacement therapy.

Generic to name brand guide:

• Viagra = Sildenafil
• Cialis = Tadalafil
• Levitra = vardenafil

A man’s body is supposed to releases nitric oxide (NO) when a sexual situation arises. Men experiencing ED miss that step.

• PDE-5 inhibitors stop the enzyme called phosphodiesterase-5 (PDE-5) from hindering the levels of cGMP, which is the chemical to makes the penis hard.
• PDE-5 allows nitric oxide (NO) to flow into the penis helping men become erect.
• PDE-5 inhibitors help relax the muscles in the penis allowing blood to flow into the penis.

Reference, Reference

Testosterone plays a key role in coordinating and facilitating the erection process. There are tons of testosterone receptors located in the walls of the vascular endothelium (blood vessel walls) and these receptors don’t work without proper levels of testosterone. A good erection needs smooth muscle cells to allow blood to pump through the penis during intercourse.

Keeping blood pumping is the main function of testosterone and a healthy erection. Testosterone sensitivity and reception in the penis can also influence a strong erection. The penis is a muscle, so these testosterone receptors layering the blood vessel walls crave testosterone and work the same way as a bicep or quad flexes. Low testosterone impacts healthy muscle growth so naturally low levels of testosterone can impact the muscle in your pants.

Testosterone plays a role in starting the entire erection process, from signaling for the release of nitric oxide to the damping of PDE-5 enzyme allowing the penis muscle to flex.

Nitric oxide (NO) does quite a bit for the body but today we will focus on how NO signals molecules to relax tiny muscles in our blood vessels allowing for redirection of blood flow into the penis. NO is what’s called a vasodilator, which means it opens up the blood vessels to increase the volume of blood pumping through the body. When nitric oxide levels in the penis increase so does blood flow in the penis leading to a healthy erection.

Sexual arousal signals this release of nitric oxide (NO) so if testosterone levels are low, then the sex drive mental trigger does not initiate the release of NO.

Healthy testosterone levels help decrease blood vessel inflammation which reduces the risk of high cholesterol. Low testosterone increases the risk of hardening of the arteries aka atherosclerosis.

Healthy blood vessels and smooth vessel walls allow for more efficient nitric oxide production and release from the blood namely into the penis for a healthy erection.

If cholesterol levels are high, these arteries can be coated in atherosclerotic plaques making it difficult to release nitric oxide.

Interestingly, Nitric oxide actually stimulates testosterone production. NO helps launch one of the first steps when the pituitary gland release testosterone. Nitric oxide also inhibits cortisol production. Cortisol reduces testosterone levels and breaks down muscles. In several studies, when NO production was “cut off” cortisol levels increased dramatically.

Nitric oxide plays a critical role in regulating the performance of the endocrine axis starting in the pituitary gland by helping the system secrete insulin, growth hormone (GH), and LH.

As for testosterone, NO help with what scientists call steroidogenesis, which is the complex enzyme process where cholesterol is converted to testosterone.

To understand how Nitric oxide plays within cellular biochemical steps, researchers look at how NO starts many other physiological effects in the body. NO activates soluble guanylate cyclase leading to an increase in cGMP. Without taking this topic to another level of complexity, cGMP

smooth muscle tissues allowing them to move freely. In blood vessels, cGMP smooths out muscles in blood vessels leading to an increase in blood flow.

The effects of testosterone on erectile dysfunction start with muscle tissue in the penis.

• Smooth muscle cell creation allowing for proper blood flow.
• Normal nitric oxide release to open up blood vessels in the penis.
• Increase in blood flow circulating into the penis.
• Increased density and strength of the penis muscle.
• Smooth muscle relaxation when sexually aroused.

There are a series of events that the body goes through to produce nitric oxide. Healthy testosterone levels are not the only thing require for the production of NO. Diet is important to get nitric oxide from the enzyme called nitric oxide synthase (NOS). For example, leafy greens include nitrates. Another important nutrient needed for healthy nitric oxide levels is L-arginine. This amino acid converts into nitric oxide by the enzyme, nitric oxide synthase (NOS). All things considered, when combining arousal and healthy amounts of L-arginine the results should lead to more nitric oxide to be released into the penis creating a better erection. Arousal requires healthy testosterone and estrogen balance.

Throughout the body, L-arginine [ahr-juh-neen] helps build and repair muscle tissue. It helps releases nitric oxide in the bloodstream. The body naturally produces L-arginine but foods like red meats and fish help replenish small amounts of the amino acid. L-arginine assists testosterone during muscle growth when combined with growth hormone (GH) by kicking off the muscle protein synthesis process.

Reference, Reference

With a decrease in free testosterone comes a drop off in the frequency of spontaneous erections and sexual activity. Reference, Reference

Men suffering from low testosterone show severe episodes of ED vs. men without low testosterone. And these episodes became more severe when estrogen levels are high. ED response between testosterone and estrogen comes down to hormonal receptors that trigger bodily events throughout the body. These steroid receptors, particularly around the neurovascular areas show that healthy erections are somewhat dependent on testosterone feeding these blood vessel receptors to trigger critical processes leading to the penis. Reference, Reference, Reference

What is the main cause of erectile dysfunction?

The most common cause of Erectile dysfunction in men is reduced blood flow to the penis due to underlying conditions like diabetes, obesity, high blood pressure, or high cholesterol.

Mental issues like PTSD, TBIs, depression, anxiety, and relationship issues are also possible causes of erectile dysfunction. Reference, Reference

There is a clear connection between low testosterone levels and the chronic conditions listed above that play a role in erectile dysfunction.

Normal testosterone levels are not required for normal erections to occur but sex drive plays an important role at the starting line of an erection. A common complaint in men diagnosed with low testosterone is that they frequently talk about low sex drive.

Sex drive, ED, and Testosterone

Testosterone replacement therapy improves sexual desire and arousal is the first step to an erection. Taking a deeper look at libido and sexual arousal we should look inside the brain at the cerebral cortex and limbic system. Men with low testosterone show a clear disconnect between the pituitary gland, testicles, and these two areas of the brain throwing off the entire endocrine axis that drives all production of testosterone.

These two areas of the brain are so powerful that even thinking about sex can lead to orgasm.

The cerebral cortex helps men plan and think. Under normal circumstances, when sexually aroused, brain waves launch from the cerebral cortex triggering various nerves that elevate the heart rate and redirects blood flow into the party in your pants creating an erection. If testosterone levels are low, these testosterone sensitive nerves have nothing to initiate the erection process leading to ED.

During sexual thought, the limbic system consists of the hippocampus, hypothalamus, and amygdala driving motivation, emotion, and sex drive. The limbic system is typically the culprit for premature ejaculation because stress impairs thoughts and actions in the area of the brain.

The amygdala starts the entire process of sexual arousal. As we cover in our cognitive health article, the amygdala houses lots of testosterone receptors to trigger your sex drive. If there is not enough testosterone pumping through the brain, these receptors go hungry and the sexual desire process is thrown off.

To distinguish between mental and physical causes of sexual dysfunction (ED and PE), medical researchers claim that sexual dysfunction is mental and less physical if erections occur during sleep or when men wake up with morning wood.

Stress, depression, and anxiety can impact both erections and sex drive. External factors like stressful work environment or troubles at home impair thoughts. A common mental block for men of all ages is performance anxiety. Reference

Performance Anxiety

Performance anxiety can cause and interfere with sexual function for long periods of time among men. Many studies have confirmed that negative or stressful thoughts have a massive impact on performance in bed. These thoughts can range from fear of inadequate equipment to lack of stamina (PE) to worrying about a deadline at work. Thoughts are powerful.

Negative thoughts lead to performance anxiety. The most common thought centers around men feeling pressure to please their partner or insecurity around their ability to perform sexually (PE).

Other common causes of performance anxiety may include stress about:

• Work
• Relationships
• Body image
• Kids or other family members
• Penis size
• Finances

Performance anxiety is not as simple as worry. Stress is a serious and powerful ailment where a simple worry can intensify a sexual encounter to the point of premature ejaculation, erectile dysfunction or no desire to have sex at all. Chronic stresses can lead to low testosterone levels, which compounds performance issues creating a snowball of stresses and physical issues.

Luckily, performance anxiety is easily managed and many men overcome these anxieties through mental and physical tools.

As we discussed early on, sexual issues like premature ejaculation (PE) and erectile dysfunction (ED) are different conditions and can occur separately, but they are very much related.

Premature ejaculation can be a sign of erectile dysfunction.

It’s important for men to talk with their partners about sexual dysfunction. Opening up about these issues should not be viewed as a lack of masculinity, but a desire to make intimacy a more hot and heavy experience. Many women report that talking openly about sex makes the experience more enjoyable as a “team effort.”

Give us a call at 817-900-0304 or sign-up through our online intake process if you would like to get started with treatment!

Premature Ejaculation

The Urology Care foundation defines premature ejaculation as “…when ejaculation happens sooner than a man or his partner would like during sex.”

The American Psychiatric Association criteria for premature ejaculation as:

“In almost all or all (75-100%) sexual activity, the experience of a pattern of ejaculation occurring during partnered sexual activity within 1 minute after vaginal penetration and before the individual wishes it.”

While that seems like a simple mistake, there are actually some deeper mental and physical functions occurring in the brain and nervous system to trigger the trigger-happy response.

There are several physical factors that can cause premature ejaculation.

• Erectile dysfunction
• Low testosterone or hormone imbalance
• Prostate inflammation

Mental factors include:

• Stress
• Depression
• Sexual trauma
• Anxiety
• Relationship woes
• Shameful sexual thoughts

How serotonin helps prevent PE

Looking at the mental side of premature ejaculation, the level of serotonin that’s released during sex can impact how long a man can last in bed. Serotonin is sometimes called “the happy chemical”. There is a clear association between the function of serotonin and ejaculation meaning that if serotonin levels are low, then ejaculation occurs faster than expected. Serotonin levels can be reduced by stress and the other factors listed above.

Researchers have found that increasing serotonin levels can help delay ejaculation in men. Mean with low testosterone report low motivation or depression, which can also be related to low serotonin levels and lead to sexual dysfunction.

How penis sensitivity causes PE

If a man has increased sensitivity at the tip of the penis (the ejaculatory spinal cord sits at the tip of the corona) ejaculate will occur too fast.

One common treatment for sensitivity is to apply a topical numbing cream. Most of these creams contain lidocaine to reduce penis sensitivity and prolong ejaculation.

Topical creams for PE

Applying topical cream should temporarily desensitize the head of the penis to prevent premature ejaculation. Most men use this as the first line of defense as the creams are easy-to-use and low-cost. The good news is that most site reviews have little side effects or adverse events reported. As per usual, please call 911 should you experience moderate to severe side effects when any therapeutic treatment.

Most topical numbing creams or sprays are available over the counter or by prescription. One option is a new product called Promescent. The cream works by gently numbing the sensitive areas of the penis so the nerves prolonging intercourse and holding back the nerves from firing too soon.

Behavioral Techniques for PE

For men that don’t want to apply foreign creams to their penis… there are behavioral techniques to keep the fun going in the bedroom. Some men respond well to the start and stop method, which works as it sounds where the man stops, cools down the urge and nerves then continues with intercourse. While this method may work, it may not be fun for the significant other.

The squeeze technique is one of the first premature ejaculation techniques men try to prolong sex. The technique sounds dangerous but according to many NIH studies, the method is safe and prescribed by providers regularly. Squeezing works by manually preventing ejaculation. By applying pressure to the top penis right before climaxing makes it possible to close off the urethra to prevent ejaculation and continue intercourse 4 or 5 times throughout the festivities.

During sex, the guy must stop as the urge to ejaculate increases and begin squeezing the penis at just the right time. When applying pressure to the head of the penis decreases the urge to go. The man or partner should place the index finger on the backside of the penis and placing your thumb on the other side and gently squeezing until the urge subsides. Sex can continue after a brief 10-20 second intermission.

Oral medications for PE:

Over the past decade, researchers have found the PDE-5 inhibitors commonly used for ED have revealed promising positive results to stop PE in men. These medications may also help prevent premature ejaculation. Tons of studies show that sildenafil or vardenafil may help reduce the stimulation of the penis from the vas deferens and seminal vesicles to the urethra create a state of peripheral analgesia basically reducing the sensitivity of the penis allowing men to perform longer.

Another interesting benefit of PDE-5 inhibitors centers around the nervous system. Where sildenafil actually stabilizes the central sympathetic output, which controls hypersensitive nerves in the penis allowing men to last longer. These same studies showed that tadalafil did not provide the same level of reducing stimulation. Combining PDE-5 inhibitors and TRT can improve sex drive leading to a more enjoyable sexual experience.

Reference, Reference, Reference

Hormone levels and ED

Erectile dysfunction (ED) can be negatively influenced by hormonal imbalances outside of testosterone alone. These imbalances impair cardiovascular and thyroid health quite a bit.

Prolactin increases luteinizing hormone (LH) receptors allowing Leydig cells to produce testosterone and triggers spermatogenesis in the testicles. Too High or too low prolactin levels cause ED and low sex drive.

Thyroid hormones T3 (triiodothyronine) and T4 (thyroxine, which is the main thyroid hormone in the blood) are regulated by thyroid-stimulating hormone (TSH). TSH is produced by the pituitary gland.

High TSH means you have an underactive thyroid or Hypothyroidism.

Low TSH means you have an overactive thyroid or Hyperthyroidism.

T3: Low levels of T3 is associated with erectile dysfunction and low sex drive.

T4: If T4 is high or low with low T3 may lead to ED and low sex drive.

Estradiol imbalance: High or low levels have been linked to libido.

If estradiol spikes then testosterone decreases. High estrogen and low testosterone are associated with weaker and less frequent erections. With higher estrogen levels, physiologic steps will impact cell-to-cell communication during the release of nitric oxide leading to ED.

DHT (Dihydrotestosterone) is the active form of testosterone and the male body uses the hormone to grow hair and skin cells. When muscles fire off, DHT is the active form of testosterone enabling muscle movement. Low levels of DHT may cause ED.

Progesterone helps decrease and stabilize estrogen levels so low or high levels can impact erection health.

In several studies, researchers show that total and free testosterone is responsible for general sexual wellbeing in men while estradiol is a “distressing” hormone causing ED.

Estrogen, ED, and Testosterone

It is well established that high estrogen levels cause erectile dysfunction (ED) and high estrogen levels decrease testosterone levels.

An erection is a delicate dance of nerves so if there is a misfire or imbalance between estrogen to testosterone then at least one of these triggers will causing erectile dysfunction.

As we cover above, if estrogen increases then testosterone levels begin to decrease leading to weaker erections for men. Tissue throughout the body have estrogen receptors and have targets for a hormonal response like the testosterone hungry receptors that activate so many bodily functions in men. Elevated estrogen can hinder a male’s desire and natural ability for these receptors to get enough testosterone as estrogen floods these critical processes.

If there is an estrogen to testosterone imbalance, then the hypothalamus-pituitary axis is not producing enough testosterone to trigger an erection. Testosterone is necessary for normal erectile function and low testosterone leads to a decrease in firmness and inability to maintain a healthy erection. If estradiol increases, there is a reduction in spontaneous erections and a decrease in sexual arousal due to the obvious hormone imbalance.

 

Erectile dysfunction is more prevalent among men with high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels.

Erectile dysfunction is usually a warning sign of early onset of cardiovascular or metabolic issues, especially among overweight men.

Reference, Reference, Reference

Cholesterol, ED, and Testosterone

Cholesterol is an essential chemical that helps the body runs smoothly especially blood vessels.

Among other things, cholesterol is needed to make testosterone, estrogen, cortisol, and many other hormones that the body uses to keep arteries clear from plaque or clots.

By keeping good cholesterol flowing through the body reduces the risk of inflammation. By reducing inflammation helps the liver process fat to energy and helps send cholesterol down to the Leydig cell to produce testosterone. Low testosterone increases the risk of hardening of the arteries and reduced blood flow thus leading to erectile dysfunction. The body is amazing.

Cholesterol is converted to useful nutrients through the liver. The liver processes fatty acids helping the body absorb important vitamins like A, D, E, and K. The brain signals the pituitary gland to release stimulating hormones (LH and FSH) down to the Leydig cells in the testicles where cholesterol is converted to testosterone. Leydig cells simply absorb the cholesterol floating through the bloodstream.

Enter low testosterone. As men get older, the Leydig cells slow or stop converting cholesterol into testosterone. Researchers believe the Leydig cells stop converting with age due to an imbalance or changes to chemical reactions at the cellular level. Some researchers are looking to stem cells to validate if there is a way to reverse the aging of the Leydig cell processor, but for now, testosterone replacement therapy is the best option for men suffering from low testosterone and the common symptoms.

Vitamin D, ED, and Testosterone

Vitamin D is primarily known for its role in keeping bone healthy and dense as well as calcium-phosphorus homeostasis in kidney health. It also appears to be involved in endocrine disease, including diabetes. With the amount of vitamin D receptor in bodily tissues show that cellular health and function plays a key role in erection performance. A growing number of studies are revealing that catching rays of the sun can improve erection health. A high number of men suffering from ED also had low levels of vitamin D.

“Recent clinical works have suggested that low vitamin D levels may somehow be associated with the occurrence of sexual disturbances, especially erectile dysfunction, even if not all the studies agree on this point,” wrote the researchers. “These results need confirmation because of their potential revolutionary approach to the treatment of sexual dysfunction.”

The researchers proposed several possible mechanisms for vitamin D’s effect on sexual function. For example, vitamin D could improve endothelial integrity, and vitamin D may directly protect endothelial cells against oxidative stress. Alternatively, the activation of vitamin D by the antioxidant pathway may result in the production of nitric oxide, which promotes penile vascular dilation.

Reference, Reference

Trouble sleeping, ED, and Testosterone

ED is 64% more common in men with sleep apnea. Sleep apnea is a serious condition leading to life-impacting conditions due to the continuous drop in blood oxygen levels. Conditions like high blood pressure, health issues, erectile dysfunction, and diabetes.

Sleep apnea can be diagnosed at home with an overnight sleep study kit.

Luckily, erectile dysfunction caused by sleep apnea can be treated and reserved with a CPAP or other sleep aid devices if there are no other underlying conditions present. Snoring is a telling sign that you may have sleep apnea.

Sleep apnea causes many conditions that impact erection health leading to ED. With lack of sleep, ED and sleep apnea sufferers may experience fatigue, high blood pressure, heart issues, and diabetes. With the body needing sleep, it’s clear that the disruption in sleep is hurting the body’s desire to recover and perform at a normal level. Insomnia can lead to an increase of cortisol and stress, which as we discuss is one possible cause for erectile dysfunction and low sex drive due to low testosterone.

Researchers are taking a closer look at sleep apnea and its toll on sexual satisfaction as well over have of men with sleep apnea have erectile dysfunction.

Historic studies have shown a spike in erectile dysfunction among men who suffer from obstructive sleep disorder over the past few decades. One study showed that 70% of men seeking sleep apnea treatment also suffered from erectile dysfunction.

Looking at this topic in reverse, a study that screened ED patients for sleep apnea found that 91.3% of men suffered from both issues.

“These studies point to some very alarming consequences for men with impaired sleep habits,” said Dr. Köhler. “Men should be aware that a commitment to improving one’s sleep habits could lead to improved erectile function along with a host of many other established health benefits that accompany a good night’s sleep.”

What are the treatment options for erectile dysfunction (ED)?

Oral PDE-5 inhibitors are the most effective and standard treatment option for erectile dysfunction. However, roughly 30-35% of men who have tried these oral medications do not have a positive experience so a secondary option for these men is Intracavernosal injections.

What is sildenafil?

Sildenafil citrate has been the most widely used medication to treat erectile dysfunction for many decades. Sildenafil is the generic name for Viagra. This mediation is part of the list of oral PDE-5 inhibitors family to treat erectile dysfunction. When someone says they are on Viagra, there is a high probability that they taking generic sildenafil. Generic sildenafil is very cheap while Viagra is expensive.

Sildenafil should be taken without food 30 minutes to an hour before sex and its effects last up to 6-8 hours.

What is tadalafil?

Tadalafil is the generic form of Cialis® and it works a little bit differently than Sildenafil. Commonly called the weekend pill, Tadalafil stays active in the body for 36 hours. This mediation is part of the oral PDE-5 inhibitors family and is also used to treat benign prostatic hyperplasia.

While Tadalafil is more expensive, the pill provides more flexibility for spontaneous erection because it lasts 36 hours. It’s better for men that want to be prepared rather than making time 30 minutes before sex. Flexibility is nice when you’re going out on a date or hitting the town.

As mentioned in the above sections, sildenafil (Viagra) is more effective for premature ejaculation likely due to its more pointed effects on penis sensitivity.

A standard dose of sildenafil is 50 mg (or 25 to 100 mg) taken 30 minutes before sex. The effects of sildenafil last for approximately four hours, and men shouldn’t use no more than one dose within 24 hours. Fatty foods reduce the effects of sildenafil so the medication should be taken on an empty stomach.

Is sildenafil the same as tadalafil?

Sildenafil has been around the longest and cheaper than tadalafil for several reasons. Sildenafil works well for occasional sex and “when the time is right.”  It begins to work after 30 minutes must be taken on an empty stomach.

Many men alternate between sildenafil and tadalafil, depending on the occasion and need.

Tadalafil (Cialis) is the most popular PDE-5 inhibitor because it lasts 36 hours and allows for a more spontaneous feel than sildenafil or vardenafil. The dose of 10 mg (or 5 to 20 mg) is smaller than sildenafil should be taken about 30 minutes before intercourse. This shorter time-to-erection response allows men to have more opportunity for spontaneity. Eating beforehand does not matter on tadalafil nor does it affect the absorption of the medication.

Tadalafil is a practical option for men who do not plan when they have sex. Tadalafil is approved for low dose daily use.

Vardenafil and Avanafil are other PDE-5 inhibitors to treat ED. These two generics can be found under their brand names: Levitra, Staxyn, and Stendra. Each medication does the same thing, these oral medications provide various levels of potency and advantages.

Vardenafil is more expensive than sildenafil because it is 10 times more potent and has shown to result in fewer side effects.

Vardenafil typically starts at 10 mg (or 2.5 to 20 mg) 30 minutes before sex. Vardenafil begins working within 30 and lasts up to 4 hours.

Intracavernosal injections (penile self-injection) include prescription TriMix or BiMix

medicines that men self-inject directly into the penis.

Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work similarly to oral medication by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection.

TriMix therapy is recognized as a successful treatment for erectile dysfunction especially for those patients who have not had positive results or experience from oral PDE-5 inhibitors, (sildenafil, tadalafil, etc). The American Urological Society says men have a 90% success rate with TriMix.

Reference, Reference

Human chorionic gonadotropin (HCG) mimics LH triggering the pituitary gland to stimulates the Leydig cells of the testicles to produce testosterone.

HCG is successfully used alone to promote testosterone production in “secondary hypogonadism” or in combination with standard testosterone replacement therapy to normalize testicular size. Testicle atrophy is common among some men who suffer from “primary hypogonadism.” These men experience testicular atrophy due to the lack of gonadotropin-releasing hormone (GnRH) because the signals asking glands to produce luteinizing hormone (LH) are broken. So, without LH, the testicles stop secreting testosterone, leading to smaller testicles.

While little research has been done on the subject of HCG and ED, some men report that TRT and HCG jointly improve erection health and sex drive.

An erection is a sequence of events where the brain sends signals throughout the body triggering mental and physical actions to redirect blood flow to the penis. If any one of those triggers are off or misfire, ED will occur.

Remember back when you were younger and just the thought of sex gave you an erection thinking about sex. As men age, the ability to launch an erection on the fly becomes very difficult. Negative thoughts in general are not helping the situation by preventing an erection from popping up when things like performance anxiety, depression, and stress creep in to ruin a good time.

There is a joint venture between mental and physical mechanisms to fight ED. Sexual dreams and nighttime/morning erections may be a common occurrence, but testosterone alone does not make erections strong or lasting enough for satisfactory sex. While TRT can reverse some of those physical issues to smooth muscles and improve blood flow, PDE-5 inhibitors should be the first line of defense.

Give us a call at 817-900-0304 or sign-up through our online intake process if you would like to get started with TRT, Sildenafil, Tadalafil, or vardenafil

What Are the Signs of ED?

ED can start with softer or less frequent erections. Most men may experience erections that don’t last long enough to have quality sex while other men are unable to achieve an erection at all.

Aside from these noticeable experiences, the most common sign of ED is the lack of morning erections. If you’re unable to have satisfying sex for any of these reasons, you may have ED. If you’re experiencing low sex drive or premature ejaculation, you may consider talking with our providers about low testosterone or consider one of the PE treatments above. Our providers can go over those conditions during your first visit.

Like many physical issues that come with age, erections are one of those conditions on the list to look after for men to watch closely. While it is normal for work and life to get in the way of sex, it’s important for men to be mindful when stress, anxiety financial, or relationship issues decrease their desire for sex and impact their erections.

Unhappy sex life or loss of intimacy with partners can lead to serious issues and unwanted relationship strains.

What causes a weak erection?

Physical or psychological problems disrupt communication between the brain and the penis. Other health problems like diabetes, high blood pressure, anxiety, stress, and depression impact the trigger portion of the erection sequence.

Side effects of certain medicines.

• Drinking too much alcohol or smoking cause case erectile dysfunction (mostly short-term hindrance).
• Surgery below the waist, such as prostate cancer, can cause issues with a healthy erection.

At what age does ED start?

There is no specific age where ED starts holding back men, but there is plenty of data showing that problems start showing themselves over 40 years old. According to research, the bell curve increases to 26% in the age group 50 to 59 years and 40% in men age 60 to 69 years.

Men in their 20s and 30s are usually in their sexual peak with no issues in the bedroom but performance anxiety or premature ejaculation can hold them back. Some men under the age of 40 can certainly experience ED. The number of younger men experiencing ED has grown over the last decade. While most younger men may have psychogenic (PE) symptoms, physical issues can hinder a healthy erection.

Does erectile dysfunction last forever?

Depending on the cause, erectile dysfunction can be cured or reserved by reaching a point where men have the ability to achieve a good erection without the need for ED medication, surgery, injections, or implants. With the right diagnosis, support, and treatment, it’s possible for ED to go away without the need for ED mediation. Men should not have issues spontaneously getting an erection although with age compounding factors like high cholesterol, high blood pressure, and low testosterone make it difficult to achieve a healthy erection.

Reference, Reference, Reference, Reference, Reference, Reference

Medically peer reviewed, Written by Our Editorial Team.

Give us a call at 817-900-0304 or sign-up through our online intake process if you would like to get started with treatment!

If you do have low testosterone it can be easily treated and monitored via telehealth with the same level of care as you would receive in our traditional clinic setting in Roanoke, Texas. Give us a call if you have any questions!