Erectile Dysfunction Treatment in Washington

Whether you have never tried an erectile dysfunction (ED) medication before or have tried them all with no success, our doctors are here to help.

Maybe you tried Viagra®, Levitra®, and/or Cialis® for erectile dysfunction treatment and when it didn’t work you gave up. The doctors at our clinics in Washington may be able to help you get back the quality of life you deserve.

If you’ve never tried ED medications before but you’re having problems then its important we review your options as well as look for potential causes of ED that may also effect your overall health.

Erectile dysfunction is a common condition occurring in men. Men with erectile dysfunction may be at increased risk for heart attacks are strokes. ¹ 1. Testosterone deficiency in patients with erectile dysfunction: when should a higher cardiovascular risk be considered? Martínez-Jabaloyas JM. J Sex Med. 2014 Aug;11(8):2083-91. doi: 10.1111/jsm.12596. Epub 2014 Jun 5. × Thus, it is important to work at determining the cause or your erectile dysfunction as well as finding effective treatment options.

If you’ve tried Cialis® and it was not as effective as you had hoped you may get better results from a once a day Cialis® dosing at a lower dose. I have had some patients get really good results with one medication and then no results and multiple side effects with another. ² 2. Impact of low testosterone on response to treatment with tadalafil 5 mg once daily for erectile dysfunction. Goldfischer ER1, Kim ED2, Seftel AD3, Baygani SK4, Burns PR4. Urology. 2014 Jun;83(6):1326-33. doi: 10.1016/j.urology.2014.02.019. Epub 2014 Apr 13. ×

Also, some research has shown that testosterone replacement therapy can improve the effectiveness of medications like Viagra®, Levitra®, and/or Cialis® but other studies have shown testosterone replacement therapy not to have a significant effect on their effectiveness. ⁴ 4. Testosterone supplementation and sexual function: a meta-analysis study. Corona G1, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, Rochira V, Sforza A, Lenzi A, Mannucci E, Maggi M. J Sex Med. 2014 Jun;11(6):1577-92. doi: 10.1111/jsm.12536. Epub 2014 Apr 4. ×

There may be genetic factors which are not fully understood at this time that play into how effective testosterone replacement will be at helping to improve your erectile dysfunction. Testosterone therapy is NOT a cure for erectile dysfunction but we often see men with erectile dysfunction also have low testosterone. ³ 3. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. Yassin DJ1, Doros G, Hammerer PG, Yassin AA. J Sex Med. 2014 Jun;11(6):1567-76. doi: 10.1111/jsm.12523. Epub 2014 Apr 8. ×

I have had many patients see major improvements in the quality of their erections from testosterone replacement therapy. Our holistic approach to treating low testosterone may give you better results in terms of your erections than the standard once a month testosterone injection treatment that many doctors provide.

We typically provide weekly testosterone injections which provide more consistent testosterone levels with less surge and crash that the once a month testosterone injections cause. If your testosterone levels are only in the normal range for one to two weeks out of the month you may benefit more from our approach.

Another aspect of our approach to treating low testosterone that separates us from other clinics is how we “balance” the hormones. Just having more testosterone may make a huge difference in your life (if you have low testosterone to begin with) but in order to potentially limit potential side effects and increase your benefits while on testosterone therapy we monitor other important levels such as estrogen. ⁷ 7. Estrogen mediates metabolic syndrome-induced erectile dysfunction: a study in the rabbit. Vignozzi L1, Filippi S, Comeglio P, Cellai I, Morelli A, Marchetta M, Maggi M. J Sex Med. 2014 Dec;11(12):2890-902. doi: 10.1111/jsm.12695. Epub 2014 Sep 21. × ⁸ 8. Hormonal Modulation in Aging Patients with Erectile Dysfunction and Metabolic Syndrome. Inês Campos Costa, Hugo Nogueira Carvalho, Luís Pacheco-Figueiredo, Inês Tomada, Nuno Tomada. Int J Endocrinol. 2013; 2013: 107869. Published online Dec 28, 2013. doi: 10.1155/2013/107869. PMCID: PMC3888699 ×

New research is showing the importance of estrogen in men. Many doctors never even consider checking estrogen levels in men but in my experience monitoring estrogen is essential to testosterone replacement therapy and erectile dysfunction treatment. We’re not trying to get in touch with our feminine side right?!

Testosterone naturally converts to estrogen and that is how most of the estrogen in our bodies is made. The key is to balance the estrogen level; not shut it down or shoot it through the roof. Too much estrogen and not enough testosterone has been shown in studies to cause a sort of “leakiness”, termed venous leak, in the penis. ⁵ 5. Management of Erectile Dysfunction in the Hypogonadal Man: A Case-Based Review. Ranjith Ramasamy, MD, Jason M Scovell, BBA, Nathan A Wilken, BS, Jason R Kovac, MD, and Larry I Lipshultz, MD. Rev Urol. 2014; 16(3): 105–109. PMCID: PMC4191629 × ⁶ 6. Influence of Androgen Receptor CAG Polymorphism on Sexual Function Recovery after Testosterone Therapy in Late-Onset Hypogonadism. Tirabassi G1, Corona G, Biagioli A, Buldreghini E, Delli Muti N, Maggi M, Balercia G. J Sex Med. 2014 Dec 2. doi: 10.1111/jsm.12790. [Epub ahead of print] ×

The leakiness from too much estrogen and not enough testosterone may cause your penis to behave like more like a balloon with a hole in it than the piece of steel you grew up with. And research has shown that men with venous leak type erectile dysfunction have higher estrogen levels. ¹¹ 11. Testosterone and Erectile Function: From Basic Research to a New Clinical Paradigm for Managing Men with Androgen Insufficiency and Erectile Dysfunction. Abdulmaged Traish, Irwin Goldstein, Noel Kimb. Eur Urol. 2007 July; 52(1): 54–70. ×

There is another way you can get more “estrogen” in your body without making it yourself. Estrogen-like chemicals are all around you. One common source is plastic containing Bisphenol A (BPA). BPA is in most plastics like water bottles and even some dental sealants used to fill cavities. To learn more about BPA in your environment check out the Mayo Clinic’s website.

In a study where they gave BPA to rats the researchers found BPA was not good for rat erections suggesting BPA is likely not good for your erections either. ⁹ 9. Oral Bisphenol A (BPA) given to rats at moderate doses is associated with erectile dysfunction, cavernosal lipofibrosis and alterations of global gene transcription. Kovanecz I1, Gelfand R2, Masouminia M3, Gharib S3, Segura D3, Vernet D2, Rajfer J1, Li DK4, Kannan K5, Gonzalez-Cadavid NF6. Int J Impot Res. 2014 Mar-Apr;26(2):67-75. doi: 10.1038/ijir.2013.37. Epub 2013 Dec 5. × Further research done on rats and rabbits showed that even when given testosterone the negative effects rabbits experienced on their erections from high estrogen levels didn’t improve. This suggests that too much estrogen decreases the potential benefits of testosterone replacement therapy. The rabbits had better erections when estrogen levels reduced and testosterone levels were increased. ¹⁰ 10. Limited effect of testosterone treatment for erectile dysfunction caused by high-estrogen levels in rats. T Kataoka, Y Hotta, M Ohno, Y Maeda and K Kimura. International Journal of Impotence Research 25, 201-205 (November/December 2013) | doi:10.1038/ijir.2013.21 ×

Please keep in mind that even if testosterone therapy will improve your erectile dysfunction it is unlikely to be a quick fix. Some research has shown that men on testosterone replacement may not notice any improvements in their erections for up to 12 months (or never). Thus, we try to take a holistic approach when evaluating your erection problem to find the most effective treatment and also make sure we are working to identify the cause of you erection problems.

Men with obesity are at increased risk for erectile dysfunction as well as low testosterone. Long term treatment using testosterone therapy has been shown to help with weight loss and improve erectile dysfunction, as well quality of life. ³ 3. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. Yassin DJ1, Doros G, Hammerer PG, Yassin AA. J Sex Med. 2014 Jun;11(6):1567-76. doi: 10.1111/jsm.12523. Epub 2014 Apr 8. ×

Please review the questions below to help you self assess your ED. We will have you answer these same questions when you come to your initial visit at one of our clinics. Also, below the following questionnaire is a list of potential causes of ED which we will discuss when you come to your initial visit. You may also want to review our low t quiz.

The International Index of Erectile Function Questionnaire

1. How do you rate your confidence that you could get and keep an erection?

1 Very low
2 Low
3 Moderate
4 High
5 Very high

2. When you have erections with sexual stimulation, how often are your erections hard enough for penetration?

1 Almost never or never
2 A few times
3 Sometimes
4 Most times
5 Almost always or always

3. During sexual intercourse, how often are you able to maintain your erection after you have penetrated your partner?

1 Almost never or never
2 A few times
3 Sometimes
4 Most times
5 Almost always or always

4. During sexual intercourse, how difficult is it to maintain your erection to completion of intercourse?

1 Extremely difficult
2 Very difficult
3 Difficult
4 Slightly difficult
5 Not difficult

5. When you attempt sexual intercourse, how often is it satisfactory for you?

1 Almost never or never
2 A few times
3 Sometimes
4 Most times
5 Almost always or always

Add you score above to get your total score to see which of the following categories you fall in:

1-7: Severe ED
8-11: Moderate ED
12-16: Mild-moderate ED
17-21: Mild ED
22-25: No ED

Causes of Erectile Dysfunction

The following list ¹² 12. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. K. Hatzimouratidis (chair), I. Eardley, F. Giuliano, D. Hatzichristou, I. Moncada, A. Salonia, Y. Vardi, E. Wespes. Eur Urol. 2010 May;57(5):804-14. doi: 10.1016/j.eururo.2010.02.020. Epub 2010 Feb 20. × is long but these are potential causes of erectile dysfunction that we work to rule out when helping a patient with erectile dysfunction. Several of these conditions are rare but are important to consider as potential causes. Most of these conditions can be treated medically and correcting the cause of the problem may lead to significant improvements in your erections.

Hormonal

– Low testosterone
– Hyperprolactinemia
– Hyper- and hypothyroidism
– Hyper- and hypocortisolism (Cushing’s disease etc.)

Vasculogenic

– Cardiovascular disease
– Hypertension
– Diabetes mellitus
– Hyperlipidaemia
– Smoking
– Major surgery (RP) or radiotherapy (pelvis or retroperitoneum)

Neurogenic

– Degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy etc.)
– Spinal cord trauma or diseases
– Stroke
– Central nervous system tumours
– Type 1 and 2 diabetes mellitus
– Chronic renal failure
– Polyneuropathy
– Surgery (pelvis or retroperitoneum, radical prostatectomy, colorectal surgery, etc.)

Anatomical or Structural

– Hypospadias, epispedias
– Micropenis
– Congenital curvature of the penis
– Peyronie’s disease

Drug-induced

– Antihypertensives (diuretics are the most common medication causing ED)
– Antidepressants (selective serotonin reuptake inhibitors, tricyclics)
– Antipsychotics (incl. neuroleptics)
– Antiandrogens; GnRH analogues and antagonists
– Recreational drugs (alcohol, heroin, cocaine, marijuana, methadone)

Psychogenic

– Generalised type (e.g., lack of arousability and disorders of sexual intimacy)
– Situational type (e.g., partner-related, performance-related issues or due to distress)

Trauma

– Penile fracture

If your primary care doctor is unaware you are having problems with erectile dysfunction it is important to tell them. Erectile dysfunction is associated with increased risk of cardiovascular disease and you may be at increased risk of heart attack or stroke.