Summary:

1.) Sexual health is vital for good health yet more than half of men complain of some form of erectile dysfunction.

2.) Most erectile dysfunction is due to poor circulation or nerve damage and may be a sign of heart disease, diabetes, or other disease.

3.) Current ED treatment provides only temporary help and does not address the underlying tissue degeneration and systemic problems that led to it.

4.) New advancement in regenerative medicine are now providing long lasting treatments that address the underlying problems with the tissue

5.) PRP Injections (The P-shot) and Extracorporeal Shockwave Therapy (Linear Focused) provide an 89% success rate in improving erectile dysfunction to satisfactory and functional levels. For men with no dysfunction, they have achieved their goals in erection quality and performance enhancement.

6.) When these cutting edge treatments are combined with health optimization, hormone therapy, and lifestyle changes, the chances of beating ED are very high.

Sexual Health is Optimal Health

In my practice, I have a lot of men looking to optimize their health. One of the most frequent complaints I get is declining libido and declining erectile function. Sexual health is important for all aspects of health. There is a long list of health benefits that come from frequent healthy sex. It decreases stress, depression, pain, and risk of cancer. Having sex twice weekly even decreases your risk of having a heart attack by 50%. It improves your sense of well-being, immune function, bladder health, self-esteem, sleep quality, and even your longevity.

Unfortunately, this frequency of intercourse is not achievable for more than half of the men in America due to poor health and erectile dysfunction. Today we will discuss the most common causes of ED and poor sexual health as well as their optimal treatment and prevention strategies.

How an Erection Works

To begin, we must first understand of the basics how an erection works:

1.) Testosterone increase production of dopamine in the brain

2.) Dopamine stimulates sexual desire (libido)

3.) Desire (hopefully) leads to visual and/or contact stimulus

4.) Nerve signals increase blood flow (Cholinergic Innervation).

5.) Blood fills the spongy tissue in the penis. These structures are wrapped in a thick tissue that holds the blood in.

6.) The sudden increase in pressure closes off the veins that normally drain the blood, this cause engorgement and stiffness (called tumescence).

7.) Ejaculation is mediated by an adrenaline rush which signals the testes to release their ejaculate.

8.) After ejaculation, the nerves are over stimulated and go into a “refractory state” giving the tissue some mandatory down time and allowing blood to flow out of the penis due to a sudden drop in blood pressure.

As you can see, there are plenty of places in the cycle where things can go wrong. However, 80% of erectile dysfunction vasculogenic, meaning that poor blood flow is the culprit. Of the remaining 20%, a large portion of that is due to low testosterone. Fortunately, both if these causes are now easily treatable.

Other causes of failure include psychogenic ED (in your head too much), performance anxiety, and pornography/sex addiction disorders. These have there own unique treatment approaches, but are also helped by treating the physical aspects of ED. For example, if someone has performance anxiety due the the fact they lost their erection during their last attempt, this can make their ED go from mild to severe. However, treating the underlying cause of the ED, poor blood flow in this case, can restore confidence and resolve the psychological issues.

When sexual health fails, relationships and self-image suffer

Unfortunately, when a man suffers ED he can also suffer from serious complications. Often time a man will become depressed, lose interest in sex, and lead their partners to believe they are no longer attracted to them. Sometimes partners jump to this conclusion very quickly and exacerbate the problem with hurtful assumptions and accusations. It is best to get treatment early and aggressively at the first sign of waning sexual function.

The Importance of a Comprehensive Work-up

In my practice, I never just treat ED symptomatically with pills like Cialis and Viagra. I believe that ED is a sign of failing health (double cardio risk when ED is present) and I provide each patient with a comprehensive work-up that includes:

1.) A full history and physical

2.) Complete blood work to evaluate heart health, hormone status, nutritional status, inflammation, and blood sugar control.

3.) Ultrasound imaging of the carotid arteries to screen for clogged arteries and plaques.

4.) Evaluation of lifestyle habits and environmental factors.

After a thorough workup I will frequently identify some deficiencies and seek to correct those prior to starting regenerative therapies, which I will discuss below. Common problems I identify are as follows:

1.) Low testosterone

2.) Low vitamin D

3.) Low B vitamins

4.) High cholesterol and triglycerides

5.) Pre-diabetes

6.) Obesity

7.) Hypertension

8.) Excess stress and poor sleep (50+ hour work weeks, relationship problems, financial stress, trauma).

9.) Sedentary lifestyles

10.) Toxicity (alcohol, tobacco, drugs, too many prescription meds, bad food).

Identifying and treating these things provides your best chance for success for not only curing your ED, but will also revolutionize your health and impact all aspects of your life. Relationships will improve, your brain will come to life, and you could experience a vitality that was probably long forgotten.

Once these causative factors have been addressed, it is time to get to business and regenerate the damaged erectile tissue. This is some new and exciting stuff that I am very pleased to me able to offer my patients. There are two stars of the ED treatment world, GAINSWave and the Alma Duo..

GAINSWave & the Duo

I was among the first providers in the nation to be a member of the pioneering GAINSWave group. GAINSWave is a relatively new technology that uses low frequency high amplitude sound waves to break up gunk in the arteries that deliver blood to the genitals. It is a small handheld device that is placed in the tissue in the same way an ultrasound would be done. However, unlike ultrasound, the ESWT treatment creates and audible sound and a physical sensation that is readily apparent, but not painful because a numbing cream is applied prior to treatment. There are a ton of new studies that demonstrate the efficacy of ESWT for treatment of ED, even ED that does not respond to strong drugs like Cialis or Viagra.

While I still use the skill and techniques learned from the founder of GAINSWave, Dr. Richard Gaines, I strive for even better results by using a more powerful shockwave device, the DUO. This device is approximately 10 times more powerful than the radial shockwave devices used by the majority of providers in the Puget Sound area. The DUO utilizes linear-focused low intensity extracorporeal shockwave therapy (LI-ESWT). Because the energy is more focused in passes through the skin to affect the blood vessel with less disruption of the tissues, and thus less pain. No numbing cream is needed when using linear-focused technology.

This is a similar technology to lithotripsy, a standard treatment for breaking up kidney stones. In this case though, the energy output has been lowered to make it safe for sensitive erectile tissue but still strong enough to break up plaque in the arteries and stimulate regeneration of worn out tissue. That’s right, ESWT not only breaks up gunk, it also simulates the production of stem cells and growth factors that repair and rejuvenate damages tissue. Here is slide of erectile tissue treated with ESWT. The top slides were treated with sound, but not ESWT, as a control. The bottom slides are the treatment group, and those little white dots are stems cells coming in to repair and rebuild! This is very exciting and conclusive proof of the potential for ESWT to regenerate aged and damaged erectile tissue.

The GAINWave method utilizes ESWT as the primary intervention. However, the founder, Dr. Richard Gaines, and I agree that an integrative treatment approach works best. Providers that offer only ESWT as a treatment for ED are not providing their patients with the best chances of success. Other treatments that I incorporate are the P-Shot, vacuum pumps, custom compounded PDE-5 inhibitors (like Viagra), nutritional therapy, exercise therapy, and lifestyle coaching. I will explain a little about each of those below.

P-Shot

The P-shot, or Priapus Shot, is an injection of Platelet Rich Plasma (PRP) into the erectile tissue. In this procedure your own 60 ml of your blood is extracted and processed to concentrate the platelets and growth factors into about 10 ml. This is then injected along the sides and at the tip of the penis. This stimulates a very strong regenerative effect and combines beautifully with the GAINSWave treatment. I am a certified member of the Cellular Medicine Association, which ensures proper training and use of FDA approved equipment for all its members.

More info on the P-shot here

Vacuum Pumps

Vacuum pumps (a.k.a, penis pumps) have been used for decades to expand erectile tissue and assist in achieving an erection. They are not a good strategy by themselves, but when combined with regenerative therapies like GAINSWave and the P-shot, they serve as a valuable tool to ensure all erectile tissue is being treated and expanded to optimal size as it goes through the regenerative process.

PDE-5 Inhibitors

This class of drugs is invaluable in the treatment of ED. They work by inhibiting the enzyme that constricts blood vessels. This allows the blood vessels to enlarge so that, even if they have been narrowed by cardiovascular disease, it still allows more blood to flow through. These drugs work well, and are useful in combination with regenerative medicine, but don’t treat the underlying problems. They are also expensive and can take too long to work, killing the mood. I like to have these medications compounded into both fast acting and long lasting forms, in a sublingual tablet instead of a pill. This gives me a better product at a lower price to offer my patients. My goal is to take someone who can’t get a good erection without Viagra or Cialis (both PDE-5 inhibitors) and get them to a point that they don’t need them. However, some men can’t get an erection even with PDE-5 inhibitors. My goal for these patients to use GAINSWave, P-Shot, and functional medicine to get them good quality erections with a PDE-5 inhibitor. I would consider this a success; especially given the alternative would be Quad-Mix injections just prior to sex or an internal pump implant as both are very unpleasant options.

Nutritional Therapy

I can’t even begin to count the number of men I have seen return to good health by just cutting the junk out of their diet and eating some vegetables. As a general rule, half of what you eat every day should be veggies or fruit. Along with identifying the obvious bad players in your diet, it is important to also learn what foods are the best fuel for your body. I also always do blood tests to screen for nutritional deficiencies. Even if you eat very healthy, there are some deficiencies that are present because of absorption issues, genetic issues, or environmental factors. One example is vitamin D. For those of us in the northwest the only way to get enough is to supplement. If you live west of the Cascades and aren’t supplementing I guarantee you are deficient.

Exercise Therapy

We all know moving helps our circulation. We also know that our sedentary lifestyles are crippling

our health. However, many men don’t know where to start or how to incorporate exercise into their busy lifestyles. What exercises do you do to lose weight? Which ones are best for building strength, which are best for boosting testosterone? I give each of my patients a custom exercise prescription based on what they can do, what their goals are, and what their health needs are. When in doubt, do deadlifts.

Lifestyle

Numerous studies I’ve read suggest that the biggest reason for the epidemic levels or low testosterone among our men is chronic stress. We work too much, sit too much, sleep too little, and have sex too infrequently. Stress stimulates the production of the stress hormone cortisol. This hormone is on the same pathway as testosterone, so if you are making cortisol, you are by default making less testosterone. Here’s a simplified map of the production pathway, you can see you can make only one or the other:

Let’s wrap it up

ED is no joke. It is a sign of potential serious systemic problems. It also has a tremendous impact on your overall sense of health, well-being, and self-esteem. It can cripple relationships and insidiously undermine your life goals by getting into your head. I take it seriously and have devoted my life to the study of optimal health and wellness. I feel the science of ED treatment and prevention has finally caught up with demand and I am proud to offer an integrative and comprehensive treatment plan to my patients that incorporates all of the modern technology that has proven effective for the treatment of ED. If you have taken the time to read this I hope you will take the next step and take action. You will never regret such an important investment in your health and wellness.

If you are struggling with ED or would just like to discuss an individualized treatment plan with me, please schedule your free consult by using our contact form

Erectile Dysfunction 101