Erectile Dysfunction (ED)
By William B. Lovett, MD
Many men suffer from Erectile Dysfunction (ED), the inability to either have erections or have weak erections. There are many causes of ED and the treatment must be a planned execution of treatments to help resolve the issue, which can be resolved in 95% of the cases. The common denominator of ED is lack of adequate blood flow to the penis! Even though there are pharmaceutical approaches (Viagra and Cialis like drugs), the fact is, in most cases these products will not work if the number one cause of ED is not addressed – low Testosterone! Most physicians will treat their patients with prescription medications in hope to improving the ED problems they are experiencing. However, if you don’t treat the originating cause these medications give minor or no benefit to their patients.
In all cases, the first question you should know the answer to is – what your Testosterone Level? Most physicians will measure a Total Testosterone (TT) which is not the correct number to measure. The TT is the protein bound non-active form of Testosterone. The number which should be measured is the Free Testosterone (FT), which is the protein unbound active form. We find when giving hormone replacement from an outside source (not from you own testicles), the level of FT necessary to get a response is usually between 30 – 45.*
If after you achieve a good level of FT, where you are starting feel better overall but still have ED, then a trial of once a day Cialis is started. If no little or no improvement then we suggest a start of Viagra an hour before intercourse. We also use Oxytocin commonly to see if we divert more blood flow to the penis. (It also works well in women to divert blood flow to the Clitoris.)
There is now a more novel approach to ED. Treatment that has been in other countries and was not assessable to physicians in the United States. This treatment focuses on increasing blood flow to the penis through Neogenesis. This approach is directed towards increasing the number of blood vessels pushing blood into the penis. It is the increase blood flow in the first place that causes erections to happen. We create this by injecting growth factor into the penis. Blood Commonly we add stem cells. Benefit is usually felt with 2 weeks. This is a very successful treatment in achieving erections with ED.