Erectile Dysfunction is a common male problem. As many as 52% of men experience ED, 25% of men less than 40, 40% men aged 40, 70% men aged 70 and probably underreported due to embarrassment.
“This has profound psychological repercussions for most men,” Dr. Birken said. “But there are many options available.
Lifestyle changes contribute to this condition. Unhealthy habits include excessive alcohol Intake, smoking, obesity, excess intake of gluten or carbohydrates, as well as lack of exercise. Diseases and conditions include diabetes, metabolic disorder or insulin resistance, elevated lipids, inflammatory diet, and lack of adequate anti-oxidants.
Medications can contribute as well:
• Antidepressants
• Tricyclic antidepressants, including amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor)
• Monoamine oxidase inhibitors (MAOIs) including phenelzine (Nardil) and tranylcypromine (Parnate)
• Antipsychotic medications, including thioridazine (Mellaril), thiothixene (Navane), and haloperidol (Haldol)
• Anti-mania medications such as lithium carbonate (Eskalith, Lithobid)
• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)
• Anti-hypertensive medications
• Diuretics including spironolactone (Aldactone) and the thiazides (Diuril, Naturetin, and others)
• Centrally acting agents, including methyldopa (Aldomet) and reserpine (Serpasil, Raudixin)
• a-Adrenergic blockers, including prazosin, (Minipress) and terazosin (Hytrin)
• b-adrenergic (beta) blockers, including propranolol
• Hormone blockers include Leuprolide (Lupron) and Goserelin (Zoladex)
Many over the counter medications
• Anti-histamines
• Decongestants
Treatment Recommendations:
Treat Insulin Resistance
Insulin resistance states are characterized by defective vascular nitrous oxide production and impaired insulin-induced vasodilation, both of which are likely to cause ED. Diagnosing and treating insulin resistance should be part of the initial management plan for ED which includes diet changes, metformin, GLP-RA drugs like Victoza, as well as the supplement berberine.
Hyperlipidemia – High cholesterol and low HDL. Rather then statin drugs, diet and exercise and change lower lipid levels.
Mediterranean Diet – reduces chronic inflammation and improves nitrous oxide
Arterosil and anti-oxidants also increase nitrous oxide.
Herbal Remedies: Panax Ginseng • RhodiolaRosea • DHEA • L-arginine • Yohimbe • Cordyceps
Pumps – rings and other mechanical devices
Testosterone – Testosterone treatment is associated with increased sexual desire as well increased erectile function. Men who received testosterone reported better sexual function, including activity, desire, and erectile function, than those who received placebo
Growth Hormone Peptides – include Human Growth Hormone, sermorelin, and ibutamoren.
PDE5 – Phosphodiesterase Type 5 Inhibitors (PDE-5s) – Results from recent studies suggest that regular treatment with a PDE5 inhibitor may lead to enhanced erectile function (EF) beyond that observed with on-demand usage. This includes daily use of Cialis or the generic tadalafil
Low intensity Shock Wave Therapy – Activates penile stem cells, enhances angio-neogenesis and neuro-neogenesis with improved erectile function. Dr. Birken offers the simple and painless shockwave treatment.
PRP/Stem Cells/Exosomes (P-Shot) – Improved erectile function along with increase penile girth. Dr. Birken is certified in this procedure. Unfortunately, his medical liability carrier will not cover this service. However, Dr. Birken has other physicians that he can refer patients to if interested.
PT-141 (Bremelanotide) – PT-141 exerts effect on sexual function via action on receptors in the central nervous system. The Woodlands Compounding Pharmacy offers this peptide as a nasal spray.
Trimix – TriMix injections are a mixture of 3 drugs that provide an effective, low cost treatment for men struggling with erectile dysfunction. It is an alternative treatment for men who cannot take, have not had good results with, or experience severe side effects from PDE5 Inhibitor
Erectile Dysfunction Summary
Treatments available: • Lifestyle changes: Stop Smoking • Increase Exercise • Reduce Obesity • Improve emotional state • Depression • Anxiety of Sexual Performance • Relationship Issues • Eliminate medications known to cause • Improve physiological and metabolic impediments to ED • Insulin resistance and Diabetes • Dyslipidemia and high cholesterol • Anti-inflammatory diet • Nitric Oxide enhancement • Herbal Remedies • Optimize Testosterone • Pumps, rings and other mechanical devices • Phosphodiesterase 5 inhibitors • Viagra, Levitra, Cialis, Stendra • Pulsed Wave Therapy • Priapus Shot • Bremelanotide (Pt-141) • Tri-Mix
