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Erectile Dysfunction: 5 Tips When Pills Don't Work

Confident man
March 12, 2020

By Randy Dotinga

Men around the world spend billions of dollars each year on erectile dysfunction drugs like Viagra, Cialis and Levitra, but the medications aren’t perfect. They fail in an estimated 30%-40% of guys, and the side effects and high cost can be turn-offs too.

Fortunately, there are alternatives. We asked three men’s health experts – Alexander W. Pastuszak, MD, PhD, urologist and assistant professor at University of Utah, Bradley Anawalt, MD, endocrinologist and chief of medicine at the University of Washington, and Hunter Wessells, MD, chair of urology at the University of Washington – to walk us through the options. Here’s what they had to say.

Stay away from supplements.

“Men should be wary of these. Most don’t have great evidence that they work, and there are a lot of formulations with false claims. The natural substances in supplements can be dangerous, and they may contain drugs which can cause side effects. Since supplements are not regulated, some have toxic or inedible substances in them, like plaster.” – Alexander W. Pastuszak, MD, PhD

Be wary of testosterone therapy.

 “Testosterone therapy is only effective for men with testosterone deficiency, and any effect on sexual function for men with normal production of testosterone is due to a placebo effect. Testosterone therapy will improve sexual function within 3-4 months if it is going to have any effect, but be careful to get testosterone prescribed to you and not from an Internet website, where the purity of the drug is uncertain. A trial of testosterone to determine effectiveness on male sexual function should be limited to 6 months and then discontinued if ineffective.” – Bradley Anawalt, MD

A penis pump might make a difference.

“Penis pumps are a reasonable treatment option and are available without a prescription. They result in a good erection, but they require a hard elastic band be placed at the base of the penis to maintain an erection, and the erection is somewhat floppy. Most guys don’t love pumps because of this. They can also cause bruising, and orgasms feel weird because of the band.” – Alexander W. Pastuszak, MD, PhD

Penis injections of ED drugs might sound worse than they actually are.

 “Almost all men can get past the needle [via injections of medication into the penis]. Men often get over their concerns when they have a first trial injection, as well as when they realize just how effective the medication is. The pros are reliable, reproducible and rigid erections for most men – 80 percent– and long-lasting erections that typically last 30 minutes or more. The cons are pain, which men get used to, plus potential curvature of the penis, the formation of scar nodules, a prolonged erection, and lack of spontaneity.” – Hunter Wessells, MD

Penis implants may be a permanent solution.

“Implants are probably the most effective treatment for erectile dysfunction as they offer highly effective, spontaneous and hard erections on demand for patients. While implants are mechanical devices and can fail, they really are a great treatment choice. Almost all men are candidates, although some can’t tolerate surgery or anesthesia, and most insurance covers implants. There are always risks to any procedure. In the case of implants, there is typically postoperative pain. The other major risks of implants include failure of the device and infection, both of which require re-operation to either repair or replace the device. Men who have erectile function that can be enhanced with medications or injections should know that once you have an implant, you cannot have natural erections ever again and will always be dependent on the implant.” – Alexander W. Pastuszak, MD, PhD

Bottom line: Thanks to the variety and effectiveness of non-drug options, there’s reason to be optimistic. Dr. Pastuszak says, “I tell my patients that depending on how far they’re willing to go, I can get them back to having good erections almost 100 percent of the time.”

Editor’s note: Alexander Pastuszak, MD, PhD, is the Chief Clinical Officer for Vault Health, which provides male testosterone therapy.

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