Common questions
Erectile Dysfunction Treatment FAQ
Can erectile dysfunction be a sign of heart disease?
It can. The American Urological Association advises that men be counseled that ED is a risk marker for underlying cardiovascular disease and other health conditions. That is why treatment starts with a medical history, examination and selected lab testing rather than a prescription alone.
Can I take ED medication if I use nitroglycerin or another nitrate?
No. Sildenafil and tadalafil labeling states they are contraindicated with any form of organic nitrate, and with guanylate cyclase stimulators such as riociguat. The combination can cause a dangerous drop in blood pressure. Tell your provider about every medication you take, including ones used only occasionally.
What is the difference between alprostadil, Bimix and Trimix?
All three are injected into the side of the penis to produce an erection. Alprostadil is available as FDA-approved products such as CAVERJECT and EDEX. Bimix (papaverine and phentolamine) and Trimix (papaverine, phentolamine and alprostadil) are compounded preparations: they are not FDA-approved, and a prescriber chooses them only when a patient-specific clinical reason supports it.
Why does injection therapy start in the office?
The AUA guideline says an in-office injection test should be performed for men considering injection therapy, and alprostadil labeling directs that the first injections be given in the provider's office. The test visit sets a safe starting dose, teaches technique and checks for a prolonged erection before you inject at home.
Can I get ED treatment by telehealth?
Oral medication may be prescribed through a telehealth visit for patients physically located in Texas, North Carolina or South Carolina, after an evaluation and when clinically appropriate. Injection therapy begins with an in-office visit. Labs or an in-person examination may be required.
Does low testosterone cause ED?
Sometimes it contributes, but ED has many causes, including blood-vessel, nerve, medication, psychological and relationship factors. The AUA recommends measuring morning total testosterone in men with ED, and notes that for men with confirmed testosterone deficiency, oral ED medication may work better when the deficiency is also treated.
Do shockwave therapy and PRP work for ED?
Both are offered here, and both are still being studied. Neither is FDA-approved to treat ED. The AUA considers low-intensity shockwave investigational and PRP experimental. European urology guidelines give shockwave a weak recommendation for men with mild blood-flow-related ED, and say the evidence for PRP is not yet enough to recommend it. We explain this before you decide, and we do not promise results.
Is compounded ED medication FDA-approved?
No. Compounded drugs are not FDA-approved and are not reviewed by the FDA for safety, effectiveness or quality. FDA guidance also states that a lower price on its own does not justify compounding a copy of a commercially available drug; the prescriber must identify a specific difference that matters for that patient.
