Seattle Erectile Dysfunction Doctor: Key Strategies for Treating Erectile Dysfunction
Finding the right doctor - and the right approach - for erectile dysfunction concerns is critical to ensuring ED is properly treated. Because erectile dysfunction can be caused by a number of factors, including declining vascular function, corresponding diseases, reaction to medication, other physical ailments, and emotional issues or lifestyle choices, we believe it’s important to take a comprehensive approach. With this in mind, once the underlying causes of a patient’s erectile dysfunction are understood, there are a number of strategies to treat ED.
Topics Covered in This Article:
Obstacles - we discuss health issues that cause or worsen ED
Testosterone - What is its role in erectile dysfunction? Does replacing it help?
Medications - What are the gold-standard medications for treating erectile dysfunction?
Regenerative Treatments - What can be done to improve the capillary density and blood vessels’ health as you age? A Customized Treatment Plan - KPM works with patients to develop a tailored plan to address the underlying origins of declining sexual health.
Obstacle Removal
Improving cardiovascular health - the healthier the heart, the better the blood flow, the more consistent and reliable the erection. Vascular health and disease are major contributors to erectile dysfunction. Progressive anthrosclerosis (damage and plaque build up to the lining of the walls of the vessels) and endothelial dysfunction reduce blood flow to the penis. Diseased vessels cannot dilate, fill, and trap blood effectively to cause an erection. Vascular disease is the primary driver of age-related ED, and addressing this is paramount.
Obesity - obesity causes inflammatory, metabolic, and hormonal disruptions that all impact the health of the blood vessels and erections. Obesity is associated with lower testosterone levels, higher estrogen levels, and insulin resistance. Also, obesity often contributes to physical limitations and reduces physical activity. Across studies, men with obesity had a 30-90% chance of having ED. The Massachussets Men’s Aging Study found that a man with a 42-inch waist was 50% more likely to have ED than a man with a 32-inch waist.
Diabetes and Pre-diabetes - these are independent risk factors for ED. Erectile dysfunction occurs in 75% of men who have type 2 diabetes. Diabetes contributes to disease of the blood vessels, nerves, and endocrine system.
Reducing medications where possible - common prescriptions such as some blood pressure medications (older beta-blockers, thiazide diuretics like hydrochlorothiazide) and depression medications (specifically SSRIs), anxiety medications (i.e., Xanax), hair loss medications/prostate medications (i.e., Finasteride ), and opioid medications can be major offenders.
Recreational drugs - alcohol and marijuana, especially chronic use, can hurt erections.
Lack of exercise - not exercising accelerates vascular decline and disease. 160 minutes of moderate to intense cardiovascular exercise each week has been shown to improve erectile function. Elevate your heart rate - sweat - get out of breath. Walking around the block won’t cut it.
Standard American diet - highly processed foods participate in metabolic dysfunction, cardiovascular disease, and obesity. While not glamorous, attention to a high-quality diet is paramount. Good nutrition will help you lose weight, reduce inflammation, and improve testosterone levels and cardiovascular health.
Hypothyroidism - this is commonly missed in men and can be a contributing factor to ED.
KPM MEDICAL WEIGHT LOSS AND HORMONE OPTIMIZATION PROGRAMS CAN IMPROVE YOUR SEXUAL PERFORMANCE.
2. Testosterone Replacement Considerations
Testosterone does play a crucial role in erections through multiple mechanisms, though the relationship is complex:
Direct Effects of Testosterone on Erections
Nitric Oxide Production - Testosterone upregulates NO, which is essential for initiating and maintaining erections, and enhances the effects of medications like Viagra and Cialis.
Penile Tissue Maintenance - Testosterone helps preserve smooth muscle in the corpus cavernosum, maintain the structural integrity of penile tissue, and helps with the health and function of endothelial cells that line blood vessels.
Neural Signaling - Testosterone supports the proper function of nerve pathways involved in erections and maintains the sensitivity of penile tissue.
Indirect Effects of Testosterone on Erections
Libido/Sexual Desire - Low testosterone equals low desire and can lead to reduced arousal and erectile response.
Energy & Mood - Low testosterone often contributes low energy and mood - not great for erections
Body Composition - Adequate testosterone improves muscle-to-fat ratio and reduces metabolic dysfunction
Patients experiencing ED may simultaneously experience symptoms of low testosterone including:
Fatigue
Loss of drive and motivation
The feeling of having “passed your peak”
Low desire or libido
Difficulty reaching orgasm or ejaculating
Loss of morning or nocturnal erections
Sleep challenges
Body composition changes
Mood changes
Joint aches and pain
Night sweats
Loss of muscle mass
Low testosterone has been associated with ED and should be addressed in the appropriate patient. It’s important to note, however, that ED is a multi-variable condition, and testosterone replacement on its own is not always the cure-all.
Visit our Testosterone Replacement Therapy page to learn more.
3. Medication
PDE5 Inhibitors
These medications, including Viagra, Cialis, Levitra, and Stendra, are the standard initial intervention for ED.
PDE5 inhibitors can often be helpful by perpetuating the effects of nitric oxide in the tissue - encouraging blood vessels and tissues in the penis to relax and engorge with blood longer.
PDE5 inhibitors do not cause an erection alone - they still require physical and mental arousal.
PDE5 inhibitors are typically taken orally 1-2 hours before sexual activity and, depending on the medication, can last between 12-36 hours.
Intracavernosal Injections
KPM works with patients to understand the nuances and strategies of taking oral medications. For more challenging cases, we might discuss “super-charged” ED meds such as intracavernosal injectables like Alprostadil and Trimex.
Trimix - this is an intracavernous injection which is self-injected directly into the penis. This is often considered once oral medications have become ineffective. Men are taught to administer this medication with a small insulin needle at the base of the penis. It is mostly painless and can be very effective, even for those patients for whom oral medications no longer work. You can learn more about Trimix in our Understanding Trimix and Intracavernosal Injections blog.
Alprostadil (Caverject, EDEX) - this is a medication that is delivered intra-eurethrally or intracavernosally via injection.
A note on supplements and nitric oxide
The ability to generate nitric oxide becomes more impaired with age. As a result, overall cardiovascular health - and sexual function - can be impacted. There are some well-evidenced studies suggesting that boosting nitric oxide can improve these conditions, as increased nitric oxide relaxes blood vessels, promoting arterial dilation and increased blood flow.
There are several nitric oxide-boosting supplements available, including citrulline, arguline, beetroot, and hawthorne. KPM often recommends Neo40, a third-party-tested natural supplement that stimulates the endothelial lining of the penile arteries to produce more nitric oxide, resulting in improved blood flow and perfusion to the vascular system. This supplement is backed by eleven published and peer-reviewed clinical trials and medical industry support, which is atypical in the world of supplements.
Premature Ejaculation
There are a number of medications that specifically address premature ejaculation. Please review our Premature Ejaculation - Overview & Treatment Options blog post for more information.
4. Regenerative Treatments
Because most ED cases are caused by a decline in vascular function, employing treatments to help improve the number and function of blood vessels is highly effective. Three regenerative options consistently lead to improvement in erectile function.
Low-Intensity Shockwave Therapy (AKA GAINSWave Therapy)
Low-intensity shock wave therapy (LI-SWT) improves erectile dysfunction through several mechanisms:
Neovascularization (Angiogenesis) - The shock waves stimulate the formation of new blood vessels in penile tissue by triggering the release of growth factors like VEGF (Vascular Endothelial Growth Factor), improving blood flow to the penis.
Endothelial Cell Regeneration - LI-SWT helps repair damaged endothelial cells that line blood vessels, improving their function and nitric oxide production, which is crucial for vasodilation during erections.
Stem Cell Activation - The therapy activates dormant stem cells in penile tissue, repairing damaged structures and promoting tissue regeneration.
Nerve Regeneration - Evidence suggests that shock waves may help regenerate nerve fibers, potentially improving neural signaling and penile sensitivity.
Reduced Inflammation - LI-SWT can decrease inflammatory responses in penile tissue, reducing scarring and fibrosis that might impair erectile function.
Breaking Down Plaques - In some cases, LI-SWT may help break down micro-plaques in penile blood vessels, improving blood flow.
The treatment typically involves multiple sessions (usually 6-12) over several weeks, with acoustic waves delivered through a wand-like device applied to different areas of the penis. It's particularly effective for vasculogenic ED and represents a non-invasive, drug-free approach with minimal side effects.
What Does the Research Say?
Multiple randomized controlled trials have demonstrated statistically significant improvements in erectile function scores (typically measured by the International Index of Erectile Function (IIEF-EF) Scale.
Meta-analyses indicate that low-intensity shockwave therapy provides approximately a 4 to 6-point improvement on the IIEF-EF scale, representing a clinically meaningful change.
Most studies show 60-70% of patients experience some improvement, though complete resolution of ED is less common
Best Candidates:
Most effective for mild to moderate vasculogenic ED
Particularly beneficial for men with ED related to cardiovascular risk factors
Works best in men who still have some response to PDE5 inhibitors (like Viagra)
Less effective in severe ED cases, especially with significant structural damage
P-Shot
The Priapus Shot, or P-Shot, uses platelet-rich plasma from your blood to improve:
Erectile function
Penile sensation
Penile health
Stamina
Erections (they will become stronger and more frequent)
How Does PRP (P-Shot) Work?
The P-Shot involves separating the growth factors in your blood and re-injecting your super-charged plasma back into your body.
Growth Factor Release - platelets contain numerous growth factors (PDGF, VEGF, EGF, FGF, TGF-B). When injected, platelets release these factors, triggering local tissue regeneration and angiogenesis.
Stem Cell Activation - PRP mobilizes local stem cells, accelerating tissue regeneration and forming new vascular networks.
Improved Blood Flow - improves microcirculation to the capillaries in the penis and enhnaces vascular capillary density.
Neural Regeneration - some evidence shows that PRP may support nerve repair and regeneration, leading to more sensitivity.
Please visit our P-Shot page for more information.
Penis Pump (Vacuum Device)
Our clinic coaches patients on incorporating a vacuum device as an exercise for improving ED. When used correctly, vacuum devices can improve vascularity and are an excellent follow-up exercise to treatments such as shockwave therapy and the P-Shot. For instance, following the P-Shot, we recommend using the vacuum device for ten minutes for two weeks. You can learn more on our Penis Pumps for Erectile Dysfunction - Fact vs. Fiction blog post.
A Customized Treatment Plan
To thoroughly assess each patient’s health and evaluate the root cause of ED, KPM performs a careful evaluation, taking into account many risk factors. This evaluation is typically based on standard workups and patient evaluations - as well as a comprehensive lab that may include:
FREE AND TOTAL TESTOSTERONE LEVELS
LUTEINIZING HORMONE
THYROID - TSH, FREE T3, FREE T4, THYROID ANTIBODIES (FOR APPROPRIATE PATIENTS)
LIPID PANEL (CHOLESTEROL)
LPPLA2
HOMOCYSTEINE
HS-CRP
HGA1C
INSULIN
VITAMIN D
DHEA
CBC
CMP
PSA
B-12
FOLATE
MTHFR (FOR APPROPRIATE PATIENTS)
PREVENTATIVE SCREENING AND IMAGING
Additional labs may be chosen for appropriate patients with specific personal risk factors or family histories, including:
CARDIAC CALCIUM SCORE
CIMT (CAROTID INTIMA-MEDIA THICKNESS)
HOME SLEEP STUDIES
BODY COMPOSITION TESTING