Q. I am taking medications for ED with no benefit. Should I go for penile injection therapy?

Answered by
Dr. Manjunadh M Nair
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 05, 2017

Hello doctor,

I am a 35 year old male. I have been suffering from erectile dysfunction and have tried PDE-5 inhibitors. They work, but they do not give results anymore. I quit smoking, a few years ago, when I was diagnosed with ED. My morning erection is also not as strong as it used to be. Many check-ups in the past have revealed that my lipid profile and fasting blood glucose are normal. I tested low-normal on testosterone on many occasions, around 285 ng/dl to 330 ng/dl.

I have recently started using Enanthate 50 mg every third day with 0.25 mg of AI on the day of injections, as taking 250 mg bi-weekly was giving too many highs and lows. The decision to self-administer testosterone replacement therapy was made because medications have not been helpful. I am about to get married and would be on short vacation. I do not want to start the consultation at that time and waste whatever little time I will have. I would like to try penile injection therapy. Can I be prescribed that if I visit a specialist in person? Would it be an expensive treatment?



Welcome to icliniq.com.

  • Penile injections are tried in severe cases of erectile dysfunction (ED). Usually, it is prescribed by a urologist, since tests like penile doppler and others have to be done, to rule out any other issues. It is an option if nothing else works. But again, it is not very commonly used, and injections can be really expensive in the case of good brands, and the erection hardness you get is similar to Viagra.
  • You mentioned testosterone levels to be around 280. That is not low enough to start using injections of testosterone. In fact, there are oral medications like Clomiphene or Tamoxifen which help in increasing the levels.
  • Secondly, ED is primarily due to poor blood supply to the penis. So, after taking up to 20 mg of Tadalafil, try giving a hand stimulation after a gap of two to three hours. If that does not work, some venous disorders and psychological aspects should be ruled out, since stress and anticipation of a hard erection can worsen it.
  • Increasing testosterone levels may not be actually beneficial beyond a point since testosterone is associated with a desire and interest in sex, rather than erection hardness. So, you can consider the following natural options along with Tadalafil:
  1. Include four to five dates, figs, almonds, and cashews in your diet.
  2. Take Ashwagandha (Indian Ginseng), one capsule twice a day with milk.
  3. Practice yoga, especially Gomukhasana every day.
  4. Do Kegel exercises, that is, while passing urine, stop after five seconds, wait for 10 seconds and release again. Do it thrice daily.
  5. Do regular exercises for 45 minutes everyday.
  6. Expose yourself to sunlight for 15 minutes every day. Vitamin D can be a common cause for poor erection. 
  7. Taking a weekly dose of Calcitriol D3 sachets with milk and Nano-Leo capsules (extracts of Ginkgo biloba) can help.

For further queries consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

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