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Erectile Dysfunction

Learn More About Ways To Manage Erectile Dysfunction


I am going to take a minute to discuss the most relaxing and carefree topic you will likely, in all of your lifetime, ever have with your doctor. Let's talk about...


I suppose this chit chat about your penis could only be made more uncomfortable if your doc was me - or any other female provider for that matter. It might be why the vast majority of guys ask their physicians this question on their way out the door: "Hey, doc - just wanted to ask you about one more thing..." (the question that just so happens to be the entire reason I scheduled this appointment for my 'blood pressure' in the first place).


Please don't despair. We talk about sex all day every day. It's not weird. It's not uncomfortable. Sex is normal. It's extremely important. We all have it. If you're having an issue with sex, we need to address it. Erectile dysfunction might be awkward for you to talk about, but it isn't for us. No need to wait until I'm walking out the door. Just ask.

I put ED under the category of medical conditions referred to as, 'If you live long enough, you're going to have it' - aka, the inevitable. Stats say that 40% of men in their 40s, 50% of men in their 50s, and 60% of men in their 60s report some degree of difficulty in obtaining and/or maintaining erections - it's a lot more common than most men think.


Or perhaps better described as a window into the health of your endothelium...same thing. Erections aren't just about sex. Having an optimal erection is largely a vascular event - if you're having problems with blood flow to your genitals, then it's likely you're having blood flow problems elsewhere. ASCVD or 'atherosclerosis' is the #1 cause of death in the US and worldwide. ASCVD affects the smallest arteries first - like the ones that service your penis. Problems with erectile function can be predictive of larger vascular events down the road, like heart attack and stroke. Asking your doctor about ED now, might spare you a catastrophic vascular event down the line.

Your penis is an extension of the rest of your body - which goes without saying. If the rest of your body is a metabolic dumpster fire, then you can count on having dumpster fire-style erections. And not in a good 'college-block-street-party' type of way. Poor insulin sensitivity, crap for diet, crap for sleep, environmental toxins, low stress resilience, leaky gut, and systemic inflammation are hard on all of your arteries. It is important to identify these issues and correct them.





Smoking cigarettes is arguably the biggest modifiable risk factor in your immediate control, for improving erectile dysfunction - and pretty much all chronic disease. Cigarettes are death traps designed to destroy every organ system in your body - including your penis. They are cruel. Relentless. If you win the Big Tobacco Lottery, you might be lucky enough to drop dead smoking a cigarette while having the very last ultimate pleasure moment here on Earth. But in all likelihood, those cigs will instead render you stinky, short of breath, and flaccid until you have your ultimately fatal vascular event.




Being overweight is usually a dead give away. If you're overweight on the outside, you unfortunately scream metabolic disaster zone from the inside. If you're working on it - great. If you think you can work around it, think again. Sometimes the answer to weight loss is obvious (stop driving through McDonald's). Other times, the answer isn't as obvious. If you're having problems with optimizing your weight, it's probably because your situation is being influenced by factors you can't see just looking in the mirror. If this is you, see your doc to have blood work done. Fixing the problem is way easier if you know what's actually wrong with it.




Erections require blood flow - lots of it. Sure there are other important players, but if the blood isn't flowing, the erection just isn't happening. A systematic review published in 2018 of physical activity and erectile function showed that as little as 40min of physical activity, 4 times per week decreased erectile problems in men with ED. It also improved obesity, hypertension, metabolic syndrome, and cardiovascular disease. Win win.




If you dare read through the entirety of the site, you will notice this is as an annoyingly recurring theme. You are what you eat. Period. It's a touch more complicated than that, but not much. Garbage in, garbage out. If you're feeding your penis soft, fully processed Krispy Kreme donuts and Cheesecake Factory desserts, then it's not getting what it needs to get things done. Instead of fake food, try feeding your penis some green leafy vegetables, clean protein, and healthy fats. Nutrient dense foods help to make sure all systems in your body are primed for action.




Easier said than done, I know. Hey - as it turns out, having sex is one of the only reliable ways to reduce cortisol production. That's a fact. Great sex = better stress resilience. There is seriously no better motivator in life than this. Take a minute to get out of your head. Stop stressing about work and start thinking about sex. Your penis will thank you for it.







Is this a rhetorical question? It's not! I've heard it before. Look - a good general rule to follow in life is the old 'if it seems too good to be true, it probably is.' Mostly, you get what you pay for. And I think the universe sometimes throws in a smack upside the head for being just plain ignorant.


If the 'dick hard' pills are next to the Cheetos at the Shell Station, you should treat them with some degree of skepticism - like the same degree of skepticism you would regard anything claiming "it's not easy being cheesy". It should be a solid, 'no'.


Pills for your penis available for any human to purchase at your local gas station or convenience store, displayed next to the Cheetos, branded with anything sounding like 'Krazzy Rhino', 'Rhino 69 Power 500K', 'Rhino 7', 'Gold Rhino', 'Platinum Rhino' - or just anything with packaging that displays an unusually large, thick-skinned aggressive animal with a gigantic horn of any kind containing a single dose of a substance promising 'huge' returns on size, time or stamina, should not be purchased by you. If you must, honor them with an eggplant containing social media post. Hey - some poor soul had to pitch that to a board. All you have to do is not buy any.




OK - now we're back in the green zone. The class of medications typically used to improve erectile function are called PDE5 inhibitors. All medications carry risk, but taken correctly, these are generally pretty safe. They work by increasing nitric oxide production - which, as it turns out, improves blood flow everywhere. Currently, the PDE5i medications are even being studied and used in non-penis related medical conditions like pulmonary hypertension, Raynaud's disease, stroke, and dementia. They have side effects too, however - headache, congestion, blurred vision, acid reflux, back pain, low blood pressure, and the most famous of all - 'an erection lasting more than 3 hours'. (Insert award here for Best marketing line EVER) I don't give medical advice on this site, just provide information. Please check with your personal doctor to see if this option is a good one for you.




'Extracorporeal shockwave therapy' absolutely improves the quality of erections. Hands down - in my clinical experience, this works for the overwhelming majority of my patients. It is a non-invasive, nonpharmacologic treatment for ED - my favorite kind. Risk is right there next to zero. This is a procedure which is kind of like ultrasound but different. Both use gel and a probe, but shockwave is LOUD. It uses a much more intense and different shaped wave form to deliver pulsed energy which stimulates healing. It upregulates the growth of new blood vessels and nerve endings. This treatment works as well on your shoulder tendonitis as it does on your penis. It's not a drug. It doesn't hurt. There's no needles involved. It's awesome.


Specifically, I am a fan of AT HOME shockwave therapy. At least for ED. There is a large marketing company that advocates for in office shockwave treatments whose name I can not mention here on account of trademark laws. We did this in office treatment for many years, but stopped for several reasons - mostly it was the high cost to patients. It's expensive to come to my office for a dozen or more treatment sessions. There is a medical grade at home device now which works great at providing the same shockwave treatment and is a fraction of the price. Less money and less time. There are knock offs out there, so it's best to get this device directly from a physician.




Ah, the P-Shot®. This is an in-office procedure developed by a physician over 10 years ago. Many a Ps have been shot since that time. The procedure itself is pretty straightforward. Needles are involved, so therefore numbing is as well. We call that type of numbing a 'dorsal block' - makes your penis feel 100% gone for about 2 hours. The strangest two hours of your life, I've been told. I have also learned over the years that men are acutely aware of their penis location at all times and when it seems to have gone missing, it is a strange time indeed. But this is temporary and necessary to make everyone comfortable. In its first iteration, the penis was injected with something called 'PRP', or platelet rich plasma. We draw some of your blood, spin out the red and white cells, and keep the platelets. Platelets carry around a whole stockpile of cool things everywhere they go - growth factors, chemokines, and other mediators that regulate the healing response. It's the stuff inside the platelets that do the work.


I know - your penis isn't injured. But both shockwave therapy and the P-Shot® essentially trick your body into thinking it is - so it's your own body that gets to work and sends in the construction crew to rebuild. End result? Firmer, more reliable erections brought to you by way of personal penis regeneration. Brilliant.


In more recent times, we've thought of all sorts of things we might inject in to the penis while it is comfortably anesthetized. I am allowed to call this 'advanced regenerative therapy' because making claims about cells that might be referred to as stem is frowned upon by our regulatory agencies. I would never make such claims. However, I have heard that this type of P-Shot® is far superior to one using PRP alone.


And then, as if things couldn't get more exciting, BOTOX® entered the P-Shot® scene. It was then, that Bocox™ was born. Treatment of the penis with BOTOX® (with or without PRP and/or 'advanced regenerative therapy') improves erections by relaxing the smooth muscle that controls blood flow into the penis. BOTOX® also modulates the parasympathetic and sympathetic nervous system balance within the penis to improve erection firmness and penile health.


Gentlemen, your penis has lots of options these days. The P-Shot® comes with an array of options to help maximize your performance.




Peptides are short chain amino acids that target specific pathways in the body, and turn up or turn down their volume. Peptides aren't technically medications or hormones - they are signaling molecules that modulate what's already going on inside your body. In 2019, the very first intervention (a peptide called PT-141) was FDA approved to treat female 'Hypoactive Sexual Desire Disorder ' (low libido). As you can see by the length of this post, we had more than a few options for sexual dysfunction for men but not much for ladies. We were pretty excited about this development. After trying this for the past few years, I have mixed feelings on PT-141 for women. The feedback from women has been mixed - women who love it, love it. Women who don't love it, really don't love it. To date, PT-141 is still the only approved treatment for low sexual desire disorder in women, but it is almost exclusively used by men. It's not a hormonal or a blood flow therapy - it works on signaling molecules called neurotransmitters in the brain. The feedback on PT-141 for guys is overall extremely positive. PT-141 increases libido AND improves erections in many men who don't respond to PDE5 inhibitors.




PEMF stands for 'pulsed electromagnetic field' therapy. I'll do a comprehensive blog on this soon, but the short story is that PEMF therapy sends SAFE pulsed magnetic energy into the body through copper coils. These energy waves essentially 'recharge' your cellular battery. Like shockwave, this therapy has been around for decades and carries essentially no risk - it's non -invasive, non-toxic, non-pharmacologic. It works by stimulating regeneration and healing at the level of the cell - it is FIXING THINGS. Cell respiration, organelle repair, ATP production, and cell metabolism are upregulated while inflammation is down regulated. PEMF works with your body's own natural magnetic field to improve healing - ie to fix itself. Hard to believe, but PEMF works for pretty much anything that ails you. More recently we have learned that - not surprisingly - this intervention works to improve penis function as well. Five stars, guys.




Erectile function is mostly vascular, but hormones are involved as well. I would say, 80%/20%. Erectile tissue responds best when it is living in a testosterone optimized body. The hormone part is the easy part. Get your blood tested. If your testosterone isn't optimal, fix it. It will likely save you significant time and money getting your erections in top shape.

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Take care of your body and it will take care of you. It sounds simple, but a healthy diet, regular exercise, adequate sleep, good stress balance, and optimizing hormonal status go a long way to improving erectile function.




No, you don't have to stop drinking altogether - but if you are serious about trying to do everything you can on your end to improve erections, maybe cut back here a bit.




Open communication can help to strengthen your relationship, help to restore lost confidence, and reduce anxiety. It's important to know your own body. Your partner can't be expected to know what you need if you aren't comfortable talking about it. Your partner wants to make you feel good. Great sex happens when you are both completely honest about what you want - and great sex is an integral part of a relationship worth having.


Dr. Kristen Lindgren is extremely skilled in helping men with ED. She has helped countless men improve their sexual wellness.

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"Sickness takes time. Recovery also takes time. Let’s commit to taking this journey back to your optimal health together."  Dr. Lindgren

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