Erectile Dysfunction Treatments for Men on TRT
PDE5 inhibitors, combination injectables, and regenerative therapies for ED.
Drug Monographs
PT-141 (Bremelanotide)
Vyleesi (FDA-approved for women), compounded for men
A melanocortin receptor agonist that works on the central nervous system rather than the vascular system to improve sexual desire and arousal. Unlike PDE5 inhibitors which address the mechanical aspect of erections, PT-141 targets the brain's sexual response pathways. Administered via subcutaneous injection approximately 45 minutes before anticipated sexual activity. Particularly useful for men who don't respond to PDE5 inhibitors or who have low desire alongside ED.
Shockwave Therapy (GAINSWave)
GAINSWave, Phoenix
A non-invasive, drug-free treatment for erectile dysfunction using low-intensity extracorporeal shockwave therapy (Li-ESWT). Acoustic waves stimulate neovascularization and break down micro-plaque in penile blood vessels, improving blood flow and potentially restoring natural erectile function. Typically administered as a series of 6-12 sessions. Results may last 1-2 years. Increasingly offered at TRT clinics as a complement to hormone therapy.
Sildenafil (Viagra)
Viagra, Revatio
The original PDE5 inhibitor and one of the most recognized medications worldwide for erectile dysfunction. Works by increasing blood flow to the penis during sexual stimulation. Shorter acting than tadalafil, typically taken 30-60 minutes before sexual activity. Often prescribed at TRT clinics as part of a comprehensive men's health protocol, especially during the early weeks of TRT before testosterone levels have fully optimized.
Tadalafil (Cialis)
Cialis
A long-acting PDE5 inhibitor used to treat erectile dysfunction and benign prostatic hyperplasia. Uniquely effective as both a daily low-dose medication (2.5-5mg) for continuous ED support and an as-needed higher dose (10-20mg) before sexual activity. Its 36-hour duration of action earned it the nickname 'the weekend pill.' Widely prescribed at TRT clinics since low testosterone and ED frequently co-occur.
Trimix
Compounded only (various pharmacies)
A compounded injectable medication containing three vasodilators - alprostadil (prostaglandin E1), papaverine, and phentolamine - injected directly into the corpus cavernosum of the penis. Considered the most effective pharmaceutical ED treatment available, with success rates exceeding 90%. Typically reserved for men who fail PDE5 inhibitors. Requires careful dose titration to avoid priapism.
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