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Hormone Therapy for Men/ED



Tired?  Is your endurance and strength declining? Have you noticed a decline in your sexual function and lost interest in your sex life?

Every man could answer yes to some or all of the above at some time or another after the age of 40.  These can be common symptoms of low testosterone, but they can also occur from a myriad of other lifestyle and behavior issues as well as social and relationship issues.  Beginning at age 30, testosterone levels drop, on average, about 1 percent a year. About 5 percent of men between the ages of 50 and 59 have low levels of testosterone along with symptoms like loss of libido and sluggishness.

A condition known as “Metabolic Syndrome” is intimately linked to low testosterone.  The syndrome is a constellation of diabetes (or insulin resistance), hypertension, elevated triglycerides (fat levels in the blood), abdominal obesity and low testosterone.  Estimates range from 25% to 45% of American men over 40 fulfill the criteria for this syndrome that carries a significantly elevated risk of stroke and heart attack.  A University of California study showed that men with a low testosterone had a 33% higher risk of death over an 18-year period than men with normal testosterone.  How testosterone interacts with obesity, diabetes and cholesterol is not fully understood.  It is also unclear if the low testosterone is the cause of these health risks or is involved in some other way.  Clearly, low testosterone is much more important to overall health than simply a factor in declining strength and sexual performance.

Testosterone is essential for male development, libido (or sexual drive), and erections.  Low testosterone is often overlooked in the evaluation of erectile dysfunction (ED) because of the effectiveness of Viagra-type medications.  Low testosterone, however, is a common cause of poor or declining response from these medications and should always be checked in the evaluation of ED.  Although we do compound tadalafil (active ingredient in Cialis®) and sildenafil (active ingredient in Viagra®) as well as have testosterone boosting supplements, testosterone replacement may be all that the patient needs to restore his sexual function.  Be sure to talk to our pharmacists or your doctor to discuss the right protocol for you.

Don’t underestimate the importance of a normal testosterone level.  It has clinical effects that may modify serious medical conditions such as diabetes and hypertension.  If left unmanaged, it may increase your risk of heart attack, stroke and even death.  For years, testosterone levels have been recognized to be the key to some important quality of life issues such as libido, sexual performance and even our sense of wellbeing.   Managing low testosterone has become much simpler and easier for patients.  Identifying low testosterone is as simple as a blood test, and modern management is as simple as a daily application of a skin cream.  These creams provide better, even absorption and steady testosterone levels in the blood. 

Every man should know his testosterone level. A normal testosterone level can be an important aspect of maximizing longevity and maintaining quality of life.


ED Injections

 Erectile dysfunction (ED) is a condition in which it’s difficult to get or keep an erection firm enough to have sex.

There are many ways to treat ED, including lifestyle changes, psychotherapy, oral medications, surgical procedures, and penile injection therapy, or intracavernosal injection therapy.

Penile injections can generally be self-administered at home. They help treat ED by improving blood flow to the penis, which leads to firmer erections.

While the thought of injecting a needle into your penis may make you cringe, a 2019 Trusted Source review found that penile injection therapy is generally an effective and well-tolerated treatment for ED.


How to administer an injection

Your first two injections should be done by your doctor. During your visit, they’ll show you how to do the injections at home.  We also provide a private consultation with props demonstration when you pick up your first prescription.

The first step is to wash your hands and assemble your supplies on a clean surface.
You’ll need:

Once the medication is in the syringe, gently grasp the head of your penis between your thumb and forefinger and pull it straight out in front of you. If you’re not circumcised, pull the foreskin back before grasping the head.

Find an area in the middle of the penis shaft, on the right or left side, to inject. Alternating sides each time you inject can help you avoid developing scar tissue. Be sure to avoid an area with a visible blood vessel.

Once you’ve selected an area, clean it with an alcohol wipe. Let go of the head of your penis and pick up the syringe with both hands.

Remove the cap on the syringe, and make sure the dose is correct and there are no bubbles in the syringe. With one hand, hold the syringe between your thumb and your index and middle fingers, as though you were about to throw a dart.

Using the other hand, pull the head of the penis out in front of you again. Be careful to hold only the head, so you’re not pulling any skin along the shaft.

Place the needle against the skin in the chosen area and slide the needle into the shaft. The needle should be at a slight angle, with the plunger facing up at the 10 or 2 o’clock positions. Adjust your hand so your thumb or index finger can push the plunger.

Push the plunger quickly so that all the medication is released. Once the syringe is empty, quickly pull the needle straight out. Apply gentle, but firm pressure on the injection site with your thumb and your index finger on the opposite side of the shaft. Do this for 2 or 3 minutes to avoid any bleeding or bruising.

Put the syringe in the sharps container for disposal.


What to expect

In general, an erection should follow an injection within 5 to 15 minutes. However, some men may need sexual foreplay to achieve an erection. The erection should last about 30 to 60 minutes, though this will vary depending on your overall health and other factors.

Some men report that injections affect the sensation in their penis and their ability to ejaculate. However, these effects may be due to whatever is causing ED rather than the injections themselves.


Types of injectable medications

The three main types of medications used in penile injection therapy include:

  • papaverine
  • phentolamine
  • prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, MUSE)

Sometimes, only one medication is administered. But combinations of these medications are also widely used. Combination medications include BiMix, which is papaverine and phentolamine, and Trimix, which contains all three medications.

All these medications work by relaxing the smooth muscles and widening the blood vessels in your penis. This increases circulation and leads to an erection.


Why injections are used

Penile injection therapy is considered an established and effective second-line therapy Trusted Source for ED. That means it’s generally prescribed only if first-line therapy — oral ED medications — are ineffective or not well tolerated.

Some men don’t like the side effects of oral ED drugs, which can include:

  • congestion
  • headache
  • upset stomach
  • flushing
  • back pain

Some men may also prefer injection therapy over other ED treatments, such as having penile implant surgery and the risks and potential side effects that can accompany that approach.

2019 Trusted Source study of 105 men found that about 70 percent of men who relied on penile injection therapy for more than 8 years were satisfied with the results.


Risks and side effects

That’s not to say that ED injections are risk-free. As with any type of injection, there’s a slight risk of bleeding or bruising at the injection site. But if you’re careful and follow your doctor’s instructions, these problems may be avoidable.

Proper placement of the needle can help avoid temporary irritation and swelling.

Some men also report mild pain after injecting.

In rare cases, priapism, a prolonged erection that occurs without, or long after, sexual stimulation, may occur. To treat priapism, try applying an ice pack to your penis. Taking a decongestant containing phenylephrine may help, too. However, if the erection lasts longer than 4 hours, seek immediate medical attention.

Likewise, if you’re experiencing pain or any bleeding that lasts more than a couple of minutes after the injection, see a doctor immediately.

When to seek immediate care:

  • an erection lasts longer than 4 hours
  • pain or prolonged bleeding occurs


Getting a prescription

Your doctor can write you a prescription for an injectable medication after you’ve been diagnosed with ED. Once you have a prescription, we will fill your prescription.



Penile injection therapy is used by men of all ages to treat ED with a variety of causes. It can be used long term, though you’ll want to vary injection sites each time you inject. This helps avoid creating any scar tissue.

To achieve the best results, learn as much as you can about the process from your doctor and our pharmacist’s, and don’t hesitate to ask them questions about side effects, dose, or any other topic.

Getting the right dose may take a little trial and error, but if you’re willing to put in the time and effort, good results are possible.