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What to Do When TRT Doesn't Stop ED

Most men with erectile dysfunction find that their sexual performance improves after they start Testosterone Replacement Therapy (TRT). That’s because low Testosterone is one of the most common causes of ED.

But some men don’t experience full relief from ED after they optimize their hormones. Even if their sex drive improves, they still may experience erections that aren’t strong or lasting enough for intercourse.

We’ll discuss the potential causes of ongoing ED, as well as some solutions that can help address the problem.

ED with TRT: Your Testosterone Levels May Not Be Optimized

There is no one-size-fits-all approach to TRT.

Every patient responds differently to treatment, and the range for “normal” Testosterone levels is wide (264 ng/dL to 916 ng/dL according to LabCorp). Because of this, male patients may feel optimized at different Testosterone levels depending on their individual needs.

If you’re still experiencing erectile dysfunction on TRT, it could be because your protocol isn’t individualized enough. Rather than working with what your body needs, your protocol may target an arbitrary number or standard dosage.

When a TRT plan isn’t fully effective at optimizing T levels, ED symptoms can persist even if you experience benefits in other areas.

Defy Medical offers a customized approach to TRT, with regular follow-up and adjustment to ensure that your protocol optimizes your T levels and keeps them elevated over time to address ED and other low T symptoms.

Erectile Dysfunction and Estrogen Production

While TRT protocols focus on improving Testosterone levels, other hormones can impact how you feel.

Sex hormones like Testosterone, Estrogen, and Progesterone work together to support bodily function. Men also produce Estrogen and Progesterone, just in smaller amounts than women. Estrogen in men is responsible for important roles like maintaining sex drive.

When men increase their Testosterone levels, it’s possible for Estrogen levels to also rise. This is caused by natural balancing processes in the body.

If Estrogen levels rise too high, it can lead to erectile dysfunction and overproduction of prolactin. Elevated prolactin levels can also contribute to ED, as well as a rare condition called gynecomastia (the development of male breast tissue).

Because hormones are so complex and impact each other, it’s important to work with an experienced provider in developing a plan tailored to your needs. That way you can improve your Testosterone levels while minimizing side effects like elevated Estrogen and prolactin. Estrogen levels that are too low or too high can negatively impact men.

For male patients who demonstrate elevated Estrogen levels through blood testing and symptoms, Defy Medical also offers aromatase inhibitors (AI) as part of a TRT plan. Not all men require AIs to feel their best, so treatment is based on your unique response.

Aromatase inhibitors suppress the production of Estrogen for patients dealing with elevated levels. This often helps prevent side effects like erectile dysfunction and high prolactin levels while on TRT.

Erectile Dysfunction and Thyroid Disease

Thyroid conditions can cause erectile dysfunction. If you have imbalanced thyroid hormones, you may still experience ED on a TRT protocol, because TRT isn’t addressing the root issue.

Hypothyroidism is the underproduction of thyroid hormones, while hyperthyroidism is the overproduction of thyroid hormones. Both throw your body out of balance and can cause erectile dysfunction.

In the initial blood panel Defy Medical requires for new patients, we check for general thyroid health. We also offer a comprehensive thyroid panel if you suspect you may have a thyroid problem.

Restoring thyroid hormone balance can help alleviate symptoms like erectile dysfunction.

Hypothyroidism is often treated with Thyroid Hormone Replacement Therapy, which is similar to TRT but utilizes thyroid hormones. Learn more about thyroid disease treatment.

Erectile Dysfunction and Physical Injuries

Erectile dysfunction can also be caused by nerve damage, blood vessel damage, and blunt trauma to the groin.

Peripheral neuropathy is a type of nerve damage that can impact the penis and cause erectile dysfunction. It can be caused by physical injury as well as chronic diseases like diabetes. Peripheral neuropathy may also come with other symptoms, including a pins-and-needles feeling in your extremities.

Groin injuries can also lead to ruptured and damaged blood vessels. Erections are caused by blood flowing into the penis, allowing it to become erect. When blood flow is limited, so are erections.

Certain surgeries can cause erectile dysfunction, as well, like prostatectomies (removing part or all of the prostate) or cystectomies (removing part or all of the bladder). These surgeries often address cancerous or benign growths.

Erectile Dysfunction and Lifestyle

Lifestyle factors play an important role in sexual performance.

Erectile dysfunction can be caused by smoking, drinking alcohol, and substance abuse. It’s important to address these habits to improve your overall health as well as ease your ED.

A poor diet, lack of sleep, high cholesterol, diabetes, obesity, and other factors can cause erectile dysfunction, as well.

We recommend a healthy diet, regular exercise, and a steady sleep schedule. We also recommend checking for sleep apnea, which is a sleep disorder that often causes ED.

Testosterone Replacement Therapy can be helpful with weight loss, because balanced hormones make it easier to burn fat and build muscle. If you work to improve your body composition while on TRT, you may feel your ED ease over time.

Erectile Dysfunction and Prescription Medications

Some prescription medications have erectile dysfunction as a side effect.

Common medications that cause ED include:

  • Antidepressants and psychiatric medications
  • Antihistamines for allergies
  • Anti-inflammatory medication
  • Prescriptions to treat Parkinson’s disease
  • Blood pressure medication
  • Chemotherapy and other cancer treatments

If you’re taking these medications, we do not advise you to stop taking them.

Instead, work with your doctor to address the side effects. This could be through finding alternative treatments, adjusting the dosage, or utilizing ED therapies like sildenafil (Viagra) or other oral medications.

You should not make any changes to your medication routine without the guidance of a medical provider.

Treatments for Erectile Dysfunction

The reasons above may explain why you still experience ED while on TRT.

If you can’t alleviate your erectile dysfunction through improving your TRT plan, balancing your thyroid hormones, making lifestyle changes, and/or taking aromatase inhibitors to limit Estrogen projection, then your next step is ED treatment.

There are several therapies and treatment options available that can help.

  • Oral ED Medications

    Oral medications like Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra) are very successful for most men with mild to moderate erectile dysfunction.

    These medications are vasodilators, which means they help expand the blood vessels for greater blood flow to the penis. Blood flow is crucial for strong erections.

    Oral vasodilators typically trigger erections within half an hour to two hours.

    Defy Medical offers access to affordable medications that address ED for better sexual performance. We also offer combination therapies that include Tadalafil, Vardenafil, and Sildenafil, along with libido and mood enhancers like oxytocin and Bremelanotide (PT-141).

    Many men find Defy Medical to be a one-stop clinic for their HRT and ED needs.

  • Trimix Injections

    If your erectile dysfunction is more severe and you don’t respond to oral ED medications, penile injections are on option to consider.

    Trimix is a penile injection that includes Phentolamine, Prostaglandin, and Papaverine. These ingredients work together to dilate smooth muscle and encourage powerful and lasting erections.

    Trimix is injected directly into the penis for stronger and more immediate results. Erections typically take place within 5-20 minutes and last throughout the duration of intercourse.

    Defy Medical offers access to Trimix injections, as well as similar formulations like Bimix and Quadmix (as appropriate for the patient).

Erectile Dysfunction Procedures

There are also in-office procedures that can help ease the symptoms of ED. Defy Medical offers these procedures at our clinic in Tampa, FL.

  • Shockwave Therapy for Erectile Dysfunction

    Also known as acoustic wave therapy, Shockwave Therapy is a noninvasive procedure to treat erectile dysfunction. It delivers acoustic waves to the penis to encourage blood vessel growth and repair. This increases blood flow to the penis, which improves sexual function.

    Many patients see results within 6-8 weeks of their first session, and some patients book multiple sessions for even more improvement in sexual function.

    Shockwave therapy is considered a safe and simple procedure for most patients.

  • Platelet Rich Plasma Injections for Erectile Dysfunction

    Platelet Rich Plasma comes from the patient’s own blood and includes a concentrated amount of healing and growth factors. This PRP combination is injected into the penis and surrounding areas to encourage blood vessel healing and regrowth.

    Many patients have seen success with PRP injections, including better erections and heightened sensation. At our clinic, we take the blood sample, separate it into the concentrated PRP, and inject it — all in one simple appointment.

What to Do When TRT Doesn’t Stop ED

Testosterone Replacement Therapy offers relief from erectile dysfunction for many men. But if you still experience ED while on TRT, it may be due to one or more of the reasons above.

Defy Medical will work with you to identify the root cause of the issue and to provide treatment that can help.

This may include affordable ED medication, as well as adjusting your TRT protocol, adding aromatase inhibitors, treating a previously undiagnosed thyroid condition, and other therapies as appropriate.

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