Treatments for Men who Fail to Benefit from ED Medications

Nelson Vergel

Founder, ExcelMale.com
This is the best review I have seen on the subject.

"Abstract

Phosphodiesterase type 5 inhibitors (PDE5-i) have become first-line therapy for the treatment of erectile dysfunction. Most initial prescriptions for PDE5-i are by primary care practitioners. Urologists must now routinely manage the patient who has failed initial therapy with PDE5-i. Lifestyle modifications can be of benefit to patients. Patient education and optimization of the PDE5-i can result in a successful response. Interestingly, there are reports of up to 60% salvage after changing the PDE5-i utilized. Daily PDE5-i have shown benefit, and treatment of hypogonadism can enhance response to PDE5-i. We review the management of PDE5-i failures with emphasis on noninvasive approaches to gaining improved erectile response to these medications. An algorithm based on the reviewed strategies is proposed to guide clinicians in the treatment of erectile dysfunction.

Conclusion

Between 30 and 40% of patients fail initial attempts to manage erectile dysfunction with PDE5-i. Many of these patients can be salvaged with further noninvasive management. Specific patient instruction regarding timing of medication dosing and effect of food and alcohol are often inadequate at the time of initial prescribing. Patients should expect that it may take up to eight attempts prior to achieving the benefit of a PDE5-i. Lifestyle changes improve erectile response and overall health. Pelvic floor exercises have been shown to increase erectile responsiveness. Daily dosing of a PDE5-i may provide benefit for up to 41% of men. Switching the PDE5-i has been shown to provide response rates between 12% and 61% in patients failing a previous PDE5-i. Finally, treatment of hypogonadism and treatment with pioglitazone, doxazosin, or bremelanotide have been shown to improve PDE5-i responsiveness in small clinical studies but remain to be substantiated. High dose PDE5-i treatment carries increased rates of adverse effects, and patient drop-out increases. Finally, the authors recommend a ‘personalized medicine' approach be taken when counseling patients initially failing PDE5-i, as not all patients will be tolerant of the trials necessary to achieve success with a noninvasive approach. Further trials are necessary to determine which patient characteristics lend to a poor response regardless of the PDE5-i used, in order to direct these patients to a more effective therapy."

Click Here for Full paper
comparison of ED PED5 inhibitors drugs.jpg
 
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efete1

New Member
Hi all

Great information. In addition to these modalities, the most effective non-pharmaceutical options are PRP therapy (the P shot) and Gainswave therapy. Both work great. I use both in my clinic- happy patients!

Dr. Eric Fete
 
You can always find NEW info here, no matter how many time you have read articles.
I clicked on the older link above and actually looked at it a bit closer and noticed the flow chart (from Medscape) on Trimix titration. I had seen it a number of times before but never looked at it closely until tonight.
Some incredibly interesting information!!!!
I found the "History of ED: age 55 and greater starting dose" to very interesting!!!!!!
 
Also looked up info on Avanafil as I did not know much about it.
All I can say is EXPENSIVE, EXPENSIVE, EXPENSIVE....
GoodRX list it at right around $65.00. per tab !!!!!!!
And apparently no offshore sourcing.
 

arbncdt1

New Member
Hi all

Great information. In addition to these modalities, the most effective non-pharmaceutical options are PRP therapy (the P shot) and Gainswave therapy. Both work great. I use both in my clinic- happy patients!

Dr. Eric Fete
Thank you for posting this response. Do you know the cost and how long this therapy last?
 

bygeorge

New Member
You can always find NEW info here, no matter how many time you have read articles.
I clicked on the older link above and actually looked at it a bit closer and noticed the flow chart (from Medscape) on Trimix titration. I had seen it a number of times before but never looked at it closely until tonight.
Some incredibly interesting information!!!!
I found the "History of ED: age 55 and greater starting dose" to very interesting!!!!!!
Tried Gainswave and it did not provide any improvement for me. 6 treatments in six weeks.
 
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Nelson Vergel

Founder, ExcelMale.com
I think Gainswave is a rip off. A lot of money for no improvement. I have talked to 5 guys who have spent over $2,000 on it with absolutely no benefit.

 

Golfboy307

Active Member
I am going to give you guys a counter opinion on Gainswave. I posted on one of Madman's threads on alternative ED treatments. I have some mild venous leak. On TRT. I recently did 10 sessions recently over 6 weeks. My doctor was just getting going with the machine, so he charged me $1,000 for the whole set. (I realize this is still quite a bit of money) I have seen some really nice improvements in EQ both during the sessions and a month afterwards. Now, how long will it last? Studies suggest 12-24 months. We'll see. I agree with you Nelson, the price needs to come down to make this a realistic type treatment. However, just based on my experience of N=1, it sure has helped. I would do it again, especially if the price continues to come down.
 

bluerage

Member
I had pre ordered The Rocket back in December which is an at home gainswave device. Due to Covid and now a lawsuit I'm not sure when it'll actually be delivered. I'll report back with my results (if any) when I finally get it.
 

DorianGray

Active Member
I wouldn't write the treatment off just yet either, although more research (or beta testers) needs to be done. Arguably, the technology/device has advanced further than when Gainswave came out. I posted in another thread about the current one being done in clinical trial.
 

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