Venous Leakage: The Cause of Your ED?

Buy Lab Tests Online

Nelson Vergel

Founder, ExcelMale.com
By Lee Meyers


“Venous leakage.” Sounds nasty, doesn’t it? Kind of like a hemorrhage or something, eh? Well, most guys would probably rather have a little hemorrhaging than venous leakage, because it leads to weak and/or rapidly disappearing erections.


Venous leakage describes the condition where the blood escapes from the penis and thus a good erection cannot be achieved. An erection begins when penile smooth muscle relaxes enabling blood to infill the corpus cavernosum, two cylindrical “caverns” of spongy tissue running within the penis. Stage two of the erection process occurs with this infilling of the corpus cavernosum. The inflow of blood expands the spongy tissue, which begins to pinch off the emissary veins of the penis, decreasing outflow and – voila! – the erection begins to build.


NOTE: Venous leakage should not be confused with venous insufficiency, which is a condition in which the valves in the lower legs go out due to varicose veins, deep vein thrombosis, etc. There is some evidence that grape seed extract can help with this condition.


Venous leakage occurs when this second stage fails and bloods leaks out as fast as it infills. The “pinching off” of the outflow veins never occurs adequately and, basically, you’re sailing in a leaking boat. Again, though, it’s not really that the veins are leaking but rather that the veins are not receiving proper compression.

Causes of Venous Leakage
The causes for venous leakage can be summarized to several basic underlying conditions: 1) smooth muscle insufficiency and 2) structural changes of the corpus cavernosum. Now, what condition can lead to both of these erection killers? Low testosterone, a.k.a. hypogonadism.
That’s correct – low testosterone is a freight train ride to venous leakage and we’re going to look at why below. Here’s the good news: it doesn’t have to be a one-way train ride – you can get off the train.


1) Smooth Muscle Dysfunction. Researchers now know that testosterone both maintains smooth muscle and the nerves the fire them in the corpus cavernosum. For example, researchers have noted that in castrated animals, the nerve fibers and myelin sheaths around them actually shrink and “wither”. And they have also noted that smooth muscle content in the corpus cavernosum decreased as well. Yes, testosterone affects everything in a male!


2) Corpus Cavernosum Integrity. The research points to the fact that low testosterone can actually affect the connective tissue within the corpus cavernosum. While you are losing smooth muscle, you are also likely gaining more connective tissue, i.e. collagen. The ECM (extracellular matrix) changes for the worse, another structure implicated in erectile dysfunction. This is a sort of “hardening” similar to what causes problems throughout your body. You need for the corpus cavernosum to be flexible and expandable in order to properly compress the outflow.


The bottom line is that researchers have found that in a low testosterone environment, the inside of the penis literally atrophies and is replaced with inelastic, fibrous tissue.


For some of you that have discovered that you lived in a hypogonadal state for years without knowing it, this may be a scary prospect. “Did it do permanent damage?” is the natural question to ask yourself. Below we discuss some study results that show about where venous leakage can occur.

How to Improve Venous Leakage
However, before I write anything else, let me state that the good news is that the studies show that, if testosterone is restored, normal erectile function usually goes with it. This means that the damage could not have been too severe from a long term low testosterone environment and indicates that a significant reversal is usually possible.
Venous Leakage and Testosterone


So what is the magic number at which internal penile damage begins to occur and venous leakage begins to rear its ugly head? In one study, researchers looked at men with venous leakage, all of whom had testosterone < 300 ng/dl (10.2 nmol/l). Obviously, 300 ng/dl and less can be a problem area for many guys. Low Testosterone: How Low is Too Low?


However, could we say, then, that 300 ng/dl is the threshold? Actually, for some men, it is probably higher than that as indicated by one study where all participants had venous leakage and some men had testosterone up to 400 ng/dl. [8] In other words, it depends on the individual, but it is possible that some men will begin to experience damage to the penis at 400 ng/dl (13.6 nmol/l) with still others at 300 ng/dl or even 250.


Is there a solution? Several studies to date have shown that by restoring testosterone to more normal levels, a partial reversal is possible. Of course, just how much of a reversal can be achieved likely depends on many factors, including the number of hypogonadal years as well as various lifestyle factors. The good news is that a study of Russian, low T men with erectile dysfunction and venous leakage showed good results from testosterone therapy. In this study, almost all of these men were unresponsive to PDE5 Inhibitors such as Cialis, Levitra and Viagra and all of them had testosterone below 300 ng/dl (10.2 nmol/l). In spite of their seemingly dire circumstances, about a third of the men were cured through just testosterone therapy alone. Another third were cured through a combination of testosterone and PDE5 Inhibitors. The means that a solid majority of the men were significantly healed of their venous leakage and achieved a substantial reversal with the help of TRT.


By the way, some of you who may not respond well to PDE5 inhibitors, such as Viagra or Cialis, may find that restoring your testosterone via TRT restores your erections for the above reasons. One study looked at hypogonadal males who did not respond to Viagra and found a significant restoration of erectile function after TRT (Testosterone Therapy). Very similar results were found in a study of Cialis non-responders as well. In other words, sometimes the problem is nitric oxide and sometimes it is low testosterone (or both).

The post Venous Leakage: The Cause for Your ED? appeared first on Testosterone Wisdom.

Continue reading...
 
Defy Medical TRT clinic doctor

thirdstone

New Member
Great article, thanks Nelson!

It brings to mind two questions (well, I've actually had these two questions for a while now...):

1. Assuming you're already on TRT, is there any way to know if venous leakage is the cause of ED?
2. Is there any treatment to improve venous leakage, like for example shock-wave therapy, p-shot, or stem cell therapy?
 

Nelson Vergel

Founder, ExcelMale.com
This is what Dr Mohit Khera told me when I asked him about a venous leakage procedure.



"I would not recommend this procedure. Many of the venous leak procedures in the past resulted in congestion and penile pain. Most experts have abandoned the procedure but Irwin Goldstein in San Diego has done many. Best ways to improve venous leak.



1. Regular sex

2. Daily Cialis

3. Testosterone

4. Penile stretching device

5. Wear a penile band"
 

Nelson Vergel

Founder, ExcelMale.com
Endovascular Therapy for Vasculogenic Erectile Dysfunction: A Systematic Review and Meta-Analysis of Arterial and Venous Therapies.
June 2, 2019

To systematically review and perform a meta-analysis on the safety and efficacy of endovascular therapy in the treatment of the two most common etiologies of vasculogenic erectile dysfunction (ED): veno-occlusive dysfunction (VOD) and arterial insufficiency (AI).

PubMed, Web of Science, ScienceDirect, and Scopus databases were searched for published English literature regarding endovascular ED treatments. Case series (n ≥ 3) were included. Multiple data points were obtained, including demographic data, etiology, diagnosis method, imaging studies, treatment approach, technical success, clinical success, complications, and follow-up.

Sixteen relevant articles were obtained and a total of 212 patients with VOD and 162 with AI were identified. The VOD cohort were treated either percutaneously (60.4%; n = 128) or after surgical exposure of the deep dorsal vein (33.5%, n = 71), or it was unspecified (6.1%; n = 13). The most common embolic used was n-butyl cyanoacrylate (51.9%; n = 109). Meta-analysis found an overall clinical success rate of 59.8% in VOD patients. Complications occurred in 5.2% of patients (n = 11), with 9 considered to be mild and 2 considered to be severe. The AI cohort contained 162 patients most commonly treated via stenting of the internal pudendal artery (40.1%; n = 65). Meta-analysis found an overall clinical success rate of 63.2% in AI patients. Complications occurred in 4.9% of patients (n = 8), with 4 considered to be mild and 4 considered to be severe.

Endovascular therapy for medically refractory ED is safe and may provide a treatment alternative to more invasive surgical management; however, conclusions are limited by the heterogeneity of clinical success definitions among the included studies.

Journal of vascular and interventional radiology : JVIR. 2019 May 16 [Epub ahead of print]

Sai K Doppalapudi, Ethan Wajswol, Pratik A Shukla, Marcin K Kolber, Manu K Singh, Abhishek Kumar, Aaron Fischman, Ardeshir R Rastinehad
 

DDD

Member
So these posts lead me to a question. How does a person judge which TRT dosage regimen is best when you also have venous leak.? If a guy has always associated libido with getting an erection, then if you are not getting a good erection because of a venous leak, it can make you think your TRT regimen is off and maybe your taking too much anastrozole (or not enough). How do you judge if TRT is working when you have a venous leak and erections are already comprised. Do you understand what I am asking?
 

Nelson Vergel

Founder, ExcelMale.com
Veno-occlusive dysfunction is a commonly diagnosed cause of impotence. Surgical removal of the intermediate (deep dorsal vein and its tributaries) venous system of the penis has been advocated as an effective treatment but recurrence of the dysfunction is common after a few months. We studied prospectively the first 100 cases of veno-occlusive dysfunction undergoing surgical treatment at our institutions.


Am J Mens Health. 2018 May;12(3):634-638. doi: 10.1177/1557988318754931. Epub 2018 Mar 26.

The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction.
Efesoy O1, Çayan S1, Akbay E1.

Abstract
Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD. The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT. The mean age was 58.81 ± 4.56 (52-69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively ( p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases. This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.
 

DorianGray

Active Member
Some additonal interesting info:


Given the broad correlation of vascular deficiency to ED, I wonder why 3D-CT cavernosography isn't the foundation of proper diagnosis, especially in younger men.

Interesting in the article also: "...Furthermore, these pictures might reveal the up to now unexplained relation between erectile dysfunction and hemorrhoids..."
 

Nelson Vergel

Founder, ExcelMale.com
Some additonal interesting info:


Given the broad correlation of vascular deficiency to ED, I wonder why 3D-CT cavernosography isn't the foundation of proper diagnosis, especially in younger men.

Interesting in the article also: "...Furthermore, these pictures might reveal the up to now unexplained relation between erectile dysfunction and hemorrhoids..."

I agree. I will ask Dr Khera this question.



Yes, the hemorrhoid's reference is unexpected!
 

Nelson Vergel

Founder, ExcelMale.com
Can venous leakage be ruled out if one responds well to trimix?

I think if you can sustain an erection with under 0.5 cc of Trimix for over 1 hours, may be (just my opinion).

They actually use Trimix to create an erection to do Doppler ultrasound tests of the penis.

 

DorianGray

Active Member
I need to look into this. Troubling that I might have such a condition although symptoms are mild. One would think being in good shape, non-diabetic, not overweight, normal BP, etc. would be spared.
 

bluerage

Member
Should I be concerned that I need triple that amount to maintain an erection for an hour or so?
I think if you can sustain an erection with under 0.5 cc of Trimix for over 1 hours, may be (just my opinion).

They actually use Trimix to create an erection to do Doppler ultrasound tests of the penis.

 

Nelson Vergel

Founder, ExcelMale.com
 
Buy Lab Tests Online

Sponsors

bodybuilder test discounted labs
Defy Medical TRT clinic
nelson vergel coaching for men
Discounted Labs
TRT in UK Balance my hormones
Testosterone books nelson vergel
Register on ExcelMale.com
Trimix HCG Offer Excelmale
Thumos USA men's mentoring and coaching
Testosterone TRT HRT Doctor Near Me
how to save your marriage

Online statistics

Members online
4
Guests online
8
Total visitors
12

Latest posts

Top