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Dr. David
Dr. David, Physician Experienced in Urology
Category: Urology
Satisfied Customers: 49460
Experience:  Board Certified Physician with extensive experience in Urology
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I would be most grateful for your advice and help with

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Hello Doctor,
I would be most grateful for your advice and help with erectile dysfunction (ED) and premature ejaculation (PE). I am a 55 year old male and I have had ED since around 40. I did not realise what was happening at the beginning and eventually a few years later approached my general practitioner (GP) who put me on 25mg of Viagra which was extremely effective.
Over the years I had to increase the dosage and in recent times I find that Viagra is not effective even on the highest dosage 100mg.
Please note that I have the following medical conditions:
- Polycythaemia rubra vera – I am venesected once a month subject to my blood test results – haematocrits;
- Secondary hypogonadism - Now taking 10mg on each arm daily of a testosterone pump. Started with 25mg each arm sachet but this eventually started increasing the haematocrit levels and hence the changeover to the pump for greater control and lower dose;
- Recently put on once daily eye drops per eye for glaucoma – Timolol I believe.
Could it be that any of my diagnosed conditions are potentially a causal factor in my ED and PE?
I approached my own GP (not the same doctor who originally put me on Viagra) when Viagra become less effective and unfortunately, he was not very helpful and stated that nothing can be done which was disheartening. Therefore, I approached a second private GP and she was really very encouraging and helpful. She and the endocrinology consultant suggested taking a highest dose of an alternative PDE5 inhibitor without taking alcohol and on an empty stomach. I have found that at least at times Levitra can be reasonably effective with this approach. Not always – but at times penetrative sex has been possible.
The second GP also gave me information on a medically recommended penis pump and wanted me to check whether its okay to use it with the haematology consultant. I have now done this and the haematology consultant was okay with me using a penis pump.
Therefore, I am wondering whether the next steps would be to use the penis pump (not yet tried this device) along with taking maximum dose of Levitra? Would appreciate your thoughts on this?
Please note that I have been taking 30mg Priligy for the PE and it has been pretty helpful. Of course, due to the irregularity of sexual activity with Viagra becoming less effective – PE becomes more of an issue. It’s a kind of vicious cycle.
Can you please also advice on the following new treatments I have been reading about recently:
- Linear shockwave therapy for ED;
- Clinical studies on nitro-glycerine-based gel in newspapers recently at University College London Medical School;
- The second GP mentioned that with my polycythaemia I cannot use the alprostadil injection – is this the case?;
- Are there any other new treatments that may be helpful in my case?
A clinic I contacted to ask about linear shockwave therapy recently has mentioned that the following supplements are helpful – pine bark and l-arginine. What are your thoughts on this please?
If you could please help with my specific queries and any other advice you can give me as well would be very gratefully received. I had no problems with ED whatsoever until around 40 and then it was a difficult period when I first started getting ED and then when the 25mg Viagra was working so well – it was a good period. Since the effectiveness of Viagra at the maximum dose has reduced, its been a challenging and dispiriting period once again. Its difficult to know and understand what to do next to be honest.
Thanks a lot in advance.
Regards,
Dev

This is Dr. David. I am reviewing your question now and will be with you momentarily.

yes, you should try the penis pump

the penis bump is helped by having a soft silicone or rubber penile ring at the base of the penis which can help hold blood in the penis to help maintain erections

doing kegel exercises can help strengthen your pelvic muscles.

you should take the highest dose of levitra

what is your height and weight

loosing weight and cutting carbs out of your diet and sugar and gluten and white flour over time can help you loose weight

loosing body fat over time can help improve your body's testosterone levels

body fat makes estrogen in your body

cutting out alcohol can help your erections as well.

Customer: replied 7 days ago.
Hello Doctor,
Thanks for your reply.
I am 165 pounds and about 5 feet 11 inches tall and pretty slim build with some but not too much body fat. I only drink around 5 units of alcohol a week in an average week.
What are your thoughts on new treatments like linear shockwave therapy for ED and the nitroglycerin based gel that is being clinically tested currently please?
Thanks,
Dev

https://www.menshealth.com/health/a19546293/nitroglycerin-gel-for-erectile-dysfunction/

researchers discovered that nearly 1 in 4 men reported a significant improvement in their sexual functioning score—a questionnaire including measures like confidence getting and keeping an erection, hardness of erections, and satisfaction with sex—after the treatment with the nitroglycerin gel, compared to just 14 percent of men who used the placebo gel.

the nitroglycerin gel worked fast: 70 percent of men noticed the start of an erection within 10 minutes, and 44 percent reported an erection in five minutes or less.

https://nypost.com/2018/01/08/new-erectile-dysfunction-gel-is-literally-dynamite/

it is not available yet.

I wouldn't do linear shockwave therapy at this point.

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