(615) 767-6726


Erectile Dysfunction – (impotence) is the inability to get and keep an erection firm enough for sexual activity. If erectile dysfunction is an ongoing issue it can cause stress, tension, and affect self-confidence in both you and your partner! Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease. Erectile dysfunction (ED) becomes more common as men get older and as testosterone levels drop over time. Age is the most common variable associated with ED. Approximately 40% of males have some experience of ED by age 40, and by age 70, nearly 70% of males are impacted to some degree. The cavernosal (penile) arteries are small in diameter and as men age, cardiovascular diseases, hypertension, diabetes, and other co-morbidities play an increasingly significant role in blocking blood flow. Prostate resections or removals can affect erectile function as well.

Both ED and premature ejaculation can have a physical cause or a psychological cause. Depression, performance anxiety, and other sexual disorders can be strong contributing factors even when physical causes also exist. While the vast majority of patients with ED will have physical disease, some may have a psychological issue; particularly younger men. Even when the underlying cause is physical, there are almost always psychological consequences to ED with marital and relationship issues, cultural norms and expectations, loss of self-esteem, shame, anxiety, and depression. or our ED patients, we will make the process comfortable! It is a simple process of explaining in layman terms how men are made that hopefully has you glad you came to talk it through and discuss options of treatment. You will have a specialized, tailored treatment approach to fit your needs. There is nothing more effective out there than Trimix, and the way we will formulate dosing is anything but common!


We will also achieve Level-Up care by establishing a very tailored approach to Erectile Dysfunction with many different options. 

1. PDE5 inhibitors (eg: Viagra, Cialis, Levitra) – not only offering pills but also sublinguals (stronger doses, more effective, quicker-acting) which are slowly absorbed under the tongue and at higher doses than are typically available.

2. Trimix, a penile injection, will be given as a test dose in office to evaluate it’s effectiveness due to its risk of priapism (prolonged erection that won’t resolve). We do several dose adjustments in order to specialize the dose for each patient. This is an approach that is extremely difficult to find.

3. ESWT – extracorporeal shockwave therapy, non-invasive treatment option that uses soundwaves to promote healing and treat ED. Has been used for a number of different types of treatments, eventually moved into treatment for urologic conditions in 1982.

4. PT-141 (or Bremelanotide) is used off-label by men for sexual performance enhancement. Given as a subcutaneous injection 45 minutes before sex, it boosts libido and desire by acting on the central nervous system. It improves erections, desire, and pleasure. It’s useful for treating ED and can be combined with treatments like testosterone, Viagra, or Cialis for enhanced effects.

5. Platelet-rich plasma (PRP) injections – the treatment uses a patient’s own blood cells to accelerate healing in a specific targeted area.


Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected and is often an unmet therapeutic need. There are two types of PE, primary and secondary. The difference between the two is the amount of time you’ve had the problem. Primary PE is diagnosed when this concern has always been present, and secondary PE is seen when the condition develops at some point; for this reason, it is also referred to as “acquired” premature ejaculation. As many as 1 out of 3 men say they experience this problem at some point. The International Society for Sexual Medicine (ISSM) definition of PE includes reduced ejaculatory latency, lack of control and associated negative personal consequences. The ISSM Committee defined PE as a male sexual dysfunction characterized by: 

1. Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration from the first sexual experience (“lifelong”), or a clinically significant reduction in latency time, often to about 3 min or less (“acquired”).

2. The inability to delay ejaculation on all or nearly all vaginal penetrations.

3. Negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

Patient assessment and management options differ depending on the classification of PE. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment, psychosexual behavioral therapy and psychological therapy. Medications such as SSRI’s (selective serotonin re-uptake inhibitor) are often prescribed for treatment. See the Resource Page for more detailed information, and call us for an appointment and discussion on how to approach your treatment.


1. Behavioral methods 

2. Pelvic Floor Exercises

3. Topical sprays, condoms

4. PE combo medications – oral or sublingual (under the tongue) medications taken as needed before sexual activity that will include help with prolonging ejaculation time and ED if needed