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Erectile Dysfunction

COVID and ED: The Role of Trimix

The list of symptoms, both long-term and short-term, from SARS-CoV-2, or COVID-19, continue to grow. Long-haulers suffering from exhaustion and other symptoms for months on end have led to research examining the effects of COVID on every system in the body. The list of medications that might treat symptoms of COVID gets longer and longer as the pandemic drags on. Research on the male reproductive system in patients with COVID has added erectile dysfunction and concerns about male fertility to the list of potential long-term adverse effects of COVID.

Researchers in China are running a clinical trial using sildenafil to assess its potential benefits in the treatment of COVID. Other researchers are looking at the effects of COVID on the vascular system (blood vessels) and the potential long-term effect on the cardiovascular and male reproductive system. From using ED treatment medications such as sildenafil to treat COVID, or purchasing Trimix to treat the long-term effects of COVID on erectile function, there are no conclusions yet, but let’s look at what they have found.

We know the excessive inflammatory reaction from COVID in some people adversely affects both the nervous and the cardiovascular systems. SARS-CoV-2, the virus that causes COVID, damages the lining of blood vessels. When this lining is damaged, scarring occurs. Blood flow is decreased in scarred blood vessels and the potential for blood clots increases. Blood vessel damage contributes to the lung and heart damage found in patients with COVID and men with erectile dysfunction.

In its 2018 guidelines, The American Urological Association panel points out the importance of accurate and timely diagnosis and treatment of erectile dysfunction. They state that the presence of ED may be a sentinel event that provides the opportunity to address multiple issues that may affect a man’s overall health. The underlying problem in both ED and cardiovascular disease is blood vessel damage. Symptoms of ED may precede symptoms of cardiovascular disease by five years, giving men additional time to determine the causes of their vascular disease and implement any lifestyle modifications or treatment before the damage is more permanent.

The Chinese clinical trial using sildenafil is important both for its potential benefits to treat COVID and as a reference sample population to determine whether preemptively using sildenafil decreases the rate of ED and cardiovascular disease long-term in men treated with sildenafil versus those who were not.

What Does the Research Say About COVID and the Potential for ED and Male Infertility?

The SARS-CoV-2 virus has infected millions of people this year. Hyper- inflammatory state and cytokine storm are used in everyday language, whereas, just a year ago, only a segment of the medical profession who treated the critically ill used these terms.

Cytokine storms that occur in people with more severe COVID result from an overreaction of the immune system. This overreaction causes widespread clotting and damage to small blood vessels. The lining of blood vessels are targets for the virus. The long-term potential for vascular disease and cardiovascular disease, and the increased risk for type 2 diabetes after COVID are extremely relevant findings to researchers in men’s health and the men they treat. Vascular disease, cardiovascular disease, and type 2 diabetes all are risk factors for erectile dysfunction.

Generating an erection is a complex physiological process that requires an intact nervous system, adequate hormone levels, the ability to dilate blood vessels and markedly increase blood flow into the penis, and the psychological desire for this process to occur. COVID damages blood vessels, and isolation harms psychological health. The potential impact of COVID on men’s health now and well into the future may be enormous.

COVID-19 and Testosterone

In males, cells in the testes called Leydig cells express the enzyme ACE2, the entry point for the SARS-CoV-2 virus. Leydig cells produce testosterone. Overall, men with COVID have more severe disease and a higher mortality rate than women. One study found that the lethality rate for COVID in men was three times that in women (Porchedu et al., 2020). Lower testosterone levels lead to upregulation of ACE2 receptors, which makes it easier for COVID to enter the lungs. Decreased testosterone levels in males can lead to increased inflammation and reduced immune response. Reduced testosterone levels have been used to prognosticate which men will become more critically ill from COVID (Sansone et al., 2020).

What does this mean? It is hard to say without more research. Will testosterone level screening and testosterone replacement therapy minimize the lung and cardiovascular effects and severity of COVID-19? It’s possible, but there is an increased risk of blood clotting secondary to COVID infections. Testosterone increases the risk of blood clotting as well. Is it possible to replace enough testosterone to help the immune response and decrease inflammation without causing widespread blood clots in men with lower testosterone levels?

These questions are not likely to be answered in time to impact the treatment of COVID. However, they may lead to further research, which may help determine whether testosterone replacement therapy should be more readily accepted and endorsed as a treatment for the physiological decline in testosterone levels with aging that may put older men at increased risk from viral infections that lead to cardiovascular complications and type 2 diabetes.

Regardless, the testes are a target for this virus, and the implication of this can have lifelong effects on male fertility (Hussain et al., 2020).

ED Medications and COVID

Oral medications for erectile dysfunction increase nitric oxide in the body by inhibiting the enzyme PDE5. These medications are used to treat ED because they increase blood flow to the penis. Nitric oxide relaxes blood vessels, increasing blood flow and thereby increasing oxygen delivery to tissues. Drawing on the strong similarities between the causes of ED and cardiovascular disease, it would seem logical that we should try ED medications as a potential treatment for COVID. A clinical trial is underway in China doing just that.

Syringe and Vials of Medication

In the United States, several research groups are experimenting with having patients with mild to moderate COVID inhale nitric oxide. This treatment has already shown potential in Italy.

The Effects of COVID on the Male Reproductive System Long-Term

If COVID causes long-term vascular damage and increases the worldwide incidence of ED, men will need effective treatment.

Men should be informed of all treatment options that are not medically contraindicated and supported in the SDM (shared decision making) process to determine the appropriate treatment (for ED). Although many men may choose to begin with the least invasive options (i.e., oral medications), the Panel notes that it is valid for men to begin with any type of treatment, regardless of invasiveness or reversibility.

American Urological Association

Trimix, Safe and Effective Treatment for ED

Many physicians and healthcare providers may only be familiar with using oral medications to treat ED. The American Urological Association felt that it was important to endorse a process of shared decision-making when treating ED. Men should be made aware of all the major treatment options, along with their risks and benefits. Some men may have tried oral medications and felt they were not effective or caused unwanted side effects.

Intracavernosal injections or ICI medications such as Trimix may be an option that better meets their needs. Injectable medications to treat ED have been used since 1983 and are considered the most effective non-surgical solution for ED, according to the American Urological Association (American Urological Association, 2018).

Trimix is injected into the corpus cavernosa of the penis to produce an erection. The American Urological Association panel reported that 53.7 to 100 percent of men achieved a satisfactory erection with Trimix, and 46.3 to 98.8 percent of men were happy with their choice to use intracavernosal injections as a treatment option.

How to Get Trimix Injections Online

Invigor Medical’s platform has proven successful for thousands of patients. You select the medication desired, fill out the intake form, and consult with your doctor, or a doctor from our partner company, Telegra MD, to evaluate whether you are a good candidate to buy Trimix online. The doctor sends the script to the pharmacy. The pharmacy mails the medication to you.

Trimix and other medications used to treat ED require a prescription. Buying these medications without a prescription is risky. The American Urological Association endorses a shared decision-making process. Why? Because this results in the best medical outcomes. Men are experts on their needs and the symptoms they feel. Requiring a prescription ensures that men partner with healthcare providers who are experts on the options available to treat ED.

Trimix Injections
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Trimix Injections

Trimix Injections are used as a second-line treatment when oral ED medications don’t work.

Learn About Trimix Injections


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice


  1. Hussain, A. N., Hussain, F., & Hashmi, S. K. (2020). Role of testosterone in COVID-19 patients – A double-edged sword?. Medical hypotheses144, 110287.
  2. Sansone, A., Mollaioli, D., Ciocca, G., Limoncin, E., Colonnello, E., Vena, W., & Jannini, E. A. (2020). Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. Journal of endocrinological investigation, 1–9. Advance online publication.
  3. American Urological Association. (2018). Erectile Dysfunction: AUA Guidelines. Retrieved from
  4. Porcheddu R, Serra C, Kelvin D, et al. Similarity in case fatality rates (CFR) of COVID‐19/SARS‐COV‐2 in Italy and China. J Infect Dev Ctries. 2020;14:125‐128.
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Published: Dec 15, 2020


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