Erectile Dysfunction: The Best Treatments for ED

The best erectile dysfunction treatment options with Kristine Clements, ARNP-C

TREATMENTS MENTIONED

• Trimix Injections
• PT-141
• Oxytocin

TIMESTAMPS

• 0:54 Causes of ED
• 2:21 When does ED usually start?
• 3:45 Who can get ED?
• 4:17 Can ED be cured?
• 6:40 Injectable ED medications: Trimix, Bimix, Quadmix
• 9:04 Do penile injections hurt?
• 11:37 What do patients say?
• 12:21 What is the success rate of Trimix?
• 13:43 Oral ED options: Cialis, Viagra
• 15:04 Side effects of penile injections: Trimix
• 16:24 Treatments for libido: PT-141, oxytocin
• 18:55 Oxytocin spray
• 20:15 Stackable medications: PT-141, oxytocin

Transcript

Savannah 0:09
Hello, everyone. Welcome to the Invigor Podcast. I’m Savannah Webb joined by James Timmons, and today we are with Kristine Clements, who is an ARNP-C and specializes in erectile dysfunction. How are you doing today, Kristine?

Kristine 0:26
I’m well, thank you for having me.

Savannah 0:28
Yeah, definitely. James, if you want to kind of maybe talk about what we’re going to be going into today.

James 0:33
Yeah. So today, we’re going to be discussing everything from the causes of erectile dysfunction to the best available treatments. So Kristine, educating ourselves in these things is important. So we want to spend the next few minutes having you help us understand a few things about erectile dysfunction. So what is the science behind ED? Like what is physically happening in the body?

Kristine 0:54
Typically, it’s multifactorial. So there is some vascularity resistance going on, whether that’s from diabetes, high blood pressure, can be from high cholesterol. Could be other things; maybe they have pelvic fractures, or they’ve had, you know, paralysis of some sort. Maybe they have Parkinson’s disease or neurological issues. And so it can be a variety of reasons.

Savannah 1:25
Can you maybe talk about some of the main causes of erectile dysfunction?

Kristine 1:30
The main causes that we mostly see are diabetes and high blood pressure, and obesity.

Savannah 1:38
Obesity, is that, how does obesity play into erectile dysfunction? Does that have to tie in with the vascular sort of issue with it or…

Kristine 1:46
Anytime you have extra weight, you are taxing your body in some way, whether that’s on your heart or your lungs, and it does affect vascularity.

James 1:59
Yeah, we saw how obesity affected people with like, during COVID and stuff. I mean, yeah, just overall, it can definitely… it’s pretty common knowledge that obesity affects just about everything, but it’s interesting how it plays into erectile dysfunction. Yeah, how would… how would you… how common is erectile dysfunction?

Kristine 2:21
Yeah, the numbers about how common it is, is hard to find, really, because a lot of patients and people don’t seek treatment. So they’re embarrassed, they don’t go to their doctor and talk about it. And so they just kind of suffer in silence. But I would say, from the best that we know, probably it affects 50% of men, 40 and up.

James 2:46
Okay. Okay, I just turned 40, so… clock is ticking.

Kristine 2:50
You know where to go.

Savannah 2:51
Maybe. Can you tell us a little bit about, is there any misconceptions about erectile dysfunction that you hear a lot about?

Kristine 2:58
Well, what I would say is that patients think that there is nothing that can be done. “I just have this,” you know, “I cannot” you know, “have relations with my wife, with my girlfriend, with my partner… and there was nothing that we can do.” But I would say the majority of the time we can treat erectile dysfunction successfully with a variety of ways.

Savannah 3:22
Wow. Very interesting. Um, yeah, that’s… you know, it’s definitely one of those maybe more sensitive sort of health issues where I feel like people might be a little bit more reluctant to come forward and… and talk about it and admit that it’s an issue that they’re having, where it’s… it’s really, it’s something that doesn’t seem to be quite that way. Anybody can be affected by it, right? Different risk factors and things like that.

James 3:45
Yeah, so you don’t have the ability to like, just see somebody walking down the street and you know that they’re suffering from erectile dysfunction.

Kristine 3:50
That is, you know, that is so funny because I have patients that are marathon runners, triathletes that are the epitome of health, and they suffer from ED. So it is not just, you know, sometimes we don’t know the reason.

James 4:08
Yeah.

Kristine 4:09
Which can be so frustrating.

James 4:10
But you know, the key to the solution.

Kristine 4:12
We do.

James 4:12
The treatment.

Kristine 4:13
We definitely can help most of our men, which is great.

James 4:17
Yeah, so I mean, next question… get closer into that. Can ED be cured?

Kristine 4:24
Sure.

James 4:25
Okay

Kristine 4:25
It can be cured, absolutely! If it is multifactor, patients get their blood pressure under control, their cholesterol down, their body weight within normal limits. They can have ED issues and then all of a sudden, you know, they’re functioning at full capacity and doing fine. So they either get off meds, you know, altogether and they’re able to perform and function as they normally would.

Savannah 4:52
I want to talk a little bit more about the treatments, the actual treatments of erectile dysfunction, and how you were saying it can be cured. What can you tell us about some over-the-counter options available?

Kristine 5:04
Over-the-counter options? Not so much, those are gimmicky; don’t really do anything except for take your money. Now, there are some things that they can do like wave therapy, which is ultrasound, frequencies, treatments. They’re expensive, and they often don’t last for very long. So the longevity of those treatments are not there. But that is something that is non-invasive that patients can maybe seek if they don’t want to take medications. And supplements like arginine, carnitine, both of those can help with vascularity too.

Savannah: Can you go a little bit more into those two options that you talked about?

Kristine: Yeah. So there’s a couple of different ways to give both of those, those are amino acid blends. They can be given topically like on the inner thigh. And so they then absorbed systemically that way and help with blood flow in the pelvic region. And so they just take that, or put that on their inner thigh before… before sex. Also, they can use an injectable, and they come as an injectable. And you use that, you know, on a weekly basis to help as well.

James 6:26
So you say the word injectable, and I already know the answer to this, but I know that when men listen to that, they shudder. So can you tell us a little bit more about how the injectables work? Like what exactly does that mean?

Kristine 6:40
Sure, yeah. So when oral medications are not effective, or they’re not an option, because maybe you’re on other blood pressure medicines, and they just don’t jive well together. We have something like an injectable, a penile injectable, which is either bimix, trimix, or quadmix, based on the severity of their erectile dysfunction. There isn’t a lot of nerve endings on the side of the shaft where you give the injection. Most of our patients are quite comfortable. They don’t even feel it. It is just getting over the psychological part of “Oh my gosh, what am I getting into, giving myself an injection?”

James 7:20
Yeah, and I know that, that anyone that doesn’t know, they’re probably imagining a long needle. So can you tell us a little bit about just, what that, what that needle looks like?

Kristine 7:33
I can. The syringes are tiny. They are the tuberculin, what we call insulin syringes; very small, tiny, engage. So their diameter is very small, and they’re just such that they get into the cavernous body into the penile shaft where the medication goes, and then that will cause the relaxation and the blood flow to create the erection.

Savannah 7:58
You talked a little bit about the bimix and trimix. Can you maybe explain the difference between those two different medications?

Kristine 8:06
Sure. So based on the severity of a man’s erectile dysfunction, the provider will determine what medication would be best for them. Trimix is three ingredients, bimix is two, quadmix is four. And so like I said, based on their age and their severity, the provider would then recommend which level of treatment they would need. Bimix often is, you know, reserved for less severe ED, or ones that have some sort of sensitivity to an alprostadil, which is a medication in the injectable. And quadmix, then, we reserve for patients that are older or some that need some help with scar tissue breakup, with atropine in that mix can help do that for them.

Savannah 9:04
And each of these, I don’t assume it would be much different. They’re all an injection, but do any of them, what do your clients say about how it feels? Does it really hurt? And is this one of the main things that causes them to maybe not go for this option?

Kristine 9:19
Once they have made the decision to try an injectable, a lot of times they’ve done their doctor Google, and researched, and have really… I think the patients that come and wanted to do the injectable, they’ve done a lot of research. And like I mentioned before, there’s not a lot of nerve endings on the side of the shaft. So most of them are quite comfortable. They usually call us back and say, “Oh, you were right. It didn’t, it didn’t hurt.” Because if it hurt, they would not want to do it. Now, I’m just gonna be done.

James 9:54
Yeah, it’s funny. You mentioned they all did probably do a lot of research because I’m imagining like yeah, I don’t think I would like just walk into a room like, “Okay, stick me.” Yeah, so there’s probably like emotional barriers they have to go through to get to that point. And they’re like, “Okay,” and it’s like, not as bad as they expected, you know?

Kristine 10:13
Yeah, and a lot of times they’ve all come to us because their friend or their brother-in-law, or their father-in-law, or somebody has used it, and they have heard about it from somebody they know and they trust, and that is big because nobody, you know, better to learn from somebody you know and trust.

James 10:32
For sure. Yeah. So do you know anything about homeopathic treatments?

Kristine 10:38
Homeopathic treatments? Are you specifically asking about drops and that sort of thing?

James 10:45
Sure, Yes.

Kristine 10:47
I know of no homeopathic treatments that…

James 10:51
Okay. Okay.

Kristine 10:52
Honestly. Yeah.

James 10:53
Okay.

Kristine 10:53
I’m sure they sell them somewhere, but I am not sure. There is an injectable, or excuse me, intra-urethral suppository. So you basically stick a urethral suppository… in which case, it’s an alprostadil, but I have not heard that it works very effectively, and it also burns and hurts.

James 11:18
The only place I welcome any suppositories is into my mouth. Like I wouldn’t put an actual suppository in my mouth. But… yeah, urethral suppository sounds like a nightmare.

Kristine 11:32
Most patients think… yeah, it’s a nightmare. Yeah.

Savannah 11:37
Kristine, is there, I want to, I want to go back to the topic of the trimix and bimix injections a little bit. Do you have any patient testimonials to share with us?

Kristine 11:49
I can tell you, I’ve had patients cry on the phone and call back and say, “This has changed my life. You have saved my marriage. This has saved our marriage.” So those kinds of testimonies from patients are, you know, just make it all worth it. You know, because they’re coming to us out of desperation when nothing else has worked. And they’re looking for help. And so that we can give them back their sexual life. It’s life-changing for them.

Savannah 12:21
And with that, what would you say, statistically, what is the success rate of these treatments?

Kristine 12:28
90%.

Savannah 12:29
90%. Wow.

Kristine 12:30
That’s pretty high. Yeah, we can treat most men. You know, the next step would be a penile implant through their local urologist/surgeon, but 90% of the time, we’re able to give men, you know, an adequate sex life, or one that they’re happy with. Now, a 70-year-old man may not have a 21-year-old erection again. I don’t want them to, you know, get unrealistic expectations, but it should be a, you know, a firm enough erection that they’re able to engage in and be happy with. And that’s what we want.

James 13:09
Yeah. Have you had any people cry, like out of pain on the phone?

Kristine 13:15
No, I haven’t.

Savannah 13:19
No, like I’m doing it right now. We’re on the phone.

Kristine 13:22
No. Now, there are patients that don’t follow the instructions and they inject improperly and they may, you know, have some issues that way. Yeah. But we provide very good, you know, instructions and videos for them, for them to feel comfortable about giving their injection properly.

James 13:43
Well, speaking of foolproof methods of erectile dysfunction meds, tell us about the oral medications. I know there’s sildenafil and tadalafil. Is that how they pronounce it?

Kristine 13:56
Yeah. tadalafil/sildenafil, Viagra/Cialis, for patients that, you know, know of it by their trade name.

James 14:05
Okay.

Kristine 14:05
But those medications are great, they are systemic, so they go through your entire body. They can interfere with a patient’s own medication lists such as high blood pressure medications or some of their components of treating the high blood pressure, so they’re not for everyone. The other thing is, is they don’t always work for everyone, which is why there is an injectable. But the statistics show that about 75% of men who use an oral sildenafil or tadalafil get good results, so that’s, it’s a high number.

James 14:43
But that’s a C and trimix has a, is an A.

Kristine 14:47
That’s right. You got it. That’s right. And some men get good results with using it, but they have headaches, and stuffy noses, and blurred vision, and the side effects for some of those can be debilitating for our men.

Savannah 15:04
If we could go back, again with the injections, is there side effects with those as well?

Kristine 15:10
Side effects from the injection can be very… it’s really very low. Because we are just treating the erection only. The metabolism of the medication is really done at the site. And so if they are injecting properly, and their medication is of the right dose, usually you’re getting a good firm erection… adequate duration. Some men will develop a priapism, which is an erection longer than four hours, in which case we have a safety precaution for them. There is an antidote that they can inject… will bring their erection down. But I would tell you that most often it doesn’t happen in our patients because they’re following good direction.

Savannah 15:57
Okay. So it’s important to take your advice.

Kristine 16:00
That’s right. Don’t over inject. Don’t, you know, you don’t want to just go at it alone.

James 16:05
Yeah, don’t take Viagra and an injection at the same time.

Kristine 16:08
That’s right. Yeah. Yeah, one or the other.

Savannah 16:11
Could you take them together? What would happen?

James 16:13
Yeah, good question.

Kristine 16:14
You would develop a priapism most likely. You would have a four-hour erection. So it isn’t advised that they take them together. One or the other.

Savannah 16:24
Okay. Well, with all of this, I wanted to talk a little bit about libido because that is an important factor in all of this. So, what are some of the available libido treatments out there? Or maybe libido medications?

Kristine 16:40
Okay, so we’ve got a couple treatments for libido and one is FDA-approved for women for low libido and we’ve got PT-141, which is great because these are not for the vascular system, they work on the nervous system. So they talk to your brain basically, to spit out more dopamine that helps with desire and sexual activity. Helps with erection firmness too. The nice thing about these is that you just take them as needed basis. They come in a nasal spray or an injectable, not a penile injectable though, just a subcutaneous injectable.

Savannah 17:25
Can you tell me what subcutaneous is?

Kristine 17:27
Just right underneath your skin.

Savannah 17:28
Oh, okay.

Kristine 17:29
So you can do your abdomen, your hip, your buttock area. So it’s not a penile injectable, and some patients would rather start there and, you know, see how they do with that. So yeah.

Savannah 17:41
Yeah, so those libido medications that you were talking about. Do those work with men as well?

Kristine 17:47
That’s right. Both men and women on both those medications can be used for both.

Savannah 17:53
Okay, so it definitely is… So the PT-141 can be used maybe at the same time, if they’re planning on having sex?

Kristine 18:03
You can, you can take PT-141 prior to engaging, like an hour before. Usually the onset is within that hour. And it lasts between two and four hours.

Savannah 18:16
Okay.

Kristine 18:17
So it’s kind of a nice length of time.

James 18:20
So it just gives you the desire?

Kristine 18:22
Helps with desire. Spits out, yeah, more dopamine.

James 18:26
So, if you have like healthy erectile function, but you just have like a low sex drive, then…

Kristine 18:33
Right.

James 18:33
Help with that, Okay.

Kristine 18:34
Absolutely.

James 18:35
Cool. Yeah. So you can, I mean, so you have like a whole menu of options that we have a healthy sex life.

Kristine 18:41
Well, we have good treatment specialists too, that you can call in and talk to them, and they can really formulate a good plan for you, before it goes to the provider for them to even further talk clinically for you.

Savannah 18:55
Wow. The last thing on my list here is something called oxytocin spray. Can you just tell us a little bit about that as well?

Kristine 19:02
Yeah. Oxytocin is a peptide. You know, it’s used in labor and delivery to induce contractions. So it is used for that. But what we’ve found is, is that it also helps with… um… it’s a cuddle hormone, is what we call it. So it helps with libido and desire. And it works as a nasal spray. Yeah, nasal spray is what we have available currently for that.

Savannah 19:32
A nasal spray, so it’s nothing like the injections.

Kristine 19:36
No injection.

James 19:36
So it’s a spray. So it could be a like a love potion. So if you wanted a woman to be attracted to you spray her without her knowing. Right?

Kristine 19:44
That’s right (sarcasm). You could try that.

James 19:47
I won’t try it.

Kristine 19:48
Okay.

James 19:48
But some people could. Yeah

Kristine 19:50
Somebody could.

James: That would be an interesting experiment.

Savannah 19:52
Would that really work, though?

Kristine 19:53
No, no, it has to be systemically.

James 19:56
She’s not allowed to say it would work.

Kristine 19:59
So… So yeah, in the same way that PT-141, you would you give it about an hour prior and onset… A little bit less. Probably about two hours for…

James 20:10
So spray her an hour early.

Savannah 20:13
Spray her an hour early.

Kristine 20:15
Both men and women. And you can use that in conjunction with other treatments too. So those are nice. Those are stackable, what we call stackable medications that you can use with something like a Viagra, Cialis or an injectable.

Savannah 20:28
Okay, so it can be used on top of other medications. Is it addictive at all? When you, when I hear oxytocin, I think of oxycontin?

James 20:36
Yeah, same.

Kristine 20:37
Oh, totally different

James 20:38
Is not the same spelling.

Kristine 20:41
No, oxytocin is a natural hormone. So no, not addicting. Any of these medications, really, if you use them, you’ll get an effect and benefit from them. If you don’t, there’s no wean down or dependency issues with any of those.

James 20:58
Sorry, said wean down and I thought… That’s the opposite of what we’re trying to accomplish…

Savannah 21:07
That would be the antidote.

James 21:08
Yeah yeah, exactly. That’s what you should call it. So yeah, what what ED medications does Invigor Medical offer?

Kristine 21:17
Everything that we’ve talked about today we offer. So you are able to just jump on if you want to read more about any of those medications or supplements and think any of them could be right for you. If you want to call in, chat in, with our treatment specialists, they would be happy to help you as well. And so we offer everything we’ve talked about today.

James 21:40
Okay.

Savannah 21:41
Great! Christine, thank you so, so much for joining us. You’re just a wealth of information and we really appreciate it.

Kristine 21:47
Thank you for having me. I really enjoyed coming on.