The best treatment plans for ED in young men are always based on a thorough evaluation of all possible causes. You are entitled to, and in fact need, a full evaluation. And interestingly, sometimes the evaluation itself, and knowing the results, improves a man’s sexual functioning–though we will not be stopping there.
Our team includes a sex advisor/counselor who can help you understand what is making you anxious around sex, and give you techniques to decrease your anxiety about sex. He has also helped many of our younger patients get better at sex. We also have an exercise physiologist, who will work with you on both diet and exercise, which can have a profound effect on the quality of your erections.
If the evaluation does not show that there is anything wrong physically, rest assured we will not “cut you loose.” We need to get you rigid erections that you can maintain during intercourse! (We also need to manage any other sexual issues you have, like premature ejaculation, delayed ejaculation, low libido etc.)
Our medical approach is to treat you aggressively from the very start and then scale back as you need less and less. Many, if not most, men in this age group do very well with maximum dosages of the PDE5 inhibitors. Sometimes this is combined with a constriction band.
The majority of our younger patients find that over time, with good sexual experiences while using the medication, their confidence improves and they need less of the medication and need it less frequently.
What if the PDE5 inhibitors (like Viagra) don’t work?
Many of you may have tried the PDE5 inhibitors at submaximal dosages, with poor success. Many of you will have been taking them incorrectly (e.g. Viagra with food or alcohol) or with the wrong timing.
If you have been doing everything right, and still not getting and maintaining an erection with the maximum dosage of the pills, you may temporarily need something stronger. We have had many younger men on injections, who then “graduated” to pills, and then off all treatment.
What’s the chance of pill dependency/addiction?
Many younger men are concerned that this will create a dependency on the medication. However, you cannot become dependent because there is no tachyphylaxis to these medications. This means, that unlike some other drugs (opiates, benzodiazepines) your body does not get used to these medications over time, so you won’t need to up the dosage over time to get the same effect. In fact, we have found the opposite to be true. Over time, many of our younger patients need less medication and need it less frequently.
Thus, we do not recommend trying to get away with as little medication as possible. Rather, we want to “blast” your psychogenic sexual dysfunction out of the water. We want you to use the medication, until way after your body is telling you don’t need it any more. Fortunately, with erections the signals are rather obvious!
It has been very frustrating for us, over the years, to see Erectile Dysfunction in young men, when a solution is so achievable with the right treatment.