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    Suggest treatment for erectile dysfunction

Posted on Mon, 17 Jul 2017 in Urinary and Bladder Problems
Question: Hello, my name is xxx, and about two months ago, I was diagnosed with ED... I am taking ASOX9 male enhancement pills for three weeks now... I see absolutely NO effects, and NO results!?!?!. However, I have read other ASOX9 reviews on internet, and some people reported first result within one to two weeks... I am about to give up on ASOX9... I would love to know if you have any other reported results from other ASOX9 users just like me?

FYI, prior to taking ASOX9, I had been taking VigRX male enhancement pills for 6 weeks, I also saw no results.
I am also currently taking (for about 4-5 weeks) Steel Libido RED pills, in addition to ASOX9. I take 4 pills at once in the evening, and sometimes I see some effects of erection, however erection does not last more then 30 seconds to a minute...

The funny thing (or rather sad), I do have a boner in the morning when I wake up, so I have no idea why I can't have the same in the evening with my wife...

Do you have any recommendations for other male enhancement pills?

Thank you very much!
Answered by Dr. Manuel C See IV 11 hours later
Brief Answer:
Diet exercise foreplay and pharmacologic RX.

Detailed Answer:
Good day and thank you for being with healthcare magic!

I m sorry to hear that your have erectile dysfunction at an early age of 44. I think you may have a psychogenic cause for your erectile dysfunction. I can say this because you have good morning erections.

Also it is worth mentioning that you have to identify and differentiate between erectile dysfunction and premature ejaculation.

You need adequate exercise,and healthy food intake. Effective enjoyable foreplay also goes a long way for good sexual intercourse with your partner.

I don't have personal experience with my patients regarding ASOX and steel libido but from what I read they are supplements with no approved therapeutic claims.

For my patients with your same profile i usually prescribe sildenafil (e.g. Viagra) to jumpstart the erections and bring back the confidence of the patient for his erection. I am unable to write you a prescription and it would be best to see a Urologist for this.

Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Manuel C See IV 40 hours later
Hello, thank you very much for your reply!
I have the following questions:
(1) What does "psychogenic cause" exactly mean? Could you please explain it to me in layman terms, since I don't have medical degree to fully understand its meaning?
(2) If I do have morning erections, does it mean I have ED? My understanding of ED is a complete lack of erection under any circumstances... am I wrong?
(3) What is the difference between ED and premature ejaculation? What can cause premature ejaculation? I actually do have premature ejaculations, and cannot last more then 30 seconds to a minute maximum...
(4) I have been taking anti-anxiety drug called "Trintellix" as 10 mg / day prescribed by my physician doctor (it is a fairly new drug on a market). Do you think "Trintellix" could have side effect and cause my ED issues?
(5) Regarding Viagra, do all of your patients experience side effects like headache and chess pains for example? Or maybe only older men experience side effects?
(6) Do you think a high cholesterol level could cause blockage in the blood vessels, and significantly slow down blood flow in the penile area?
Per my doctor Urologist, I had done penile test, which concluded I have a diminished flow on both sides of my penis.
FYI, I am a very healthy man, who excises daily (weigh lifting, jogging), and I watch what I eat, trying to stay with only healthy food.
Thank you very much!
Answered by Dr. Manuel C See IV 8 hours later
Brief Answer:
Antidepressants could be causing ED.

Detailed Answer:
Thank you for your follow up questions.

1. Psychogenic means that nothing is wrong in your organ per se. and your mind is causing the erectile dysfunction. Morning erections are a good sign that the organ is able to have an erection and the blood flow is going on the penis to produce an erection. Re : the test that your Urologist did showed a diminished blood flow in the penis which may mean you have a mixed etiology for your erectile dysfunction.

2. answered in number 1.

3. Premature ejaculation (PE) is involuntary ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration and inability to delay ejaculation that is causing distress to patient and partner.

Erectile dysfunction is unable to have an erection or loss of erection without ejaculation or orgasm. Premature ejaculation as stated above is hasty ejaculation prior or shortly after vaginal penetration.

PE is caused by over excitment, lack of experience, anxiety towards new partner. Treatment are relaxation methods, anti depressants have also been shown to increase vaginal penetration time because of it's side effect of sexual dysfunction.

4. Yes all anti depressants have an effect on libido because of its effect on serotonin. Various anti depressants have various effects in terms of how bad it messes up the libido and ultimately may cause ED. Your medicine has a milder effect on sexual drive as compared to older anti depressants but yes it mag have caused your ED and I suggest discussing this with your physician.

5. Not all would have the side effects and this side effects are very mild and most of the time doesn't force them to stop drug intake. they are tolerable effect of the drug and it's benefits for outweigh the discomfort.

6. Yes cholesterol plaques, hypertension and Diabetes may cause ED and decrease penile blood flow.

Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Manuel C See IV 13 hours later
Thank you very much, Doctor!
Below, I have some follow up questions in regards to your last reply.

I have two separate problems:

Problem 1: when I am aroused, my estimated penile erection is only about 75-80% of my physical ability (when compared to my previous years of penile erected strength and size). I am taking ASOX9 for about 3 weeks now, and I was told it should help to improve my erectile condition to 100% of my ability. Does Viagra guarantee a 100% full penile erection?

Problem 2: due to problem 1 above, my erection does not last long during the intercourse, even if I am very much aroused. Is this because of diminished blood flow in the penile area (physical issue)? Or is it because of my mind (mental issue)? Or is it a combination of both physical and mental issues together?

Problem 3: for some reason, I am able to have and to maintain erection in a top position, but I am not able to maintain erection in the bottom position!?!?... Could you please try to explain it???

Problem 4: anti-depressant "Trintellix" (10 mg / day) --> per advise from my physician doctor, I have stopped taking it about 5 weeks ago (05/11/2017), however my ED problem did NOT go away. Do you think if I don't take Trintellix for another 2-3 months, my ED problem may go away? Or, my ED problem will stay with me for the rest of my life?

FYI, for about 3-4 years, I was taking another anti-depressant drug called Sentraline HCL-Zoloft (50 mg / day), and in September 2016 my doctor switched this drug to Trintellix (10 mg / day) due to early ED symptoms I experienced in the bedroom. Do you know anything about Sentraline HCL - Zoloft???

Problem 5: effect on serotonin --> what can I do and how can I improve serotonin condition? Is this condition temporary or permanent for the rest of my life?

Last question --> in your reply to my question 3 above, you have said "anti depressants have also been shown to increase vaginal penetration time". So, I am confused - what anti-depressants do I need to take in order to increase vaginal penetration time? Or, perhaps I mis-understood you?!?!...

Thank you very much!
Answered by Dr. Manuel C See IV 20 hours later
Brief Answer:
Yes Viagra will help you.

Detailed Answer:
Good day.

1. Yes viagra would definitely increase erection and girth of your penis and I really suggest you try it.

2. You loss erections because of ejaculation or lose erections spontaneously without ejaculation?
It may be both mentally and physically.

3. Hard to say why but my best guess is that maybe you are more stimulated with one position over another.

4. Zoloft produces more ED as compared to Trintellix. Depression in itself causes sexual dysfunction
You need to see your psychiatrist to discuss side effect of medicines.

5. anti depressants causes increase in serotonin because it has been theorized that lack or decrease in serotonin causes depression and anxiety. Sunlight have been shown to increase serotonin together with vitamin b6.

6. anti depressants decreases libido therefore prevents ejaculation. the decrease in libido also causes erectile dysfunction.

Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Manuel C See IV 2 hours later
Thank you very much, doctor!

(1) Regarding your recommended Viagra, I have these questions:
1A) do I take it any time daily (10 mg / day)
1B) do I only need to take it 1 hour before sex?

I have heard people taking it different ways. My preference is to take it any time daily, since I have no idea when I will have an opportunity to have sex.

By the way,
(A) my urologist recommended me Cialis (10 mg / day). I decided first to try male enhancement pills, since they have no side effects.
(B) my urologist ordered blood work two months ago, and here are the test results:
- Free T calculations = 106 pg/ml (ref. range = 47 ~ 244)
- Testosterone - Total = 572.1 ng/dL (ref. range = 249 ~ 836)
- Prolactin = 8.0 ng/mL (ref. range = 4.0 ~ 15.2)

(2) I have loss of erections spontaneously during sex without ejaculation, and I can NOT control it!?!?!
2A) What does it mean?
Also, during sexual intercourse I can loose erection easily, and then, I have a very hard time to have an erection again?!?!?
2B) What does it mean?

(3) I noticed, during day time, my penis is completely 'dead' and cold. However before I start having ED issues, my penis during day time was always 'alive' and feeling hard... Also, during sex, my penis is NOT fully erect (somewhat erect). However, in the past, my penis used to be very very erect and hard.

3A) is it because of diminished blood flow in penile area?
4B) is it due to the lack of stimulation and sexual arousal?

(4) I would like to clarify about Zoloft - it was originally prescribed by my physician doctor about 3-4 years ago for anti-anxiety only, and not for depression (I never had issues with depression).

4A) do you think if I am no longer taking Zoloft (since September 2016), I will stop having ED issues lets say in a year or two?
4B) do you think my condition is permanent, and Zoloft completely destroyed my ability to have erection without Viagra or male supplement pills?

(5) Question --> if my ED issues are psychogenic (you have said "nothing wrong with my penis per se"), then why penal test results had shown a "diminished blood flow on both sides of my penis"? FYI, they did inject my penis with some fluids 10 minutes prior to penal test via ultrasound equipment, which caused an erection.

(6) Do you recommend me to start taking vitamin B6? What is daily dose (mg)?

Thank you very much!
Answered by Dr. Manuel C See IV 8 hours later
Brief Answer:
Suggest to take Cialis.

Detailed Answer:
Good day,

A) Cialis would be a good drug for you since it's effect lasts for 3 days while Viagra effect is only for 4 hours. I would recommend cialis rather than taking Viagra once a day then you'll have to drink a low dose before having sex.

B) Loss of erections without ejaculation is definitely erectile dysfunction. And yes you have erectile dysfunction.

C) The reason for your ED could be because of diminished blood flow and decrease in libido. You mentioned before you have good morning erections. Morning erections means that your organ is still okay but maybe not 100% because of diminished blood flow in the penis.

D) Some patients report having the sexual drive back in months to years but I believe it would slowly come. You need to exercise to boost testosterone.

E) With the test result I believe you have both physical (diminished blood flow) and mental (SSRI effect etc. ) that is causing your ED.

F) Vitamin b6 recommended dosage is 1.5-1.8mg per day. intake of zinc may also help. Just make sure that your daily vitamin contains both minerals.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
Follow up: Dr. Manuel C See IV 2 hours later
Thank you very much!
1) What do I need to do to increase the blood flow? What are my options beside Cialis?
2) What do I need to do to increase my Libido? What are my options? Do I need to take pills?
3) I excercise daily for over 20 years, jogging and lifting weights, playing soccer, riding bike, roller blading, sometimes camping.. what else do I need to do to boost testosterone level? Do I need to take pills?
4) I take daily the following pills:
- multivitamins for men ("Men's One Daily" - for about 10 weeks)
A) it has 15 mg of Vitamin B-6 --> is this too much? You said 1.5 ~ 1.8 mg in your reply, correct?
B) it has 300 mg of Zinc --> is this enough? FYI, ASOX9 below also has 50 mg of Zinc... is it okay or too much?
C) it has 8 mg of D3, however I am already taking Vitamin D3 pill daily (2000 IU) - per recommendation from my physician doctor.

- vitamin D3 (2000 IU) for 2 years

- valerian root (450 mg) for about a year --> do you think it is possible for Valerian root to slow down blood flow in penile area?

- male supplement pills ASOX9 (for almost 4 weeks) - it has Zinc 50 mg, Tongkat XXXXXXX 400 mg, Maca 250 mg, L-Arginine 250 mg, Ginseng Eleutherococcus Blend 125 mg, and Proprietary Blend 745 mg.
A) what are the ingredients of Cialis?
B) how many mg / day of Cialis is recommended?
C) I am not clear on how Cialis pill work - when I take one pill, does it make penis big right away? Does it make penis big without arousal? Do I need to wait for some time before it kicks in and starts working? I have heard in some cases Cialis does not work the first or second day... so, do I need to take Cialis for a week before I see the results?
D) What are reported Cialis side effects?
E) Does Cialis interfere with Trintellix?
Thank you very much!
Answered by Dr. Manuel C See IV 40 minutes later
Brief Answer:
Once every 3 days would be my recommendation.

Detailed Answer:
Good day thank you for your questions.

I don't think there is a way to increase penile blood flow naturally and intake of viagra and Cialis would increase the blood flow. Cialis contains tadalafil and it has the same side effect profile as Viagra as discussed previously. Low dose daily Cialis intake 10 mg has been to be safe but still need to to take 10mg before having sex. I suggest you take 20 mg an hour before and it would last for 3 days the effect of the drug.

If you drink the medicine you will still need to be stimulated before having an erection. effect would be felt one hour after intake. And no it has no interaction with Trintellix.

Your supplements are all okay and you may take a little more than the recommended doses because it is hard to get over dose with those vitamins.

I am sorry I am not familiar with valerian root.
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Manuel C See IV 3 days later
Hello, thank you very much!
My ED issues started about 2 years after I was taking Zoloft. My physician doctor told me that I have decreased in libido, and my urologist told me that I have diminished blood flow in penile area.
My questions:
1) Does Cialis increase blood flow in penile area?
2) Does Cialis increase libido?
3) What can be done to increase libido, and are there any male supplement pills that I can take (besides Cialis)?
4) Is there is a difference between libido and sex drive?
5) Are there any medical doctors who specifically specialize in ED?
6) Do you specialize in ED?

Below, is my behavior - it is happening about once per week, so I will describe it in only one short story:
Last Friday morning, I started to feel some enjoyable tingling and itching in my testicles, and some blood flow in penile area... Friday evening I was "aroused" (about 75% erection = penis was semi-hard). I felt aroused and excited, and I was able to have an intercourse which lasted about 4-5 minutes... That was a really big deal for me, and a boost of confidence... So, Saturday morning, I woke up having the same enjoyable feeling!!!... And, I was aroused again, and I have started an intercourse, however... after about 30 seconds I completely lost erection, and I was NOT able to have orgasm... I was very aroused and excited, but in the middle of the intercourse I completely lost erection... I have NO idea why?!?!?...
A) Is it because I have a low libido?
B) Is it because blood flow stopped?
C) Is it because I was "tired" from the sex from night before?
D) Is it because I have a low level of testosterone?
E) Is it because it was morning time, and typically erections in the morning are rare?
I am frustrated and I need advise.
Thank you very much!
Answered by Dr. Manuel C See IV 14 minutes later
Brief Answer:
Yes cialis increases blood flow.

Detailed Answer:
Yes Cialis increase blood flow in the penis and will give you erections.

No Cialis doesn't increase libido. Sex drive and libido are synonymous.

Sex psychologist/ therapist specialize in sex and can help you greatly.

Your experience could be because of all the things you mentioned acting together. But if you have sex drive then your libido is okay and maybe because of the decrease blood flow that is why you lost erections or in a good day you only have 75% erections.

Your testosterone levels are within normal so it's not your problem. Typically morning erections are regular because of testosterone surge in the morning.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Manuel C See IV 46 minutes later
Thank you!
1) I have a very strong desire to have sex, but I have no erection
A) is it because I have a low libido?
B) it is because I have a diminished blood flow?
C) Or both A and B above?

2) What is the difference between psychologist and therapist?
I think my problem is not psychological, my problem is physical - Zoloft killed my libido, and I am frustrated because I created a problem for myself by taking Zoloft... I think it is irreversible process, and I will never be healthy again. Please tell me otherwise, doctor!?!?!
Thank you very much!
Answered by Dr. Manuel C See IV 8 minutes later
Brief Answer:
I think your condition is not permanent.

Detailed Answer:
If you have desire to have sex then your libido is okay and you have problems physically (blood flow). Cialis would help you with increasing blood flow to the penis and cause erections.

Therapist and psychologist are same.

I believe it the effect of the Zoloft is not probably permanent and you just wait for the effect to decrease and be normal.
Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Manuel C See IV 1 hour later
Thank you very much, doctor!!!
(1) If have any experience with Zoloft side effects, when do you think I will be normal again, 6 months, 1 year, 2 years...? What is the worst case?...
(2) Sometimes I can get aroused, but sometimes even after 20 minutes of foreplay I can NOT get aroused at all, no matter how much exiting is foreplay before intercourse. Does it mean I have low libido, or low blood flow? Or both, low libido AND low blood flow?
(3) If I start taking Cialis (for a year), then when and how will I know that I am back to normal from Zoloft side effects?...
Answered by Dr. Manuel C See IV 8 hours later
Brief Answer:
You need to follow up with psychiatrist to discuss medicine side effects.

Detailed Answer:
Technically Zoloft will stay in the system only for 15 days thereby its effect should be completely reversed in 2-3 weeks. Although some patients report they have decreased libido several years after taking Zoloft. This is something you should discuss with your psychiatrist because it is within the scope of his specialty and the psychiatrist would be able to help you better and answer your question regarding the drug and its side effects.

What do you mean aroused? Aroused as in get an erection ? or Aroused meaning the desire to have sex? Libido/sex drive is the desire to have sex while Erectile dysfunction is the inability to have an erection despite the want or desire to have sex.

You'll know if your able to have an erection and have normal sexual activity without taking Cialis.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Manuel C See IV 2 hours later
Thank you very much!
Yes, when I said "get aroused" I meant to say "get erection".
(1) So I do have a great desire to have sex, but I can't have an erection.
Does it mean I have a low Libido? Or does it mean I have a low blood flow?
(2) the last few days I don't feel my penis is alive, it hangs like a cold piece of meat, and it feels "dead"...
Do you think some energy pills would help me to start feeling my penis again?
(3) If I take Cialis for the very first time, how long before I start feeling anything? Is it one hour, or three days? Is it better to take it daily in the morning or in the evening? With or without food?
(4) is there a concern about addiction after taking Cialis for a long time?
(5) is Cialis better then Levitra?
Thank you very much!

Answered by Dr. Manuel C See IV 7 minutes later
Brief Answer:
Cialis is better.

Detailed Answer:
I think you have the libido but the organ is not functioning properly. No there is no addiction for Cialis and it would work after one hour of intake and would last for 3 days. if your going to take it daily, it doesn't matter whether it's morning or evening as long as you take it same time everyday.

The supplements and vitamins that you are taking is more than enough and you don't need more.

Cialis is better because it can be taken with our without meals and last longer than levitra.
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Manuel C See IV 1 hour later
I see... so I have low Libido. So why my organ is not functioning properly, if it is erected in the morning?
Do any of your patients have the same ED symptoms as I?
Do any of your patients take any male supplement pills?
If yes, then what brand / name are those pills? Did those male supplement pills help them with ED issues?
Thank you very much!
Answered by Dr. Manuel C See IV 5 hours later
Brief Answer:
Drink Cialis to have good erection.

Detailed Answer:
No your libido is okay dinner you have the urge to have sex. Your penis has erectile dysfunction. Sorry no I don't have a patient with your same problem.

My patients with ED drink Viagra or Cialis then they are happy about their sex life already.
Above answer was peer-reviewed by : Dr. Kampana
Answered by
Dr. Manuel C See IV


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