Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
152 Doctors Online

By proceeding, I accept the Terms and Conditions

Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

HCM Blog Instant Access to Doctors
HCM BlogQuestions Answered
HCM Blog Satisfaction

Suggest treatment for low testosterone levels

Answered by
Dr.
Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2279 Questions

default
Posted on Thu, 8 Jun 2017 in Urinary and Bladder Problems
Question: To whom may I speak regarding testosterone and ED injections?

not--as I am--a urologist? what's the difference?
doctor
Answered by Dr. Mirjeta Guni 1 hour later
Brief Answer:
Hormones are part of endocrinologist:

Detailed Answer:
Hello again,
Usually the endocrinologist deals with the hormonal side, the urologist deals with vascular or mechanical problems of the urogenital tract.
Regards,
Dr.Mirjeta


Brief Answer:
Would be a pleasure to help you;

Detailed Answer:
Hello,
Endocrinologist are the specialists who deal with them.
Will be a pleasure to help you, just write the questions or concerns you have.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Mirjeta Guni 16 hours later

I use Trimix, and it worked well for three weeks. It didn't the last time I tried it.
Is there a correlation between ejaculation and the intervals of time sexual activity takes place. What I described happened on Friday. I would like to try today, but am nervous about doing so.

My urologist says my testosterone is "border line low." Would you advise injections.
This is really frustrating.
doctor
Answered by Dr. Mirjeta Guni 11 hours later
Brief Answer:
Increase the dose of Trimix:

Detailed Answer:
Hello again,
At your age the testosterone is expected to be ''borderline low''. Usually the low testosterone level causes loss of libido and not ejaculation problems. So i do not think testosterone injections would help in your case.
As trimix has helped before, you should keep using it. You should know that the dose should be adjusted according to the symptoms. If ejaculation is not reached with the actual dose, you should increase it.
The common initial dose should be .05cc to .2cc depending on the level of ED. Increase by 0.025 cc to 0.050 cc until a satisfactory dose is reached.
Hope the information will help.
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Kampana
doctor
default
Follow up: Dr. Mirjeta Guni 8 hours later
I increased it yesterday --twice and no result. Phoned pharmacy just now and they rattled off a series of questions, and concluded I was doing everything correctly.
They expressed XXXXXXX that it worked so well the first two times but not afterwards

I went through the same problem for two months last year, then tried caverject. It worked so well after two times that, I resumed oral medication--cialis, viagra, and XXXXXXX Then difficulties arose in April. Tried coverlet; didn't work. Then trimix.

You said nothing about my the intervals between injections. So I assume that doesn't matter.

What is stronger Trimix or Caverjet ( which now comes in .40 cc[?]?

Baffled.


doctor
Answered by Dr. Mirjeta Guni 18 hours later
Brief Answer:
Caverject versus Trimix:

Detailed Answer:
Hi again,
Regarding to interval of injections:
Both TriMix and Caverject carry a warning that they should not be used more than once every 24 hours, and not more than three times in a week, or else incidence of fibrosis (scarification and curvature of the penis) rises.
Caverject contain Alprostadil, while Trimix alprostadil, papaverine, and phentolamine, so i would say that trimix is stronger (if the dose of alprostadil is the same at both preparations).
There is an option for cream preparations of Trimix that is more easy to use than the injections.
Normally they are a second alternative when viagra, cialis are not efficient.

Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Mirjeta Guni 35 hours later
Thanks for you comprehensive responses and please forgive the stylisic and grammatical imperfections in some of the above questions.

I saw my urologist today. After some pressure from me we agreed on TriMix Super
100 (mcg) of alprostadil; 3 mg phentolamine; 30mg papervine. He wanted me to first try .50 cc (?) of TimMix standard But I wanted to wait. I see my parter on Friday wanted to be ready for my friend.

He did warned me of the dangers (of which I was aware) of priapism. But I have been taking ED medications for 10 years. I routinely started with the highest dose, and sometimes--I know this is wrong--doubled the quantity. They worked up to last year. Priapism was never a problem. He prescribed the smallest dose ( I don't have the prescription) and indicated a slight increase --so the pharmacist in Florida, three thousand miles away) told me if there was no satisfactory result in twenty minutes.

How real, in your opinion, is the danger of priapism under the dosage he prescribed? I know you cannot answer authoritatively My interest is in an erection, but not at any cost, of course.

The problem was with that first bottle of TriMix standard. It worked perfectly twice once on a Wednesday under my doctor's supervision, the other on a Friday. And that was it. I waited an entire week before trying it a third time. Nothing. Two days later the same thing.

The pharmacist suggested my doctor examine the bottle. But he was not interested (he'd just come from surgery).

Can you speculate as to the reasons for the mishap. The pharmacist (or the doctor or myself) can't understand what happened. The directions say the medication should be frozen, but I left in the refrigerator for a week. Maybe that had something to do with it.

Thanks
doctor
Answered by Dr. Mirjeta Guni 16 hours later
Brief Answer:
About Trimix efficiency:

Detailed Answer:
Hi again,
The risk of priapism with Trimix injections is about 16 % (of course in larger doses the risk is the highest). Using high doses without sliding scale (increasing it gradually) increases the risk of priapism.
There should be a very detailed analysis to try to find out why Trimix does not work some times, there are many causes starting from the examination of the bottle, the way you inject it, the environmental factors (psychological status ect).
You should discuss them carefully with a physician in person.
Best wishes,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Prasad
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Drug/Medication ,   ,   ,  
Lab Tests

Recent questions on  Testosterone level

doctor1 MD

My total testosterone level is 735, with my free test level being 71, with a range of 50 to 180 for free test according to the doctor. Is my free...

doctor1 MD

Hi j got married one month before and notice something Surprising.i was not able.to keep erection during intercourse.however erection was.ok but it...

doctor1 MD

I am a 52 years old man 10 months ago I notice I was not getting a erection. My doctor said my prostate was a little large but not to bad {I am on...

doctor1 MD

I am a 62 year old male. I am seeing my regular doctor soon for my checkup. I have requested a testosterone test be done along with my other...

doctor1 MD

Hi Doctor I was on diane 35 for a year and a half along with glyciphage. upon getting a scan and blood tets recently the results show that i still...

doctor1 MD

sir i want to know that my testosterone levels are just in normal range, but what i have observed my testicles have reduced in size and they seems...

doctor1 MD

Hi...im 22 years .. I had a problem with erection from 5 months..and it statrd with pain at anus and it also developed in penis and loss of...