Erectile Dysfunction Treatments: DHEA, Shockwave Therapy, and More

Treatment for erectile dysfunction

Hello, in the past year or two, I've started to notice issues with my erectile function.
Currently, I can achieve an erection and ejaculate through self-stimulation, but I feel that the hardness is not sufficient.
Previously, I could maintain a strong erection every day, but now, although I can ejaculate through self-stimulation, I clearly feel a decrease in hardness.
The situation during intercourse has also been deteriorating.
If I take a few days off from sexual activity, I can insert, but I may not be able to ejaculate successfully and might lose my erection midway.
If I attempt to have intercourse for several consecutive days, I may have issues even achieving an erection, although I can still get a slight erection through self-stimulation, just not with good hardness.
Morning erections are also inconsistent.
Recently, I sought medical advice, and the doctor conducted hormone tests.
He mentioned that my cortisol levels, which is a stress hormone, are excessively high and explained that my testosterone levels are slightly low, suggesting that I need to supplement with DHEA to improve my hormonal status.
He indicated that when testosterone is low, DHEA is used for supplementation, and if DHEA is insufficient, it could lead to problems.
Therefore, he recommended taking Suromon (DHEA).
Additionally, I have previously taken Viagra, which was effective, but I experienced significant cold-like side effects, which were uncomfortable.
I did not ask the doctor for medication but mentioned that if I did not want to take medication, I could consider extracorporeal shockwave therapy.
I have the following questions:
1.
Since my DHEA levels are normal according to the report, does this mean I cannot or should not directly supplement with testosterone medications or supplements? If so, why is DHEA being supplemented instead of testosterone? I found online that many outpatient doctors recommend Suromon; why is that? Is there really no alternative, or is the efficacy of this capsule genuinely worth recommending? However, there seem to be very few reviews about this product online.
2.
I found that some online sellers offer a box of 60 capsules for NT$1200-1400, but the outpatient doctor sold me a box of 60 capsules for NT$1600.
Is the clinic charging too much, or is the quality of the online sources not guaranteed?
3.
The extracorporeal shockwave therapy costs NT$6000 per session, and I need to undergo 6-12 sessions.
However, I found that there is little discussion online specifically about shockwave therapy for erectile dysfunction; I only know that it can promote vascular growth in the corpora cavernosa and can treat vascular erectile dysfunction.
My question is, how can one determine if they have "vascular erectile dysfunction" through any specific tests? If there is no way to confirm this condition through testing, then if I do not have vascular issues, wouldn't undergoing this therapy be pointless? I would like to know if this treatment method is currently popular in the country or if it is the only effective treatment outside of medication.
Additionally, are there any risks or side effects associated with this method? Is the cost reasonable?
4.
The outpatient clinic mentioned that the therapy should be done twice every two weeks, with a gap of one or two days between sessions, and then continue this way for another two weeks.
However, I found online information suggesting once a week.
What are the differences between these two treatment approaches?

a, 30~39 year old female. Ask Date: 2020/02/02

Dr. Du Mingyi reply Urology

DHEA is a precursor for the synthesis of testosterone.
If the source of the medication is transparent, it can be purchased online.
There are concerns about buying extracorporeal shock wave therapy, which is a recently popular new technique that has no side effects.
The standard price is 6,000 NTD, and there may be slight variations in the treatment provided by different physicians, but this generally does not affect the efficacy.

Reply Date: 2020/02/02

More Info

Erectile dysfunction (ED) is a common condition that affects many men, particularly as they age. It can stem from various causes, including hormonal imbalances, psychological factors, and vascular issues. In your case, it appears that hormonal factors, particularly low testosterone levels and elevated cortisol, are contributing to your symptoms. Let's address your questions regarding DHEA, shockwave therapy, and other treatment options.

1. DHEA vs. Testosterone Replacement: DHEA (dehydroepiandrosterone) is a hormone produced by the adrenal glands and serves as a precursor to both testosterone and estrogen. If your DHEA levels are normal, your doctor may still recommend supplementation if they believe that increasing DHEA could help boost testosterone levels indirectly. Testosterone replacement therapy (TRT) is typically reserved for cases where testosterone levels are significantly low and symptomatic. The reason your doctor suggested DHEA instead of direct testosterone supplementation could be due to the potential side effects and risks associated with TRT, such as increased risk of cardiovascular events and prostate issues. DHEA is often seen as a safer alternative, especially in men with borderline testosterone levels. The popularity of DHEA supplements, like the one you mentioned (賜汝蒙), may stem from anecdotal evidence and some studies suggesting benefits in sexual function and overall well-being, although scientific consensus is still evolving.

2. Cost of DHEA Supplements: The price discrepancy you noted between your doctor's office and online sellers could be due to various factors, including the quality of the product, the source of the supplements, and the markup from the clinic. It's essential to ensure that any supplements purchased online are from reputable sources to avoid counterfeit products. The higher price at your clinic may reflect a guarantee of quality and purity, which is crucial for hormonal supplements.

3. Shockwave Therapy for ED: Shockwave therapy is a relatively new treatment for erectile dysfunction, particularly effective for vascular-related ED. It works by promoting blood flow and potentially regenerating blood vessels in the penis. To determine if your ED is vascular in nature, doctors may conduct tests such as penile Doppler ultrasound, which assesses blood flow to the penis. If your ED is not primarily vascular, shockwave therapy may not be as effective. However, many clinics offer this treatment as a non-invasive option, and it has gained popularity in recent years. The risks associated with shockwave therapy are generally low, but some patients may experience mild discomfort or bruising at the treatment site.

4. Treatment Frequency: The treatment regimen for shockwave therapy can vary based on the clinic's protocols and the specific needs of the patient. Your clinic's recommendation of two sessions every two weeks may be tailored to your condition and response to treatment. In contrast, weekly sessions may be more common in other practices. The key is to follow your doctor's advice, as they can adjust the treatment plan based on your progress and any side effects you may experience.

In summary, addressing erectile dysfunction often requires a multifaceted approach, including hormonal evaluation, lifestyle changes, and possibly medication or therapy. It's crucial to work closely with your healthcare provider to determine the best course of action tailored to your specific situation. Regular follow-ups and open communication about your symptoms and treatment responses will help optimize your care and improve your quality of life.

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