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Hormone Therapy for Men

Men’s Health

Get a better erection and get it immediately.

What is Erectile Dysfunction?

Erectile dysfunction (ED) is the repeated inability to achieve or maintain an erection sufficient for satisfactory sexual performance1. It occurs in 15 to 30 million men in the United States. Incidence of ED increases with age but can be successfully treated.

Intracavernosal Injection

An intracavernous injection, according to the American Urologic Association, is the most effective non-surgical treatment for ED. Injections into the penis, unlike oral medications, trigger an automatic erection. Injection can be done by the individual 5 minutes prior to sexual activity and should last for no more than 1 hour. Injection is considered second line to be used if oral therapy fails. Compounds that can be injected include alprostadil, papaverine, and phentolamine. Alprostadil and phentolamine are the most common agents used as monotherapy. However, combination therapies are used to increase efficacy and decrease side effects. Combination therapy includes Tri-Mix and Bi-Mix. Both products are not commercially available and must be compounded by specialty pharmacies and require a prescription from your doctor.

Self-Injection of Tri-Mix/Quad-Mix/Tri-Mix XL


Getting Started

  • Wash hands and keep the penis clean.
  • Have alcohol swab, syringe, and bottle of injectable solution ready.

The Syringe

  • Wipe the rubber top of the vial containing tri-mix with alcohol.
  • Remove the cap of the needle, fill the syringe with air by pulling back the plunger to the desired dosage.
  • Insert the needle into the rubber stop of the vial, inject the air, and then turn the vial upside down with the needle inside.
  • Slowly Pull back the syringe to the dosage required.
  • Tap the side of the syringe so the air bubbles float to the top and inject out the air bubbles before use.
  • Remove the needle from the bottle and recap.

Prepare The Site

  • Location of injection is between the base and mid portion of the penis at 9-11 and 1-3 o’clock. Avoid the midline because it can injure the urethra (where urine and sperm pass) and the penile arteries and nerves at 12 o’clock. Avoid any visible veins or arteries on the surface.
  • Pull the head of the penis towards to side of the leg and select a site for injection.
  • Clean the site with alcohol.

Injection

  • Steadily penetrate the skin with the needle at 90º. Push the needle to the end.
  • Inject Tri-Mix over a few seconds and withdraw the needle.
  • Apply compression at the injection site for 2 minutes. More time may be needed to prevent bleeding.
  • Dispose the needle and syringe in the proper container.
Erectile Dysfunction

General Rules For Injection

  • Use the smallest effective dose. Further dosage increases may result in more adverse effects.
  • Injections should be given at a maximum of three times per week or once every 2 days.
  • Seek medical attention if an erection lasts longer than 4 hours.
  • Sexual stimulation should occur after injection.

Common Causes of Inadequate Response

  • Injection into wrong location
  • Leakage of agent prior to injection
  • Premature Ejaculation during stimulation
  • Feelings of stress prior, during or after injection
  • Localized pain during and after the injection process
  • Inadequate Dose
Erectile Dysfunction

Steps To Correct Inadequate Response

  • Review injection technique
  • Evaluate timing of injection in relation to stimulation
  • Involve partner and inject in a comfortable environment
  • Try combination therapy with lower PGE-1 dose
  • Reassess dose with your physician and if approved by physician increase in 2-3 days or change to a more potent agent it at maximum doses