Silicon Valley Urologist – Dr. Jonathan C Hu

Restoring Confidence and Intimacy

It's not as hard as you think

Rediscover the Intimacy You Deserve – At our clinic, addressing Erectile Dysfunction is more than a medical journey; it’s a personal one. We understand the impact on your life, and our compassionate team is here to support you every step of the way. With personalized care, trust, and comfort, we’re committed to helping you reclaim the joy of connection and intimacy. Your journey to renewed confidence starts here.

-Jonathan Hu. MD


Erectile Dysfunction

Erectile Dysfunction (ED) is a common condition characterized by the inability to achieve or maintain an erection firm enough for sexual intercourse. While occasional difficulty in achieving an erection is normal, persistent issues may indicate an underlying health concern.

Causes of Erectile Dysfunction

  • Physical Factors:
    • Chronic illnesses like diabetes, hypertension, cardiovascular diseases, and obesity can affect blood flow to the penis, leading to ED. Other physical factors include hormonal imbalances, injuries to the pelvic area, and side effects of certain medications.
  • Psychological Factors:
    • Stress, anxiety, depression, and relationship problems can contribute to erectile dysfunction by interfering with the brain’s ability to send signals to the penis to initiate an erection.
  • Lifestyle Factors:
    • Unhealthy habits such as smoking, excessive alcohol consumption, drug use, and lack of exercise can increase the risk of developing erectile dysfunction.
In healthy young individuals experiencing erectile dysfunction, the underlying cause is often psychological in nature.

Treatment Options for Erectile Dysfunction:

  • Hormonal:
    • In cases where hormonal imbalances are contributing to ED, hormone replacement therapy may be recommended. This can involve testosterone replacement therapy to address low testosterone levels: Testosterone, free testosterone, LH, FSH, prolactin, estradiol
    • Other labs include: dihydrotestosterone (DHT), insulin-like growth factor-1 (IGF-1)
  • Lifestyle Changes:
    • Adopting a healthy lifestyle, including regular exercise, a balanced diet, sleep (without obstructive sleep apnea (OSA) and stress management, can improve overall health and potentially alleviate symptoms of ED.
  • Psychological Counseling:
    • Counseling or therapy sessions with a mental health professional may be beneficial for individuals experiencing ED related to psychological factors such as stress, anxiety, or depression.
  • Medications:
    • Oral medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are commonly prescribed to help achieve and maintain erections. These medications work by increasing blood flow to the penis.
    • Injection medications such as Trimix (three drugs: alprostadil, papaverine, and phentolamine, which are injected directly into the penis to promote penile blood flow and induce an erection.)
  • Vacuum Devices:
    • Vacuum erection devices (VEDs) can be used to manually create an erection by drawing blood into the penis. This device consists of a cylinder placed over the penis, which is then pumped to create a vacuum.
  • Penile Implants:
    • For individuals who do not respond to other treatment options, surgical placement of penile implants may be considered. These implants are inflatable or malleable rods inserted into the penis to facilitate erections

The Diagnosis

  • Clinically Based:
    • Typically diagnosed through a combination of medical history assessment, physical examination, and laboratory tests. Your healthcare provider may inquire about your symptoms, medical history, and lifestyle factors. They may also conduct a physical examination to check for any underlying conditions.
  • Penile Doppler ultrasound with a trimix injection

What is Penile Doppler ultrasound with Trimix Injection?

Diagnostic procedure used to assess blood flow and vascular function in the penis. During the procedure, a small amount of a medication called trimix, which contains a combination of medications that help relax blood vessels and improve blood flow, is injected into the side of the penis. This medication induces an erection, allowing the ultrasound technician to evaluate the blood flow within the penile arteries and veins using ultrasound imaging. By assessing the speed and direction of blood flow, this test can help diagnose the underlying cause of erectile dysfunction, such as arterial insufficiency, venous leak, or other vascular issues.


Therapy (e.g., Cognitive Behavioral Therapy, Sex Therapy):

    • Therapy requires time and commitment, as progress may not be immediate, and multiple sessions may be necessary to achieve desired outcomes.
    • It’s essential to work with a qualified therapist experienced in treating sexual health issues to ensure effective and supportive guidance throughout the therapy process.

Oral Medications (e.g., Viagra, Cialis, Levitra):

      • Common side effects may include headache, flushing, indigestion, nasal congestion, and dizziness.
      • More serious side effects such as sudden vision or hearing loss, priapism (prolonged erection), and allergic reactions are rare but possible.
      • It’s important to note that oral medications are not suitable for everyone, especially those with certain medical conditions or taking specific medications that may interact with them.


Injection Medications (e.g., Trimix, Caverject):

      • Injection site reactions such as pain, bruising, or bleeding may occur.
      • There is a risk of priapism (prolonged erection lasting more than four hours), which requires immediate medical attention to avoid tissue damage.
      • In rare cases, injection therapy may cause scarring or fibrosis of penile tissue, affecting erectile function.


Vacuum Erection Device (VED):

        • Common side effects include bruising or petechiae (small red spots) on the penis, particularly at the base, due to the constriction ring.
        • Some men may experience discomfort or pain during or after device use.
        • Improper use or overuse of the device may cause temporary numbness or desensitization of the penis.
        • In rare cases, the constriction ring may cause penile skin injury or loss of penile sensation.


Penile Implant Surgery:

      • Surgical risks include infection, bleeding, or adverse reactions to anesthesia.
      • There is a risk of device malfunction or mechanical failure, which may require additional surgery to repair or replace the implant.
      • Long-term complications may include erosion of the implant through the skin, device migration, or urinary incontinence.
      • Surgical complications such as wound healing issues or scarring may occur, although they are relatively uncommon with experienced surgeons.



For optimal effectiveness, it’s generally recommended to take on-demand medications like Sildenafil, Tadalafil, or Vardenafil on an empty stomach, about 30 minutes to 1 hour before engaging in sexual activity.

I highly recommend a daily 5 mg dose of Tadalafil. Not only does it assist with erections without the need for precise timing, but it also aids in improving urination.

  • In some cases, erectile dysfunction can be an early warning sign of underlying health issues such as cardiovascular disease, diabetes, or hormonal imbalances. Therefore, it’s essential to address ED with a healthcare provider to rule out any potential underlying conditions.

Some natural remedies, such as lifestyle changes (diet, exercise, sleep, stress management) and certain supplements, may help improve erectile function, but their effectiveness varies, and they should be discussed with a healthcare provider

  • It’s essential to see a doctor if erectile dysfunction persists for more than a few weeks or if it’s causing significant distress or affecting your relationship. Additionally, if you have underlying health conditions that may contribute to ED, seeking medical advice is crucial.