Diagnosis

At the Male Care Center, the first step is a thorough medical evaluation to make an accurate diagnosis and determine the cause. The assessment may include laboratory tests, and such specialized tests of sexual function as penile Doppler ultrasound (to measure blood flow) and nocturnal penile tumescence testing (an at-home test to monitor erections during sleep). At our center, if needed, we also perform cystoscopy (to examine the interior of the urinary system) and prostate ultrasound with biopsy.

After the assessment is complete, a comprehensive treatment plan is created, tailored to the specifics of each patient. After the initial treatment, we monitor progress and modify treatments, if necessary, to ensure the best possible results. At the Male Care Center we are committed to working with each patient until healthy, fulfilling sexual functioning is restored.

Watch Video on Causes and Concerns with Dr. Fred Grossman

Notice to Medicare Patients

Treatments

Erectile Dysfunction

ED in most cases results from a physical cause, but it also can be related to psychological distress or lifestyle. Sexual function can be affected by existing or not-yet-diagnosed health issue such as hypertension, high cholesterol, cardiovascular disease, low testosterone, diabetes, or thyroid problems. Depression, anxiety or stress can also contribute to ED.

Some prescription medications prescribed for depression and hypertension, for example, can have ED as a side effect. If possible, we might suggest switching to a comparable medication without that side effect.

Medications
About 60 percent of men respond well to medications such as sildenafil citrate (Viagra), tadalafil (Cialis) and (vardenafil HCI) Levitra. If the Male Care Center prescribes this treatment, we work closely with each client to determine the best medication and most effective dosage.

These medications, known as phosphodiesterase (PDE) 5 inhibitors, work by enhancing the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. The result is increased blood flow to the penis, which allows the natural response to stimulus to occur: an erection.

However, these medications are not appropriate or effective for every person. Men who are on nitrates for angina or alpha blockers for prostate problems are not good candidates. And, for some men these medications can have side effects that outweigh the benefits.

When these medications are ineffective, and if impotence is persistent, the Male Care Center recommends further investigation to identify the cause of chronic dysfunction. Rather than just fixing the symptom, our philosophy is sexual function must be viewed - and treated - as a reflection of a man's overall health and well-being.

Injections
Needle-injection therapy uses a fine needle - so discomfort is minimal - to inject a drug into the side of the penis, and generally produces an erection in 5 to 20 minutes that lasts about an hour.

The drug most often used is alprostadil, a synthetic version of the hormone prostaglandin E. The effect is to relax the smooth muscle tissue in the penis, enhancing the blood flow needed for an erection.  Other drugs may be added if necessary.

Implants
Another option is the rapid recovery penile implant, in which a device is surgically implanted in the penis, which creates an erection at the time and duration of your choosing. These can be either an inflatable device or semi-rigid rod made from silicone. This treatment is not recommended when other methods have not provided relief.

Premature Ejaculation

Premature ejaculation can happen randomly without cause, or be brought on by inflammation of the prostate or urethra, low testosterone levels, anxiety or stress. After diagnostic tests rule out inflammation or low testosterone, there are treatment options - antidepressants or topical anaesthetic creams - to successfully combat this condition.

Antidepressants 
Certain selective serotonin reuptake inhibitors (SSRIs) including paroxetine (Paxil), orsertraline (Zoloft) can be prescribed to delay ejaculation, though they are not specifically approved by the Food and Drug Administration (FDA) for this use. Another option is clomipramine (Anafranil), a tricyclic antidepressant that also eases the condition.

If this is the designated treatment, the Male Care Center will recommend medication and dosage.

Topical anesthetic creams
Creams containing lidocaine or prilocaine, applied to the penis before intercourse, dull sensation and may delay ejaculation.

Low Testosterone

Declining testosterone levels can be to blame for waning sexual function and desire, and also for depression, irritability, memory lapses, impaired concentration as well as decreased lean muscle mass and bone density. Average serum testosterone levels decrease by 1 percent each year for men 30 and over, but treatment can restore normal levels within weeks.

Testosterone replacement therapy
If tests confirm low serum testosterone, replacement therapy can provide significant benefits to sexual performance (as well as to mood, concentration and energy) within three to six weeks. With continued use, replacement therapy can also improve bone density and lean muscle mass.

Testosterone replacement therapy is usually delivered in a daily gel or patch, though it can also be given in weekly injections or by pellets implanted in an outpatient procedure every three to four months. During the course of treatment, testosterone levels are monitored regularly to ensure the dosage is keeping levels within normal range.

Clomiphene citrate is a medication that stimulates the body to produce more of its' own testosterone. It works by stimulating the pituitary gland to release a hormone that in turn causes the testes to manufacture more testosterone. Originally used to treat infertility in women, the use of clomiphene citrate for low testosterone is officially "off-label." But this medication has been proven effective in increasing testosterone in men in many clinical studies and has been prescribed safely for years.  We have many men using it safely and effectively. 

Human chorionic gonadotropin (hCG)
This drug also stimulates the testicles to produce more testosterone by causing the pituitary gland to release hormones, which then jumpstart the testicles to make more testosterone. This medication is usually given with an intramuscular injection, and has been used successfully as a temporary boost for men with borderline or slightly low testosterone levels.

Benign Prostatic Hyperplasia (BPH) 

The prostate is a walnut-sized gland below the bladder. When enlarged it can cause a number of symptoms that while not life-threatening can interfere with quality of life. BPH is not prostate cancer, but rather a benign, non-cancerous enlargement of the prostate that is common among men 45 and older. As a urologist, Dr. Grossman offers a range of treatment options for BPH including medication,  minimally invasive procedures and surgery that successfully relieve symptoms.

Medications

A number of medications can be prescribed for BPH. Alpha blockers(Flomax, Uroxatral), relax the muscles around the prostate thus easing symptoms, but not reducing the growth of the gland. Another option, 5 alpha reductase inhibitors (Avodart), alleviate symptoms and swelling by decreasing male hormone levels which in turn reduces prostate size. Both can have side effects, which depending on the medication include erectile dysfunction, diminished libido, ejaculation problems, dizziness or headache.

Minimally Invasive Procedures and Surgery

Better and more long-lasting relief from BPH symptoms is achieved with other treatments, such as traditional surgery (TURP), laser surgery and thermal therapy (TUMT). Thousands of men have been successfully treated with each of these techniques, which are all FDA approved and covered by Medicare and most private insurance plans.  

Transurethral resection of the prostate (TURP), is the gold-standard, traditional surgical method of treating BPH. This surgery, done under general or spinal anesthesia, removes prostate tissue through the urethra, without an external incision. A potential aftermath of surgery is retrograde ejaculation, in which semen is directed back into the bladder rather than through the urethra. Patients usually stay in the hospital  one or two days after surgery. 

Laser surgery is a noninvasive alternative to TURP, and new technology continues to advance the effectiveness of this approach. In the procedure, while the patient is under anesthesia, a laser is used to destroy prostate tissue. Post-treatment sexual side effects are rare. In most cases, men can resume normal activities within 24 hours.

Transurethral microwave thermotherapy of the prostate (TUMT) is an office-based procedure that uses computer-controlled microwave energy to destroy tissue. This procedure can be performed without anesthesia, and has other key benefits: quick recovery and usually no sexual side effects.

Penile Curvature and Peyronie's Disease
Surgery 
For men with a severely curved penis, pain or sexual dysfunction related to these conditions, surgery is an option. Dr. Grossman offers the Egydio procedure, which with a single incision can lengthen the shortened side of the penis. In less severe cases, one can just shorten the longer side of the penis.

Vitamins 
While controlled studies have yet to prove this remedy, there have been reports that vitamin E taken orally can ease Peyronie's disease. There have also been isolated cases showing improvement with potassium aminobenzoate (Potaba), colchicine, topical verapamil,  pentoxiphylline and others.

Topical Therapy
Mild to moderate cases of Peyronie's disease may be improved with "transdermal iontophoresis" of a steroid (dexamethasone) and a calcium channel blocker (verapamil). With this method, the medication is applied directly to the skin and is readily absorbed into the tissue.

Steroids and verapamil reduce fibrous tissue and ease pain. Prior to this approach they were delivered by injection directly into penile "plaque" (fibrous scar tissue that restricts erections).

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