Hello Dr. I am 55 years old and have been diagnosed with ED for past 10-15 years. I have been taking cialis for past 6-8 years with the good results. Within past year I have noticed that Cialis is not responding well and erection is not consistent. To better explain, it seems like I am going through up and down cycles and staying in a down cycle with poor erection for a long time. Needless to say, i have switched to Viagra with the similar results. I have visited my urology and after blood test he indicated that my 250 T level is low respect to my age and Low T level might be the reason. I have gone through TRT process and now my T level is at 600 which I would assume to be in the normal range. After TRT my erection has improved and it lasted only for a month before I entered again in the down cycle and have difficulty to get out of it.

I would appreciate any feedback or recommendation you may can provide.



You will need to look at other treatments for your ED now that testosterone supplementation and the PDE5 inhibitor medications like cialis and viagra are no longer effective.  Options include MUSE (a medicated urethral suppository), penile injections, external vacuum systems or penile prosthesis implants.  Talk to your urologist about which of these options is appropriate for you at this point.  Each option has pros and cons.  We usually reserve the penile prosthesis for those patients who have failed all other therapies.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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