Hi Dr, I am looking for a clue and understand why my erection is not consistent. There are times when I am going through a period of time may be weeks when I cannot have a quality erection and difficult to have a intercourse, but as soon a I get one strong erection and intercourse it would be good for a week or so before it go down again for a while and have difficulty with erection
I also have to add that have been on Cialis for past 6 years and past six months i have run into this issue that even I an taking Cialis my erection is not consistent. I visited my Urology and after the blood test it turns out that my T level of 250 is too for 55 years old man and he suggested that the cause might be a low T level. 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 must also add that I am still taking Cialis and sometime switched to Viagra/ Levitra with the same results

I would appreciate your feedback and any suggestion you can provide.


Intermittent ED is a mystery in many patients that tends to get pigeon holed as psychogenic ED. This for sure is upsetting to a patient that has had no stresses or history of mental illness. May I suggest that there is more than meets the eye in an online conversation. During an examination I look at a multitude of circumstances that may effect sexual performance such as testosterone but other hormones also. Estrodial (estrogen) in high levels can have the same effect as low T with the addition of enhanced breast fat (gynocomastia). High prolactin is also a factor along with general cardiac health, allergies and many other triggers. Many people are unaware that Sudafed (pseudoephederine) the decongestant is a very powerful vaso constrictor that can effect erections to a great deal. I use this drug to treat patients with prolonged erections (priapism) and if it can remove an erection then why could it not prevent one? One must have a very thorough medical history taken to evaluate the cause of ED in a young healthy person as yourself. I recommend a trip to a urologist that specializes in the treatment of ED, preferably at an academic institution where monetary reward is not a deciding factor of treatment.  


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Thomas A Suppe RDMS CLT


Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.


For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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