Erectile Dysfunction on TRT: Deep Dive

Take a deep dive into the anatomy, physiology, evaluation, and treatment of ED, based on medical evidence. ED is a real medical problem, and it's a warning that something much worse is around the corner. I share a concrete, actionable plan to protect and restore your vascular health using lifestyle changes, nitric oxide optimization, and targeted medications like PDE5 inhibitors (Cialis/Viagra), ARBs, and GLP-1s. #ErectileDysfunction #MensHealth #TRT #Testosterone #HeartHealth #ManMedicine #NitricOxide #Longevity #mensfitness 0:00 Erectile dysfunction: why it matters 7:08 Defining ED and how common it is 10:51 ED is more than testosterone or estradiol 12:40 Aging, evolution, and realistic expectations 17:35 Penile anatomy and blood-flow mechanics 20:13 How veins maintain an erection 22:49 Trauma and fragile penile blood vessels 23:34 Brain, nerves, and types of erections 23:45 Psychogenic versus reflexogenic erections 26:12 Nocturnal erections and REM sleep 30:14 Spinal cord injuries and sexual function 32:50 Nitric oxide and major ED causes 33:30 How PDE5 inhibitors work 35:15 Vascular, hormonal, neurological, and drug causes 39:26 Psychogenic ED and performance anxiety 43:11 Medications that can cause ED 46:31 ED patterns before and during TRT 47:00 Three TRT-related ED scenarios 49:23 Sudden sexual dysfunction after starting TRT 51:03 Vascular ED and venous leak 51:09 Veno-occlusive disease explained 54:30 Small penile arteries and atherosclerosis 1:00:30 ED as an early cardiovascular warning sign 1:06:17 Cardiovascular risk reduction for ED 1:06:20 Blood pressure, lipids, diabetes, and body fat 1:09:36 Microvascular and endothelial dysfunction 1:14:02 Flow-mediated dilation testing 1:17:08 Testosterone, prolactin, and ED timelines 1:17:39 Testosterone’s role and PDE5 synergy 1:19:41 Why testosterone improvements take months 1:26:17 Prolactin and other hormonal contributors 1:29:07 Estradiol myths and endothelial health 1:30:35 Why guidelines rarely focus on estradiol 1:34:35 Estradiol supports nitric oxide production 1:39:51 Association does not prove estradiol causes ED 1:52:49 Estradiol studies in men on TRT 2:00:52 Serotonin and rare TRT sexual dysfunction 2:02:36 Estradiol’s effects on serotonin signaling 2:08:25 Why a small subset reacts to TRT 2:10:02 Waiting, lowering dose, and avoiding long-term AI use 2:13:29 Additional ED contributors and diagnostic workup 2:13:37 Sleep apnea, pelvic floor, and gut health 2:14:30 Comprehensive labs and specialist evaluation 2:16:46 Penile Doppler and endothelial testing 2:19:07 PDE5 inhibitors and foundational treatment 2:19:18 Tadalafil, sildenafil, and potential longevity benefits 2:24:21 Aerobic exercise as ED treatment 2:25:25 ARBs, ACE inhibitors, and endothelial health 2:28:46 Weight loss, supplements, and metabolic drugs 2:30:53 L-arginine and acetyl-L-carnitine 2:32:31 Nebivolol with tadalafil 2:34:44 Metformin, GLP-1s, and SGLT2 inhibitors 2:39:45 Advanced ED therapies and procedures 2:39:49 Apomorphine as an adjunct 2:41:31 Trimix and QuadMix injections 2:42:44 PT-141 for PDE5 inhibitor nonresponders 2:44:43 Low-intensity shockwave therapy 2:49:18 Vacuum devices, surgery, and penile prostheses 2:53:21 Key takeaways and prevention Recommended Books: Testosterone Decoded: Understanding testosterone, TRT and male hormonal health by Dr. Max Draper https://a.co/d/0bX1O4aO If you would like to book a consultation with Dr. Winge: https://www.manmedicine.com/offers/5f... Join the Practice: https://www.manmedicine.com/#mm-medic... Join the Man Medicine Academy private group: https://www.manmedicine.com/offers/yG... Download the free Testosterone Replacement Therapy Field Manual: https://www.manmedicine.com/#mm-newsl... TRT Fundamentals Course: https://trtfundamentals.com/co