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Erectile Dysfunction (ED) treatment at Refyne combines comprehensive medical evaluation with prescription-based management to improve erectile function while identifying and addressing underlying contributing factors.
Erectile Dysfunction Consultation
Contents
About the Treatment
A Comprehensive, Individualized Approach
Erectile dysfunction treatment at Refyne Medical Aesthetics and Wellness begins with a comprehensive medical evaluation to better understand the factors that may be contributing to a patient’s symptoms and determine which treatments can be used safely. We review the patient’s medical and cardiovascular history, current medications, previous ED treatments, symptoms, sexual health concerns, and treatment goals.
Medication screening is particularly important before prescribing PDE5 inhibitors, such as Viagra, Cialis, or Stendra. Patients are evaluated for medications that may interact with ED treatment, including nitrates such as nitroglycerin, alpha-blockers, and certain medications used to treat pulmonary hypertension. Blood pressure is measured, and patients receive appropriate counseling regarding medication interactions, precautions, and when additional medical evaluation may be necessary.
We also obtain baseline measurements including height, weight, BMI, and abdominal circumference. During the consultation, patients are educated about factors that can contribute to erectile dysfunction, including cardiovascular disease, high blood pressure, diabetes, elevated cholesterol, obesity, hormonal abnormalities, certain medications, smoking, and other health conditions.
Comprehensive Laboratory Evaluation & Monitoring
Laboratory testing is conveniently performed in-house as part of the ED evaluation, allowing us to look beyond the symptom itself and identify underlying factors that may be contributing to erectile dysfunction. Baseline testing may include hemoglobin A1c and glucose markers to evaluate blood sugar, as well as a lipid panel to assess cholesterol and cardiovascular risk.
Hormonal evaluation may include total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) to determine whether low testosterone or another hormonal factor may be contributing to symptoms. Additional laboratory testing may be obtained when clinically indicated, with results interpreted alongside the patient’s symptoms, medical history, medications, physical measurements, and overall health.
Individualized ED Therapy
Treatment is selected based on the patient’s evaluation, laboratory findings, medical history, and individual needs. When appropriate, prescription Phosphodiesterase type 5 (PDE5) inhibitors such as Viagra, Cialis, or Stendra may be used to improve erectile function by enhancing the normal blood-flow response involved in achieving and maintaining an erection.
Treatment may also involve addressing underlying factors contributing to ED rather than managing the symptom alone. Depending on the patient’s evaluation, this may include testosterone replacement therapy when clinically indicated, medical weight management, and coordination with the patient’s primary care provider or specialist when appropriate.
Prescription Management & Patient Education
When a PDE5 inhibitor is prescribed, patients receive education on how and when to take their medication, expected effects, potential side effects, medication interactions, and important safety precautions. We also discuss factors that can affect how well the medication works and what patients should expect from treatment.
Prescription therapy can be adjusted based on treatment response, tolerability, medical history, and patient preference, allowing us to determine an appropriate medication and regimen for each patient.
Follow-Up & Ongoing Management
Follow-up allows us to evaluate erectile function, medication effectiveness, side effects, blood pressure, and overall response to treatment. Medication or treatment recommendations can be adjusted when clinically appropriate rather than leaving patients to manage ED medication without continued medical oversight.
Because erectile dysfunction can sometimes be associated with broader health concerns, follow-up also provides an opportunity to continue addressing hormonal health, weight, and other identified contributing factors. Patients who require evaluation or treatment beyond the scope of our practice can be referred or coordinated with the appropriate medical specialist.
What Does ED Treatment Address?
What Is Erectile Dysfunction?
Erectile dysfunction (ED) is the persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual activity. Although ED becomes more common with age, it should not automatically be considered a normal or unavoidable part of aging. Erectile function depends on healthy blood vessels, nerves, hormones, and psychological and sexual health, which means changes in erectile function can sometimes provide important information about a man’s overall health.
ED may develop gradually or occur more suddenly, and symptoms can vary from difficulty achieving an erection to erections that are not firm enough or do not last as long as desired. Because there are many potential causes, identifying factors contributing to ED is an important part of determining an appropriate treatment plan.
Understanding the Risk Factors for Erectile Dysfunction
Erectile function is closely connected to vascular and metabolic health. Conditions such as high blood pressure, high cholesterol, diabetes, insulin resistance, obesity, cardiovascular disease, and smoking can reduce the ability of blood vessels in the penis to properly dilate, leading to a decrease of blood flow to the penis that is necessary to achieve and maintain an erection.
The American Urological Association (AUA) specifically recommends counseling men that ED can be a risk marker for underlying cardiovascular disease and other health conditions that may warrant further evaluation.
Other contributors may include certain medications, neurologic conditions, previous pelvic surgery or radiation, hormonal abnormalities, sleep disorders, alcohol or substance use, stress, anxiety, depression, and relationship or sexual-performance concerns. For this reason, our approach focuses not only on treating the erectile symptom but also on identifying potentially modifiable factors that may be contributing to it.
PDE5 Inhibitors and Their Role in ED Management
Phosphodiesterase type 5 (PDE5) inhibitors—including medications such as Viagra, Cialis, and Stendra—are commonly used oral medications for erectile dysfunction. PDE5 inhibitors work by enhancing the nitric oxide pathway, which helps dilate blood vessels and increase blood flow to the penis, making it easier to achieve and maintain an erection during sexual stimulation.
Medication selection, dosing, timing, medical history, and concurrent medications are important considerations. Patients taking nitrate medications should avoid PDE5 inhibitors because the combination can cause a potentially dangerous decrease in blood pressure. Proper patient education is also important, as factors such as when the medication is taken, food intake, and adequate sexual stimulation can influence how effectively the medication works.
Weight, Metabolic Health & Erectile Function
Overweight and obesity can contribute to ED through several interconnected pathways. Excess body fat is associated with insulin resistance, diabetes, high blood pressure, abnormal cholesterol levels, inflammation, and cardiovascular disease. These conditions can reduce the ability of blood vessels to properly dilate, decreasing the blood flow to the penis necessary to achieve and maintain an erection. Obesity may also contribute to lower testosterone levels in some men, which can further affect sexual health and erectile function.
When clinically appropriate, ED management may therefore include addressing weight, nutrition, physical activity, metabolic health, blood pressure, glucose regulation, and other cardiovascular risk factors rather than relying exclusively on medication to treat the symptom.
For patients with overweight or obesity who meet appropriate treatment criteria, medical weight management with Tirzepatide may be incorporated into the treatment plan at Refyne Medical Aesthetics and Wellness. Tirzepatide can support significant weight loss and improvements in metabolic health, including blood sugar regulation and other cardiometabolic risk factors that may contribute to erectile dysfunction. Lifestyle interventions including regular physical activity, smoking cessation, and reducing excessive alcohol consumption may further support erectile function and overall health. When testosterone deficiency is identified through appropriate evaluation and laboratory testing, Dr. Brooklyn Buras, DNP, APRN, FNP-BC may also consider testosterone replacement therapy as part of an individualized treatment plan.
Testosterone & Erectile Function
Testosterone plays an important role in male sexual health, particularly libido and normal sexual function. Because testosterone deficiency can coexist with erectile dysfunction, the AUA recommends measuring total testosterone levels in men being evaluated for ED.
When low testosterone is confirmed in an appropriately evaluated patient, testosterone replacement therapy may improve symptoms of ED as well as improve the response to PDE5 inhibitors, like Viagra, Cialis or Stendra in some men. Testosterone therapy, however, should not be presented as a stand-alone treatment for every case of erectile dysfunction. The AUA notes that for men with both ED and testosterone deficiency, PDE5 inhibitors may be more effective when combined with testosterone therapy.
Treating More Than the Symptom
At Refyne Medical Aesthetics and Wellness, ED management is approached as part of a patient’s broader health rather than as an isolated sexual symptom. Treatment may include oral ED medication when appropriate, evaluation and management of testosterone deficiency, assessment of weight and metabolic health, lifestyle modification, laboratory evaluation, and referral for additional cardiovascular, urologic, or specialty evaluation when indicated.
The goal is to help improve erectile function while also identifying and addressing potentially modifiable factors that may be contributing to ED. Treatment is individualized based on medical history, symptoms, laboratory findings, medications, cardiovascular risk, physical measurements, and the patient’s personal treatment goals.
Who Is a Candidate?
Candidates are adult men who have ongoing difficulty getting or keeping an erection firm enough for satisfying sexual activity. Many men also have related concerns, such as low libido, low energy, weight gain, or a diagnosis like diabetes or high blood pressure.
PDE5 inhibitors are not safe for every patient. They are not appropriate for men who take nitrate medications or certain other drugs that lower blood pressure. They may also not be appropriate for men with unstable heart disease, a recent heart attack or stroke, very low or uncontrolled blood pressure, or certain eye conditions. Men with sudden-onset ED, ED after a pelvic injury or surgery, a curved or painful erection, or symptoms that suggest heart disease may need evaluation by a urologist or cardiologist. In these cases, Refyne helps coordinate the appropriate referral.
The ED Consultation
Your first visit is private and focused on understanding your full health picture. Your provider reviews your symptoms, medical and cardiovascular history, current medications and supplements, past ED treatments, lifestyle, and goals. Blood pressure, height, weight, BMI, and abdominal circumference are measured, and baseline labs are drawn in-house. Your provider then explains what may be contributing to your symptoms and recommends a treatment plan, which may include medication, testosterone evaluation, weight management, or a referral when appropriate.
What to Expect During Treatment
ED treatment with PDE5 inhibitors is taken by mouth at home, according to the timing your provider recommends. There are no in-office procedures, needles, or numbing for this part of treatment. At your visit, you receive clear instructions on how and when to take your medication, how food and alcohol can affect it, and what to expect. If testosterone therapy or medical weight loss is part of your plan, those treatments follow their own in-office process.
Recovery and Aftercare
There is no downtime. Common side effects of PDE5 inhibitors include headache, facial flushing, nasal congestion, indigestion, and, with some medications, back or muscle aches. These are usually mild and temporary. Seek emergency care for an erection lasting longer than 4 hours, chest pain, or sudden changes in vision or hearing. Follow-up visits let your provider review how well the medication works, check your blood pressure, and adjust your plan as needed.
Results
Many men notice improvement with the first few doses of a PDE5 inhibitor, although finding the right medication, dose, and timing can take a few tries. PDE5 inhibitors work only with sexual stimulation and do not cure ED, so results depend on continued use. Improvements from testosterone therapy, weight loss, and better metabolic health tend to build over several months. Results vary based on the underlying causes of ED, overall health, medications, and lifestyle.
Why Choose Refyne for ED Treatment?
At Refyne Medical Aesthetics and Wellness, ED care is led by Dr. Brooklyn Buras, DNP, APRN, FNP-BC, a board-certified Family Nurse Practitioner with a primary care background. Treatment starts with a careful medication and cardiovascular screening, in-house labs, and physical measurements, so the underlying causes of ED are evaluated, not only the symptom. Because Refyne also offers testosterone replacement therapy and medical weight loss, contributing factors can be addressed in one coordinated plan, with ongoing follow-up and referrals when needed.
FAQ
What causes erectile dysfunction?
ED can be caused by blood vessel and heart health, diabetes, high blood pressure, high cholesterol, obesity, low testosterone, certain medications, smoking, stress, and other factors. Often more than one cause is involved.
How do ED medications work?
PDE5 inhibitors such as Viagra, Cialis, and Stendra improve blood flow to the penis during sexual stimulation, making it easier to get and keep an erection.
Am I a candidate?
Most adult men with ongoing ED symptoms can be evaluated. Your provider will confirm that medication is safe based on your heart health, blood pressure, and current medications.
Why do I need lab work?
Labs can reveal contributing factors such as high blood sugar, high cholesterol, or low testosterone that may change your treatment plan.
Can low testosterone cause ED?
Low testosterone can contribute to low libido and ED in some men. Testosterone is checked as part of your evaluation, and treatment is considered when a deficiency is confirmed.
Are there side effects?
Common side effects include headache, flushing, nasal congestion, and indigestion. PDE5 inhibitors must not be taken with nitrate medications.
Can ED treatment be combined with other therapies?
Yes. ED treatment may be combined with testosterone replacement therapy, medical weight loss, and lifestyle changes when appropriate.
Is my consultation confidential?
Yes. Your visit and medical information are private and handled with care.