FrankTalk.org

I'm a 19 year old guy who has suffered with fairly severe erectile dysfunction for around the past 6 years. I've tried all the conservative treatment approaches (cialis, viagra, injections, VED) with highly unsatisfactory results. I've never had a positive sexual experience with a girl, and I've tried dozens of times.

Under the advice of Dr. Irwin Goldstein, I traveled to Greece for a month last summer for 12 treatments of shock-wave therapy under the guidance of Dr. Hatzichristodoulou. While I loved my time in Thessoloniki, the treatment made absolutely no noticeable difference whatsoever in the quality of my erections. I did a Doppler ultrasound with Goldstein following the visit, and Goldstein believed there was some improvement in regards to the amount of scar tissue in my corpus cavernosum. I saw the same pictures he did, and I was very skeptical that there was any improvement between the two. After trying PRP with Goldstein to no avail, I made up my mind that it was time for an implant. I needed to move on with my life. While I've considered giving shock wave therapy another try as Goldstein recommended, I simply don't have the ability to put my month on hold while I fly back to Greece for a month to try a treatment that didn't work the first time.

Additionally, doctors like Mikkel Fode, and Tobias Kohler are very skeptical of the proposed effects and mechanisms of the shockwave therapy, and they don't recommend paying out of pocket for such treatments.
https://www.youtube.com/watch?v=tbi51quPDYg
https://www.youtube.com/watch?v=MKcGEzg ... T&index=18


I felt very confident in my decision, until two things happened.

1) First, I encountered the recent FrankTalk thread about young guys getting implants, where many users claimed that each revisions carries a massive increase in the chance for infection. Given I'm only 19, if I have the implant surgery done soon, I'm likely to need at LEAST 3 revisions over the rest of my life, potentially more, potentially more if I encounter problems.


2) Second, It was to my dismay that I see that under Dr. Kramer's redesigned website, he now lists Energy Wave Therapy as one of the treatments he offers for erectile dysfunction. https://www.kramerurology.com/erectile- ... t-options/
The write-up on Chesapeake Urology of energy wave therapy lists it as a very promising, effective treatment that helps most men who try it. Doctor Kramer is hailed as one of the best (if not THE best) implant surgeon in the world. He's the guy I had chosen to do my surgery, and I'm currently in the rather complicated process of scheduling an implant surgery with him right now. I felt confident in his hands. But if he endorses a treatment like Energy Wave Therapy, it makes me wonder if perhaps I'm being too hasty with the implant and I should give it another try.

On one hand, respected and renown doctors like Kramer, Kaprman, Goldstein and Hatzichristodoulou are either huge propenents of Shock Wave Therapy, or at least offer and endorse it as a treatment option. Furthermore, there is some evidence that backs up and supports Shock Wave Therapy, even if it isn't much. https://www.ncbi.nlm.nih.gov/pubmed/30664671
This article, co-authored by Dr. Hatzichristodoulou (who I underwent treatment under in Greece) "In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED."

On the other hand, doctors like Mikkel Fode and Tobias Kohler are very skeptical of Shock Wave Therapy, as is the Sexual Medicine Society of North America, as Kohler points out. They don't advocate paying money for them, and only encourage undergoing Shock Wave Therapy treatment under a clinical trial. Furthermore, I have my own experience that a month of treatment with Shock Wave Therapy did nothing noticeable for me. I've also heard differing opinions regarding what the treatment will do and how long it takes to be effective. Dr. Goldstein for example, stated that results from Shock Wave Therapy should take a few months to be fully realized, as for that matter does Chesapeake Urology's website, who Kramer now works with. On the other hand, talking with Dr. Hatzichristodoulou in Greece, he told me that if I wasn't experiencing results after the end of treatment, I wasn't going to be getting any further down the line. So even the proponents of the therapy can't agree on how it works.

Furthermore, there is no chance that I'll be accepted into any clinical studies, given that I've already undergone the treatment myself. So if I want to try it again, I'd have to fly to Baltimore or Greece for a month and put my entire life on hold, cost my father a lot of money, and likely loose my job. I haven't even gone to College yet because of all this ED stuff, I have no girlfriend, and I'm lonely and jealous of all my male friends and their sexual experiences. I just want a hard, working cock that can satisfy a girl and satisfy myself. But I don't want to get an implant if I'm going to putting myself at enormous risk every time I need a revision, but nor do I want to put my life on hold to chase after some promising ED treatment that different doctors have completely different opinions regarding.

I feel very discouraged. What should I do?

WindWizard wrote:
Furthermore, there is no chance that I'll be accepted into any clinical studies, given that I've already undergone the treatment myself. So if I want to try it again, I'd have to fly to Baltimore or Greece for a month and put my entire life on hold, cost my father a lot of money, and likely loose my job. I haven't even gone to College yet because of all this ED stuff, I have no girlfriend, and I'm lonely and jealous of all my male friends and their sexual experiences. I just want a hard, working cock that can satisfy a girl and satisfy myself. But I don't want to get an implant if I'm going to putting myself at enormous risk every time I need a revision, but nor do I want to put my life on hold to chase after some promising ED treatment that different doctors have completely different opinions regarding.

I feel very discouraged. What should I do?

Hello. Let me tell you I can feel your pain as I experience the same.

I met with dr. hatzchristodolou as well regarding an implant. I cannot judge his surgical skills, but he was one of the few doctors I'd like to never meet again. Saying that upfront.

Regarding the shock wave therapy and Kramer - you have to realize that it is a big business and shock wave therapy is easy money with no noticeable side effects (and a questionable effect.)

I underwent the therapy myself - and I think if it helps then just the minor cases.

What s your reaction towards injections ? Are you able to get an erection with an injection ?

If not, i d go for the implant if i were in your shoes.

It is true that you most likely will need revisions, most probably more than 3, more likely 5 to 6. And yes, the risk of infection increases, but I mean, if you get an infection in your 40s or 50s you will most likely be able to get another implant - yes you will/might lose some length and girth, but sex is way less important in this age than it is now. Compare those scenarios.

Best

mr.skin wrote:
Hello. Let me tell you I can feel your pain as I experience the same.


I met with dr. hatzchristodolou as well regarding an implant. I cannot judge his surgical skills, but he was one of the few doctors I'd like to never meet again. Saying that upfront.

Interesting. What about him did you find so unappealing? Did you undergo Shock Wave therapy under his clinic as I did?

mr.skin wrote:Regarding the shock wave therapy and Kramer - you have to realize that it is a big business and shock wave therapy is easy money with no noticeable side effects (and a questionable effect.)

I just wish more urologists, especially ones we consider to be top doctors on FT, would have the integrity to not peddle unproved and largely untested treatments at exorbitant costs... but I guess that's too much to expect of most people.

mr.skin wrote:I underwent the therapy myself - and I think if it helps then just the minor cases.

How long were you in shockwave therapy? Did you experience ANY noticeable results or no?

mr.skin wrote:What s your reaction towards injections ? Are you able to get an erection with an injection ?

Yes, but it takes a lot haha. Last time I had a doppler with Goldstein, we had to inject three times because I just could not keep an erection well, even after three injections. That said, I really, really hate injecting needles into my penis, and even if injections worked very well, (which they do not) having to inject myself every time I want to have an erection with a girl sounds like a nightmare. I'd rather just get the implant.

mr.skin wrote:If not, i d go for the implant if i were in your shoes.

You don't think that more shock wave therapy might start to actually have an effect?

mr.skin wrote:It is true that you most likely will need revisions, most probably more than 3, more likely 5 to 6. And yes, the risk of infection increases, but I mean, if you get an infection in your 40s or 50s you will most likely be able to get another implant - yes you will/might lose some length and girth, but sex is way less important in this age than it is now. Compare those scenarios.

That's a fair point... I hadn't thought about it like that. While the ability to perform sexually is no doubt important to many men of all ages, for me, I really feel like the most important years are the years of my youth. Being impotent has given me so much depression, and I haven't had a girlfriend in forever due to the ED issues... perhaps I should just stick with my original decision of getting the implant...

Thank you for your advice, and good luck to you as well my friend.

Personally, I’d go for an implant. Why not talk it over your situation with both Kramer and Karpman?

I would not worry about the infection risk in capable hands. Top doctors have an infection rate around 0.6% overall and that includes the revisions. Keep in mind that it is also a mathematical game in that a lot of old revisions require a second incision if they remove the reservoir. That makes it 2 incision sites, rather than 1 so that alone doubles the risk. I have H.I.V. and cancer so immune compromised. Despite that, I have had 2 dozen surgeries and no infections. Precautions I take is I put a cup of bleach in my bath water and soak in it for more than 15 minutes for 3 nights before and the morning of surgery. Bleach kills staph but it takes 15 minutes to do it. It is on the Clorox web site. Clean sheets each night, clean towels, clean clothes, else you can transfer bacteria back to your skin from something you used the day before. I wipe down surfaces in the hotel room with alcohol and entire bathroom with bleach water. These are simple things you can do to reduce your risk. It is doubtful that most people go to these efforts yet the infection rate is low with the best doctors. Cheers buddy.

ED2013 wrote:Personally, I’d go for an implant. Why not talk it over your situation with both Kramer and Karpman?

I'd like to talk it over with both of them. Unfortunately, I can't reach either of them. I've asked Kramer's secretaries to speak with Kramer over the phone multiple times, only to be told that he doesn't do phone consultations.

As for Karpman, I was told by his secretary weeks ago that he would give me a call, but it never happened. I guess I could call again but I don't want to bug them.

I've found these ED docs very hard to reach and very hard to schedule with sadly...

Very well written post.
I feel sorry for you, and I know how you feel. I had ED at your age as well. I could have sex, but always restricted by my venous leak.

First of all, I am no doctor, I have not done any studies on the effectiveness of shock wave therapy. But I do know one thing. Money talks. Just because someone happens to be a famous doctor, doesn’t mean they would never offer a treatment with very limited results.

As a principle, based on experience and common sense, I find it hard to believe that any treatment would have no effect whatsoever shortly after the treatment, but then magically produce a huge effect a month later… Maybe the effect can slightly strengthen over time, but to go from not noticeable to cure your ED by just waiting for a month doing nothing..? You don’t believe in that either.
The normal way is that any effect is strongest immediately and then fades…

Regarding implant, it for sure is a solution that works. It will give you a dick which you for sure can use for sex. And use very well. As good as it gets.
There are of course drawbacks to an implant, as there is to all ED treatments. The major one being that you have to pump your dick up to get hard. However, there is no point refusing an implant for that reason when the alternative is not getting hard at all, and hence have no sex at all. If your (and my) options are to either have no sex at all for the rest of our lives, or to get an implant, pump our dicks up and then fuck like a king, I think the choice is pretty simple.

Of course, a good advice to anyone as young as you would be to try all less invasive treatments without risk and with some chance of success before going the implant route. But to me, it seems you have done that already.

Finally, I’d just like to throw in another name in your implant doc shortlist. Dr. Eid.
Facts are that if FT is used to judge who’s the best, he’d win hands down. Even though I am sure Kramer is one of the best, there are still quite a few fuckups from him among FT members. Not so from Eid.
Anyway, Kramer or Eid is not the major issue. The major issue is that if you go for an implant, then pick a high volume, experienced surgeon with good reputation. You don’t want to have any higher risk of failure than absolutely necessary.
Also, I had the same issue with getting in contact with Kramer. Back when I got my implant almost 4 years ago, I got in touch with Kramer, Perito and Eid, not knowing which one of them I preferred. I never heard anything back from Kramer and Perito, but Eid had scheduled a video consultation with me within a few days. Try him!

Question: If you are a patient of Dr. Goldstein, what caused you to not consider him as your surgeon? He trained Kramer and a bunch of the other popular doctors frequently mentioned on this site? I ask, because I'm in the process of scheduling implant with Dr. Goldstein. Seems like he's the "space commander", but although I see many fellow patients here on FRANKTALK, i don't see his name come up here very frequently as a surgeon.

I’ve heard Kramer responds to emails quickly. Perhaps a member can chime in his email address. Dr. Karpman usually calls promptly. Since it’s been a few weeks, I’d call again. I don’t think it’s bugging if it’s been a few weeks.

QuestionGuy wrote:Question: If you are a patient of Dr. Goldstein, what caused you to not consider him as your surgeon? He trained Kramer and a bunch of the other popular doctors frequently mentioned on this site? I ask, because I'm in the process of scheduling implant with Dr. Goldstein. Seems like he's the "space commander", but although I see many fellow patients here on FRANKTALK, i don't see his name come up here very frequently as a surgeon.

That's a good question. I did briefly consider Dr. Goldstein for doing my implant, and he did offer his services as well when I told him I was fed up with the ineffective experimental treatments and had decided on an implant.

The main reason I didn't seriously consider Dr. Goldstein is two-fold. FIrst, While Dr. Goldstein has been implanting since the 70's, he is not a high-volume surgeon. He doesn't perform many of them on a yearly basis. I have no idea how many he's performed over his lifetime, but when we were discussing them, he said that he probably performs around a dozen or so every year. Most people on FT highly advocate going with a doctor who is a high-volume implant surgeon, such as Eid, Kramer or Karpman. Someone who does a lot of implant surgeries, and for whom implant surgeries are their bread-and-butter. Implant surgeries are certainly not Goldstein's bread-and-butter.

The second reason I'm not considering him is that he doesn't work with my insurance. I'd have to pay out of pocket. And by his own admission, as soon as I told him that, he was like, "Oh, yeah, go with Kramer of course. If you've got a Doc that good who takes you insurance? Go with him, he'll take good care of you." So that's the other reason.

I'm sure Goldstein would do a much better job than your average urologist, but I don't trust him to have the high-volume experience to do the best job on me, if I'm being honest.