Understanding Erectile Dysfunction: What Men Should Know
Learn about erectile dysfunction, its causes, and how compounding pharmacies may offer alternatives like trimix, bimix, and quadmix formulations.
Table of Contents
Erectile dysfunction (ED) affects millions of men across the world. How common erectile dysfunction is can vary a lot depending on the group of people being studied and the survey methods used, with estimates ranging from about 13% to 71%. One well-known study, the Massachusetts Male Aging Study, found that over half of men aged 40 to 70 experience some level of erectile dysfunction.
Source: Ong, Y. N., Tan, Y. G., Handayani, D., & How, C. H. (2024). Erectile dysfunction: Assessment and management in primary care. Singapore Medical Journal, 65(2), 68–74. https://doi.org/10.11622/smedj.2024011
For men experiencing ED, and the healthcare providers who work with them, understanding this condition is a critical step toward improving sexual health and quality of life. Erectile dysfunction can be frustrating and complex, but men are not alone, and options do exist.
What Is Erectile Dysfunction (ED) and Why Does It Happen
ED is characterized by the ongoing inability to achieve or maintain an erection suitable for sexual intercourse. While it’s common for most men to occasionally experience difficulty with erections, persistent ED is considered a medical concern that warrants evaluation.
Source: Exon Publications. (2025). Erectile dysfunction: Causes, symptoms, diagnosis, and effective treatment options for men. Exon Publications EBooks. https://doi.org/10.36255/erectile-dysfunction-causes-symptoms-treatment-options
Here are various physical and psychological factors that may contribute to ED:
- Vascular issues: Conditions like hypertension, atherosclerosis, or diabetes may restrict blood flow to the penis.
- Neurological disorders: ED may be associated with conditions such as multiple sclerosis, Parkinson’s disease, or nerve damage.
- Hormonal imbalances: Low testosterone, thyroid dysfunction, or elevated prolactin levels can affect libido and performance.
- Medications: Many prescription medications, including antidepressants and antihypertensives, list ED as a potential side effect.
- Psychological factors: Stress, anxiety, depression, and relationship issues often play a role, either alone or in combination with physical causes.
ED is not a normal part of aging, although it becomes more prevalent with age due to increased risk of comorbid conditions.
Erectile Dysfunction and Cardiovascular Health
Erectile dysfunction can be an early warning signal for cardiovascular health. Because the penis has smaller blood vessels than the heart, its symptoms may arise years before more significant heart-related issues develop. Men with ED, especially those under 60, should be screened for underlying heart disease, high blood pressure, and lipid disorders.
According to the American Heart Association, the presence of ED increases the risk of future cardiovascular events, making ED not just a quality-of-life concern but a clinical marker that providers should take seriously.
Source: American Heart Association. Erectile dysfunction may be warning sign for more serious health problems. AHA News. Jun 11, 2018. https://www.heart.org/en/news/2018/07/11/erectile-dysfunction-may-be-warning-sign-for-more-serious-health-problems
The Psychological Impact of Erectile Dysfunction
Erectile dysfunction (ED) involves important psychological factors. Many men face lowered self-esteem, performance anxiety, and relationship strain, which can worsen the condition. Open communication with healthcare providers is essential, and counseling may benefit some patients.
Addressing the psychological component of ED is especially important when physical causes are ruled out or when anxiety is a contributing factor. Cognitive behavioral therapy and sex therapy may be helpful to overcome these challenges.
ED in the Context of Hormonal Imbalance
Testosterone plays a major role in male sexual function, and low levels may contribute to both ED and decreased libido. Other hormones, like thyroid hormone and prolactin, also influence sexual function. Providers may order lab work to evaluate hormone levels, particularly in cases of chronic ED or low sexual desire.
When a hormonal imbalance is suspected, testosterone replacement therapy or other interventions may be considered. Compounded testosterone creams, injections, and other formulations may offer flexibility in dosing and administration.
Lifestyle Factors and Erectile Dysfunction
Lifestyle choices significantly influence erectile function. Factors that may contribute to ED include:
- Smoking
- Excessive alcohol consumption
- Obesity
- Sedentary lifestyle
- Poor diet
- Lack of sleep
Improving cardiovascular health through regular exercise, a heart-healthy diet, smoking cessation, and weight loss may help improve or reverse ED symptoms. For many men, these changes have measurable benefits on sexual performance and overall well-being.
How a Compounding Pharmacy May Help Men with ED
Men who are unresponsive to conventional oral medications, or who experience unwanted side effects, may benefit from options prepared by a compounding pharmacy. Unlike mass-produced medications, compounded preparations are made specifically for an individual’s needs, offering flexibility in formulation, dosing, and delivery method.
Compounded medications may provide:
- Custom strengths for those who do not respond to standard doses
- Combinations of active ingredients not commercially available
- Alternate delivery forms (such as injectable solutions or troches)
- Fewer fillers, dyes, or preservatives, which may help patients with sensitivities
This level of customization can be especially valuable for men dealing with complicated medical profiles or who haven’t found success with traditional ED medications like sildenafil or tadalafil.
Trimix and Other Compounded Options for Erectile Dysfunction
Trimix is a combination of alprostadil, papaverine, and phentolamine. Each of these agents works through different mechanisms to promote blood flow into the penile tissue. Trimix may be effective for men who have not had success with oral therapies and is administered via intracavernosal injection.
Trimix: Frequently Asked Questions
How does Trimix work?
Each ingredient in Trimix plays a role:
- Alprostadil relaxes blood vessels and increases blood flow.
- Papaverine helps widen blood vessels.
- Phentolamine prevents blood from leaving the penis too quickly.
Together, these actions help achieve and maintain an erection.
Who is Trimix for?
Trimix is generally prescribed for men with erectile dysfunction who:
- Have not had success with oral medications.
- Cannot take oral medications due to medical conditions or side effects.
- Need a tailored dosing solution under a physician’s care.
Your provider will determine if Trimix is right for you.
How is Trimix administered?
Trimix is administered as a small injection into the side of the penis using a fine needle. Most patients find the process relatively painless, especially after proper training. Your provider will teach you how to safely prepare and administer your injections at home.
How quickly does it work, and how long does it last?
Trimix usually works within 5–20 minutes after injection. The duration of effect can vary but typically lasts about 30–60 minutes. Your provider will help you find the right dose for safe, effective results.
What are the risks or side effects?
Possible side effects include:
- Mild pain or burning at the injection site
- Prolonged erections (priapism) lasting more than 4 hours, which requires immediate medical attention
- Fibrosis (scar tissue) with long-term use if injections are not rotated properly
Your provider will review risks and ensure you’re trained on safe use.
How is Trimix stored?
Trimix should be stored in the refrigerator or freezer depending on the formulation. Follow the specific storage instructions provided with your prescription to maintain effectiveness.
Can Trimix be adjusted for individual needs?
Yes. Because Trimix is a compounded medication, your provider can work with the pharmacy to adjust the strength and formulation based on your needs and response.
Do you compound Trimix at Central Ohio Compounding Pharmacy?
Yes. Central Ohio Compounding Pharmacy compounds Trimix prescriptions in our sterile compounding lab. We work closely with your provider to prepare a formulation and strength that fits your individual treatment plan.
How do I get started with Trimix?
You’ll need a prescription from your healthcare provider. Once we receive it, our team will prepare your Trimix and review storage, handling, and usage instructions with you.
Related: The Ultimate Guide to ED: Trimix Injections, Sildenafil, Tadalafil, More
Bimix
Bimix contains two of the Trimix components—typically papaverine and phentolamine. This combination may be considered for men who are sensitive to alprostadil or who experience side effects like penile pain with its use.
Quadmix
Quadmix includes the three ingredients in Trimix, plus a fourth agent, which varies but may include atropine or forskolin. It is typically reserved for patients who require a more aggressive formulation due to severe ED.
Related: Using the Autoinjector
Other Forms
Sublingual troches containing sildenafil, tadalafil, or vardenafil are also commonly compounded. These rapidly dissolve under the tongue, bypassing the gastrointestinal system, and may provide quicker onset for some patients.
Topical creams containing vasodilators are another alternative for those who prefer non-invasive options or who are needle-averse. These preparations are often used off-label under the supervision of a healthcare provider.
Vacuum Erection Devices (ED Pumps)
Vacuum erection devices (VEDs), also known as ED pumps, are a non-invasive, drug-free option for managing erectile dysfunction. These devices work by creating negative pressure around the penis, which draws blood into the corpora cavernosa and causes an erection. Once adequate rigidity is achieved, a constriction ring is placed at the base of the penis to maintain the erection during intercourse. VEDs may be particularly helpful for men who cannot use medications or prefer a mechanical solution. Studies show they are effective in many cases, especially following prostate surgery or when used as part of penile rehabilitation. While some users report discomfort or a lack of spontaneity, VEDs remain a valuable option in the broader toolkit of ED management strategies.
Source: National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). A vacuum-constrictor device for erectile dysfunction – Media asset. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/news/media-library/17648
When to Refer to a Specialist
While many primary care physicians manage ED successfully, certain patients may benefit from referral to a urologist, endocrinologist, or men’s health specialist. Consider referral when:
- ED is accompanied by other signs of hormonal deficiency
- There is penile deformity or Peyronie’s disease
- Oral and compounded therapies have failed
- There is suspicion of underlying vascular disease or neurologic disorder
Providers can also collaborate with compounding pharmacists to adjust therapies based on patient response, enhancing individualized care plans.
ED is a common yet complex issue influenced by a range of physical, psychological, hormonal, and lifestyle factors. Recognizing ED as a multifactorial condition enables a more complete and effective approach to care. For men who do not respond to standard medications, compounded therapies such as Trimix or sublingual troches may offer another path.
Compounded ED Medications in Ohio
When compounded medications are appropriate, working with a trusted compounding pharmacy ensures quality, precision, and collaboration in addressing ED. Contact Central Ohio Compounding Pharmacy today and ask your provider how you can get started on your sexual health journey.
References:
Ong, Y. N., Tan, Y. G., Handayani, D., & How, C. H. (2024). Erectile dysfunction: Assessment and management in primary care. Singapore Medical Journal, 65(2), 68–74. https://doi.org/10.11622/smedj.2024011
American Heart Association. (2018, June 11). Erectile dysfunction may be warning sign for more serious health problems. https://www.heart.org/en/news/2018/07/11/erectile-dysfunction-may-be-warning-sign-for-more-serious-health-problems
Exon Publications. (2025). Erectile dysfunction: Causes, symptoms, diagnosis, and effective treatment options for men. Exon Publications EBooks. https://doi.org/10.36255/erectile-dysfunction-causes-symptoms-treatment-options
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). A vacuum-constrictor device for erectile dysfunction – Media asset. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/news/media-library/17648
