ME
Marcus ElwoodMD
Medical Director
Vasculogenic ED, penile rehabilitation, Peyronie's disease
Est. 2009Erectile dysfunction & men’s sexual health
The most treatable condition
men refuse to discuss.
Erectile dysfunction affects roughly half of men over forty and improves substantially in the overwhelming majority who are properly assessed. The obstacle has never been the medicine.
Prefer to speak to someone first? Call (555) 018-4300. You will reach the clinic, not a call centre.
01
Assess
Ninety minutes. Full history, examination, laboratory panel and duplex imaging where indicated. No prescription is written before we know what we are treating.
02
Diagnose
We identify the mechanism — vascular, hormonal, neurological, pharmacological, psychological, or the combination it usually turns out to be.
03
Treat
The least invasive effective option first, escalated deliberately. Every price is published before you agree to anything.
04
Follow
Scored reassessment against your documented baseline. If a treatment is not working, we say so and change it rather than selling you more of it.
01The problem
Eight minutes is not a consultation.
The typical experience of raising erectile dysfunction with a physician runs about eight minutes. A brief conversation, a starting-dose prescription, and an implicit understanding that the subject is now closed. If the tablet works, the man never returns. If it does not, he concludes he is beyond help — and he is very probably wrong.
What that appointment skipped is the part that matters. Erectile dysfunction is a symptom, not a diagnosis. It has a mechanism, and the mechanism is knowable: arterial inflow, venous outflow, hormonal status, nerve conduction, medication burden, sleep, metabolic health and psychological state each contribute in proportions that differ from man to man.
Establishing those proportions takes time and testing. It is also the only way to know which of the treatments on this site belongs to you — and, occasionally, to catch the cardiovascular disease that produced the symptom in the first place.
A man who leaves here with a prescription and no understanding of why he needed it has been sold something, not treated.
— Marcus Elwood, MD, Medical Director
Read this part
ED is often the first symptom of heart disease.
Penile arteries are roughly a third the diameter of coronary arteries. The same accumulation of plaque narrows them proportionally far more — which is why the symptom appears here first, typically three to five years before a cardiac event.
That interval is an opportunity, and it is squandered every time a man is handed a prescription without anyone measuring his blood pressure. Every patient here is screened. Some arrive concerned about their sex life and leave having caught something more serious in time.
Read the full article02What we do
Seven treatments for ED, from least invasive to most.
We start at the top of this ladder and move down it only when we have to. Each entry carries an honest grade for the strength of the evidence behind it — including the ones where that evidence is thin.
- 01
Oral medication
First-line
The first thing we try, and for most men the last thing they need.
Well established - 02
Vacuum devices
Device
Unfashionable, inexpensive, drug-free, and genuinely effective.
Well established - 03
Acoustic wave therapy
In-clinic procedure
A drug-free, in-office protocol aimed at the blood supply itself.
Emerging - 04
Testosterone therapy
Hormonal
For men who are genuinely deficient — and only for them.
Well established - 05
Injection therapy
Self-administered
The highest response rate of any non-surgical option. Also the one nobody wants to hear about.
Well established - 06
PRP therapy
In-clinic procedure
Widely marketed. Not yet proven. Here is what we actually know.
Investigational
By the numbers
What treatment
actually achieves.
- 52%
- Of men 40–70
- 80%
- Respond
- 3–5
- Years
- 90
- Minutes
report some degree of ED
to first- or second-line therapy
ED can precede a cardiac event
with a physician at your first visit
03Who treats you
Four specialists. One condition.
A urologist, an endocrinologist, a procedural physician and a psychosexual specialist — because erectile dysfunction is rarely a single-discipline problem.
PR
Priya RaghunathanMD
Endocrinology & Hormonal Health
Hypogonadism, metabolic contributors, fertility-sparing protocols
DO
Daniel OkonjoMD
Staff Physician, Procedural Services
Acoustic wave therapy, injection training, regenerative protocols
JW
James WhitakerPhD
Psychosexual Health
Performance anxiety, couples work, adjustment after diagnosis
04How it works
Assess. Diagnose. Treat. Follow.
The sequence matters more than any individual treatment on this site. Skipping the first two steps is why so many men conclude that nothing works.
- 01
Assess
Ninety minutes. Full history, examination, laboratory panel and duplex imaging where indicated. No prescription is written before we know what we are treating.
- 02
Diagnose
We identify the mechanism — vascular, hormonal, neurological, pharmacological, psychological, or the combination it usually turns out to be.
- 03
Treat
The least invasive effective option first, escalated deliberately. Every price is published before you agree to anything.
- 04
Follow
Scored reassessment against your documented baseline. If a treatment is not working, we say so and change it rather than selling you more of it.
05The Journal
Written by the physicians who treat it.
Patient education without the marketing gloss — including the parts of this field where the evidence does not support the advertising.
Understanding ED7 min
What Your Erections Are Telling You About Your Heart
Penile arteries are roughly a third the diameter of coronary arteries. That single anatomical fact explains why erectile dysfunction is often the first symptom of a disease that has nothing to do with sex.
· Marcus Elwood, MD
Treatment6 min
Why the Pill Didn't Work
Most men who believe they have failed oral medication have never had a fair trial of it. Six things go wrong, and all six are fixable.
· Daniel Okonjo, MD
Treatment8 min
The Testosterone Problem Nobody in the Industry Wants to Discuss
Low-T clinics have made testosterone the most over-prescribed hormone in men's health. Here is how to tell whether you actually need it.
· Priya Raghunathan, MD
06Questions
The things men ask before they book.
Usually over the phone, usually anonymously, and usually beginning with an apology that is entirely unnecessary.
All questionsDo I need a referral?
No. You can book directly. If you would like us to coordinate with your primary care physician we are glad to, but nothing about your care here requires their involvement or their permission.
What happens at the first appointment?
Ninety minutes, most of it conversation. A full medical and sexual history, a validated IIEF-5 questionnaire, a physical examination, blood work, and — where indicated — a penile duplex ultrasound. You leave with a written plan, not a prescription pushed across a desk.
Is this embarrassing?
Less than you expect. This is the only thing we do. Every man in the waiting room is there for the same reason, every member of staff has had this conversation thousands of times, and nobody here finds any part of it remarkable.
Can I be seen without my partner knowing?
Yes. Your care is confidential and protected under HIPAA. We will never contact anyone about your treatment without your written authorization, and you control how we communicate with you — including whether we leave voicemails or send text reminders.
How quickly can I be seen?
New patient consultations are typically available within five to seven business days. If you have had a sudden onset of symptoms, or symptoms following an injury, tell us when you book and we will bring you in sooner.
Next step
Start with a conversation, not a prescription.
Ninety minutes with a physician who does only this. A full diagnostic workup, a written plan, and a clear price before anything begins.