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Treatment of
erectile dysfunction

All therapy options at a glance

The diagnosis is in. Now comes the crucial question: What helps? The answer depends on the cause, the severity, and your personal situation — there is no one-size-fits-all solution.

What does exist: a broad, well-documented spectrum of therapies, ranging from targeted lifestyle changes to modern biological treatments and — when necessary — surgical solutions.

This page gives you the complete overview of all treatment options — explained understandably, without promises, but with clear facts.

Diagnosis in hand — now develop the right therapy plan

Individualised, by specialist physicians, based on your lab values. Nationwide via telemedicine.

Book a consultation now

The basic principle: treat the cause, not just the symptom

The biggest problem with ED treatment in standard care is that a symptom is treated — the missing erection — without knowing the cause. A PDE-5 inhibitor (the active substance class of sildenafil, tadalafil, etc.) can improve the mechanism of the erection, but it does not treat a testosterone deficiency, does not repair damaged blood vessels, and does not resolve a psychological inhibition.

At AndroKlinik, treatment therefore always begins with a complete clarification of the cause. The therapy plan is built on what is really behind it.

AndroKlinik's therapy principle

  • 1. Identify the cause
    Hormone panel, medical history, differential diagnosis
  • 2. Treat the underlying causes
    Testosterone deficiency, vascular health, lifestyle
  • 3. Symptomatic support
    P-Shot, shockwave, PDE-5 inhibitors depending on findings
  • 4. Long-term support
    Follow-up checks, therapy adjustment, no one-off prescription

All therapy options at a glance

From minimally invasive to surgical — here are all relevant treatment options for erectile dysfunction:

Therapy option

Mode of action

Particularly suitable for

Available at AndroKlinik

Lifestyle optimisation

Improves vascular function, testosterone, nervous system

All severity levels, especially mild to moderate

Yes — as part of every plan

Nutritional supplementation

Closes micronutrient deficits (zinc, vitamin D, omega-3)

Mild ED, accompanying at all severity levels

Yes — individualised supplement plan

PDE-5 inhibitors

Inhibits cGMP breakdown → longer vasodilation

All severity levels as symptomatic support

Yes — e-prescription after consultation

P-Shot® (PRP) and P-Shot Pro®

Stem-cell growth factors regenerate erectile tissue

Vascular ED, moderate-to-severe ED, PDE-5 non-responders

Yes — on-site clinic

Shockwave therapy (ESWT)

Neovascularisation, stem-cell activation in the tissue

Vascular ED, PDE-5 non-responders, as preparation for P-Shot

Yes — on-site clinic

Testosterone therapy (TRT)

Increases NO synthesis, libido, tissue health

ED with proven testosterone deficiency

Yes — e-prescription after lab work

Infusion therapy

High-dose micronutrients IV — immediate availability

Accompanying, in case of lack of vitality and vascular component

Yes — on-site clinic

Vacuum erection device

Mechanical: negative pressure fills the erectile tissue with blood

Severe ED, transitional treatment, after surgery

No — we recommend suitable providers

Intracavernous self-injection (SKAT)

Vasoactive substance directly into the erectile tissue

Severe vascular/neurogenic ED, PDE-5 non-responders

Coordination possible

Penile implant

Hydraulic system permanently replaces erectile tissue function

Severe ED after failure of all other options

Coordination / referral

Which option suits your situation?

That is decided by your findings — not an overview table. Talk to the specialist physician now.

Book a consultation now

The step-by-step plan: how the treatment is structured

The treatment of erectile dysfunction follows an evidence-based step-by-step plan — from the basics to specialised intervention. Not everyone needs all steps. Many already achieve very good results with steps 1 and 2.

Therapy step

Measures

When to use

1

Basics: lifestyle & cause treatment

Physical activity, nutrition, sleep, stress reduction, smoking cessation · testosterone therapy in case of deficiency · medication review

Always as the first measure — regardless of severity

2

Oral pharmacotherapy + biological regeneration

PDE-5 inhibitors (as needed or daily low-dose) · P-Shot · shockwave therapy (ESWT) · infusion therapy

When step 1 is not sufficient or a vascular component is present

3

More invasive procedures

Intracavernous self-injection therapy (SKAT) · vacuum erection device · psychosexual therapy in case of psychological main cause

In case of failure or intolerance of step 2

4

Surgical intervention

Penile implant (hydraulic, semi-rigid) · vascular surgery (rarely, in young men with a local vascular problem)

After all conservative options have been exhausted

PDE-5 inhibitors: the best-known option — and its limits

PDE-5 inhibitors are the most frequently prescribed medications for erectile dysfunction. They inhibit the enzyme phosphodiesterase-5, which breaks down cGMP — the messenger that enables vasodilation in the erectile tissue. This prolongs and strengthens the erectile response to sexual stimulation.

Important: PDE-5 inhibitors do not produce an erection on their own. They enhance an already existing arousal response — without sexual stimulation, they have no effect.

Active substance

Duration of action

Onset of action

Intake

Special feature

Sildenafil

4–6 hrs

30–60 min

As needed, better on an empty stomach

Most common active substance, available cheaply as a generic

Tadalafil

up to 36 hrs

30–60 min

As needed or daily 5 mg

Long duration of action — or daily for more spontaneity

Vardenafil

4–5 hrs

25–60 min

As needed

Possibly better tolerated in case of side effects from sildenafil

Avanafil

6–12 hrs

15–30 min

As needed

Fastest onset of action, fewer side effects

When PDE-5 inhibitors are not sufficient:

  • In case of testosterone deficiency as the main cause — without sufficient testosterone, the NO system is too weak
  • In case of severe vascular damage to the vessels of the erectile tissue
  • In case of neurogenic ED after prostate surgery or nerve damage
  • In case of a primarily psychological cause — here psychosexual therapy is often more effective

Important: contraindications for PDE-5 inhibitors

  • Nitrates (e.g. in case of coronary heart disease) — absolutely contraindicated, life-threatening drop in blood pressure possible
  • Certain antihypertensives — dose adjustment required
  • Severe heart or liver diseases — medical consultation is mandatory
  • All PDE-5 inhibitors are prescription-only — no purchase without medical consultation.

P-Shot® and P-Shot Pro® (PRP stem-cell therapy): tissue regeneration from within

The P-Shot uses the body's own platelet-rich plasma (PRP) — obtained from your own blood sample — which is injected directly into the erectile tissue. The concentrated growth factors (PDGF, VEGF, TGF-β) activate stem cells in the tissue and stimulate the formation of new blood vessels.

What the P-Shot achieves in ED:

  • Improvement of blood flow through neovascularisation
  • Regeneration of erectile tissue — firmer, more natural erections
  • Improvement of sensitivity and the orgasm experience
  • Synergy with PDE-5 inhibitors — often effective again where they had previously failed

Procedure & results:

Outpatient procedure under local anaesthesia, approx. 30–45 minutes. First improvements after 4–6 weeks, full effect after 3–6 months. Repetition recommended after 3–6 months. No downtime. No risk of an allergic reaction (the body's own material).

P-Shot Pro — the extended treatment

  • Combines PRP with additional growth factors for more intensive tissue regeneration.
  • Recommended for more pronounced findings or for optimisation after a standard P-Shot.
More about the treatment: P-Shot and P-Shot Pro

Shockwave therapy (ESWT): the power of sound waves

Extracorporeal shockwave therapy (ESWT) is a non-invasive method that, originating in orthopaedics, has proven effective in andrology. Low-energy sound waves are introduced from the outside through the skin into the erectile tissue — without an incision, without anaesthesia.
More about the treatment: Shockwave

How ESWT works in ED:

  • Stimulation of neovascularisation — new small vessels grow into the erectile tissue
  • Activation of dormant stem cells in the penile tissue
  • Improvement of nitric oxide production (NO) — directly relevant for the erectile response
  • Breakdown of microcalcifications and fibrotic plaques

Procedure & treatment series:

6–12 sessions over 6–12 weeks, each approx. 20–30 minutes, almost painless. The effect sets in after the 3rd–4th session and continues to improve for months after the last treatment. Optimal combination: ESWT series first, then P-Shot — both methods reinforce each other.

Psychosexual therapy: when the cause lies in the mind

In case of psychologically caused ED — performance anxiety, fear of failure, relationship problems, trauma — psychosexual therapy is the most effective treatment. Medications can relieve pressure in the short term, but do not permanently break the vicious cycle of performance anxiety.

Therapy forms and components

  • Cognitive behavioural therapy (CBT) — identifies and changes dysfunctional thought patterns
  • Sex therapy (according to Masters & Johnson) — sensate focus exercises, rediscovering the body without pressure to perform
  • Couples therapy — when the partnership is part of the problem or the solution
  • Trauma therapy — in case of experiences of abuse or psychosexual trauma
At AndroKlinik, we coordinate the referral to specialised psychotherapists and sexual medicine physicians — as an integral part of a holistic treatment plan.

Penile implant:
The definitive solution for severe ED

When all conservative and minimally invasive therapies have been exhausted or are not tolerated, the penile implant offers a permanently effective surgical solution. It is not a first step — but for men with severe, treatment-resistant ED it is an option with very high patient satisfaction.

Two main types:

  • Hydraulic 3-component implant — the most natural result: pump in the scrotum, reservoir in the abdominal cavity, inflatable cylinders in the erectile tissue. Erect at the push of a button, discreet in the flaccid state
  • Semi-rigid (bendable) implant — simpler, cheaper, fewer mechanical parts. Permanently slightly rigid, manually bent downwards when not in use
At AndroKlinik, we coordinate the referral to specialised psychotherapists and sexual medicine physicians — as an integral part of a holistic treatment plan.

Patient satisfaction after a penile implant is over 90% in international studies — the highest satisfaction rate of all ED therapies. Prerequisite: an informed decision, correct patient selection, an experienced surgeon.

At AndroKlinik, we coordinate the referral to specialised implanting andrologists / urologists.

Start with the right first step

Specialist diagnosis + individual therapy plan. 48 hours until the findings. Nationwide via telemedicine.

Book a consultation now

Frequently asked questions about the treatment of erectile dysfunction

Does the P-Shot work better than Viagra?

This is not an either-or question. PDE-5 inhibitors work symptomatically and immediately. The P-Shot treats tissue health and improves the underlying cause over weeks and months. Many men report that after a P-Shot, PDE-5 inhibitors become more effective again — or are no longer needed at all. The optimal combination depends on the findings.

How many shockwave sessions do I need?
Usually 6–12 sessions, once a week. The effect often shows during the series and continues to improve for 3–6 months afterwards, because the formation of new vessels and tissue regeneration take time. The specialist physician assesses after the series whether a repetition or combination with the P-Shot makes sense.
Can I simply order PDE-5 inhibitors online?
PDE-5 inhibitors are prescription-only — and for good reason. They can have dangerous interactions, especially with nitrates in case of heart diseases. Non-prescription 'erection remedies' from the internet often contain no active substances or dangerous ones. Get a prescription from a doctor — the consultation with us takes 30–45 minutes and gives you much more than a prescription.
Does the health insurance cover the treatment costs?
Statutory health insurance (GKV) benefits for ED treatments are severely restricted. PDE-5 inhibitors are generally not reimbursed by statutory health insurers. P-Shot, ESWT and infusion therapies are self-pay services. In case of proven testosterone deficiency, TRT may be GKV-reimbursable under certain conditions — the doctor examines this on a case-by-case basis. Our services are primarily aimed at self-payers.
Is the treatment discreet — will anyone find out about it?
Yes, completely. The consultation takes place via video, lab findings go directly to us, the e-prescription is transmitted digitally. Only neutral descriptions appear on the bank statement. Medical confidentiality applies as a matter of course.

The next step: your therapy plan

You have all the information — now all that is missing is the conversation with the specialist physician.

At AndroKlinik, after an initial consultation and lab work, you receive a written, individual therapy plan — with a clear recommendation on which options make sense for you.

Take matters into your own hands

Erectile dysfunction is treatable — with the right plan, not with a prescription.

About the author

Dr. med. Timo A. Spanholtz
Specialist in Plastic and Aesthetic Surgery - Specialist for Men's Health and Intimate Surgery

Dr. med. Timo A. Spanholtz
Dr. Spanholtz is the founder and chief physician of AndroKlinik. With many years of clinical experience in men's health, andrology and reconstructive urology, he supports patients from the entire German-speaking region.
Learn more

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