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I red of people who kept going for decades with injections and other for as little as one year.

Can anybody explain to me the difference and the real effectiveness of injections?

I’m not a candidate for pills

It’s hard to answer this question because everyone is different in the way they respond to the injections. Hence the difference formulas of the Trimix. Also, scar tissue formation is different for people. I have been on Trimix since 2019. It still works great for me. I cannot feel any scar tissue build up in my penis. I always alternate sides of shaft where I inject and vary the distance slightly from the pubic area where shaft meets body. Per my urologist instructions. I also hold pressure for two minutes where I inject and massage the shaft tissue. Urologist also has me using a VED to stretch the tissue, only 10 minute under suction. You don’t get edema in shaft skin with that short time just a good stretch.
When will the Trimix stop working for me or anyone is not really predictable, at least not accurately because there are too many variables. The Trimix gives me an excellent hard erection for at least an hour now. It took some fine tuning to get there because at first I was hard for 3.5 hours!

JH1982 wrote:Can anybody explain to me the difference and the real effectiveness of injections?

As ETGuy said, that's a hard question to answer. Too broad of a question really, at least for short answers.

In the U.S. there are really only 3 drugs used for ED as injections, with a 4th used less often. In some other countries there is at least one other drug.

In the U.S. I think it's still true to say there is only one drug FDA approved for penile injections for ED. That drug is alprostadil, also known as Prostaglandin E₁ or more commonly PGE1. It is FDA approved in the proprietary offerings of Edex and Caverject. Both very expensive if your insurance doesn't cover them. Both come in proprietary cartridges that are very shelf stable without refrigeration but IMHO a little more difficult to inject with. They are shelf stable as they come with the drug in a dry powder form that must be mixed in the proprietary cartridge prior to use. The strengths available are fairly limited. I think Edex is limited to 10mcg, 20mcg and 40mcg, all in 1ml of bacteriostatic water when mixed for use. I believe Caverject also has an option that doesn't use their cartridge but I know little about that option.

Alprostadil mono-mixes are available from many higher level compounding pharmacies. However they're not near as readily found as the combination mixes I'll get to shortly. Alprostadil mono-mixes can be found in various mixes depending on what the compounding pharmacies see fit to produce. The pharmacy I use will make any strength mix the doctor prescribes. The compounded alprostadil mono-mixes are NOT shelf stable unrefrigerated. They come in vials pre-mixed in the bacteriostatic water. For any long term storage they must be frozen as the reconstituted mix degrades quickly at room temperature, slower refrigerated and very slowly frozen.

Much more commonly found than the mono-mixes and probably than Edex or Caverject are the tri-mixes. These mixes most commonly are mixes from compounding pharmacies containing Alprostadil, papaverine and Phentolamine in different ratios. It is my understanding that the 3 drug combination is synergistic. (Synergy is an interaction or cooperation giving rise to a whole that is greater than the simple sum of its parts."Wikipedia) The Papaverine in most mixes is the largest component with the Phentolamine a smaller component. The alprostadil is probably the most potent drug of the mix. It is measured in micrograms (mcg) where the other two are measured in milligrams (mg). The tri-mixes seem to be more stable than the alprostadil mono-mixes but still require refrigeration. It is my belief that the ability of tri-mixes to remain stable not frozen may be dependent on how important the alprostadil component is to that mix.

The papaverine and phentolamine are rarely administered as single drug preparations (for ED) but are fairly often offered as a bi-mix or combination of the two.

But back to the tri-mix. It can be had (by prescription) in a wide variety of mixes. The stronger mixes will generally have a much greater component of alprostadil. It's generally considered the heavy hitter of the three drugs. Unfortunately it's also the drug most likely to cause ache or pain. Often times the ache or pain will decrease or totally resolve with continued use, but not always. Some men just can't tolerate the drug. Unfortunately there is some evidence that the alprostadil is the component least likely to cause fibrosis or scaring. However, none of the drugs are risk free. In my humble non-expert opinion I think much of the scaring and fibrosis reported is due to poor injection technique or in some cases abuse, but that's just my guess.

If you simply can't tolerate alprostadil you're left with bi-mix, usually the combination of the papaverine and phentolamine. Sometimes they are combined with atropine sulfate creating a new tri-mix but it isn't generally referred to as a tri-mix. I'm unsure of the action and effect of the atropine so I'll let someone else opine on that.

There is also quad-mix which is generally a potent tri-mix combined with the atropine. There's even a penta-mix, but I know little about it. This is a PDF from a compounding pharmacy, one I have no experience with. It may help: http://www.wedgewoodpharmacy.com/uploads/ED%20Switching%20Guide.pdf. This link at UCSF is pretty good too: https://www.ucsfhealth.org/education/patient-guide-to-penile-injections

I've used an alprostadil mono-mix for over 11 years. It still works well for me and as far as I know has caused no ill effects. Others have reported long term success with tri-mixes. Unfortunately, it seems the injections are more like alchemy than science. Your results and long term outlook aren't really predictable. The injection therapy will likely give you an impressive erection. Whether it will be painful or not, or continue to be painful or not, will cause damage over time or not, be a long term solution or not, is unknown and will be individual to you. I'm happy with my results.

Good luck.

I used injections for 32 years before I went implant.

I had no fibrosis, scarring, or Peyronie’s at time of surgery.

My only downside to injections was they contributed to bad delayed ejaculation. The upside was a very reliable erection until the last 3 years or so. Even then I’d get a solid erection , just a short shelf life to it.

Nobody is the same. I like me implant way better than shots. But I’m not sure I would change how I did things. An implant is forever, the wiring is gone.

That’s a a sexual lifetime almost.

Txagq8 wrote:I used injections for 32 years before I went implant.

I had no fibrosis, scarring, or Peyronie’s at time of surgery.

My only downside to injections was they contributed to bad delayed ejaculation. The upside was a very reliable erection until the last 3 years or so. Even then I’d get a solid erection , just a short shelf life to it.

Nobody is the same. I like me implant way better than shots. But I’m not sure I would change how I did things. An implant is forever, the wiring is gone.

bldoink wrote:

JH1982 wrote:Can anybody explain to me the difference and the real effectiveness of injections?

As ETGuy said, that's a hard question to answer. Too broad of a question really, at least for short answers.

In the U.S. there are really only 3 drugs used for ED as injections, with a 4th used less often. In some other countries there is at least one other drug.

In the U.S. I think it's still true to say there is only one drug FDA approved for penile injections for ED. That drug is alprostadil, also known as Prostaglandin E₁ or more commonly PGE1. It is FDA approved in the proprietary offerings of Edex and Caverject. Both very expensive if your insurance doesn't cover them. Both come in proprietary cartridges that are very shelf stable without refrigeration but IMHO a little more difficult to inject with. They are shelf stable as they come with the drug in a dry powder form that must be mixed in the proprietary cartridge prior to use. The strengths available are fairly limited. I think Edex is limited to 10mcg, 20mcg and 40mcg, all in 1ml of bacteriostatic water when mixed for use. I believe Caverject also has an option that doesn't use their cartridge but I know little about that option.

Alprostadil mono-mixes are available from many higher level compounding pharmacies. However they're not near as readily found as the combination mixes I'll get to shortly. Alprostadil mono-mixes can be found in various mixes depending on what the compounding pharmacies see fit to produce. The pharmacy I use will make any strength mix the doctor prescribes. The compounded alprostadil mono-mixes are NOT shelf stable unrefrigerated. They come in vials pre-mixed in the bacteriostatic water. For any long term storage they must be frozen as the reconstituted mix degrades quickly at room temperature, slower refrigerated and very slowly frozen.

Much more commonly found than the mono-mixes and probably than Edex or Caverject are the tri-mixes. These mixes most commonly are mixes from compounding pharmacies containing Alprostadil, papaverine and Phentolamine in different ratios. It is my understanding that the 3 drug combination is synergistic. (Synergy is an interaction or cooperation giving rise to a whole that is greater than the simple sum of its parts."Wikipedia) The Papaverine in most mixes is the largest component with the Phentolamine a smaller component. The alprostadil is probably the most potent drug of the mix. It is measured in micrograms (mcg) where the other two are measured in milligrams (mg). The tri-mixes seem to be more stable than the alprostadil mono-mixes but still require refrigeration. It is my belief that the ability of tri-mixes to remain stable not frozen may be dependent on how important the alprostadil component is to that mix.

The papaverine and phentolamine are rarely administered as single drug preparations (for ED) but are fairly often offered as a bi-mix or combination of the two.

But back to the tri-mix. It can be had (by prescription) in a wide variety of mixes. The stronger mixes will generally have a much greater component of alprostadil. It's generally considered the heavy hitter of the three drugs. Unfortunately it's also the drug most likely to cause ache or pain. Often times the ache or pain will decrease or totally resolve with continued use, but not always. Some men just can't tolerate the drug. Unfortunately there is some evidence that the alprostadil is the component least likely to cause fibrosis or scaring. However, none of the drugs are risk free. In my humble non-expert opinion I think much of the scaring and fibrosis reported is due to poor injection technique or in some cases abuse, but that's just my guess.

If you simply can't tolerate alprostadil you're left with bi-mix, usually the combination of the papaverine and phentolamine. Sometimes they are combined with atropine sulfate creating a new tri-mix but it isn't generally referred to as a tri-mix. I'm unsure of the action and effect of the atropine so I'll let someone else opine on that.

There is also quad-mix which is generally a potent tri-mix combined with the atropine. There's even a penta-mix, but I know little about it. This is a PDF from a compounding pharmacy, one I have no experience with. It may help: http://www.wedgewoodpharmacy.com/uploads/ED%20Switching%20Guide.pdf. This link at UCSF is pretty good too: https://www.ucsfhealth.org/education/patient-guide-to-penile-injections

I've used an alprostadil mono-mix for over 11 years. It still works well for me and as far as I know has caused no ill effects. Others have reported long term success with tri-mixes. Unfortunately, it seems the injections are more like alchemy than science. Your results and long term outlook aren't really predictable. The injection therapy will likely give you an impressive erection. Whether it will be painful or not, or continue to be painful or not, will cause damage over time or not, be a long term solution or not, is unknown and will be individual to you. I'm happy with my results.

Good luck.

What is considered bad injection technique that may contribute to scarring?

Frenchie wrote:What is considered bad injection technique that may contribute to scarring?

In my non-medical expert opinion (I have NO medical training or expertise.), it is my opinion that bad injection technique would be:

Using dulled needles. It doesn't take much to bend the near microscopic tip so that more damaged is cause during needle insertion.

False starts where you're jabbing multiple times.

Other than adjusting depth, moving the needle around after it's already in your flesh.

Poor placement where you're having misses or partial misses where the drugs are being dispersed into the wrong tissues. Generally I experience pain if this is happening and immediately adjust the depth. Never force the plunger and never continue if depressing the plunger causes pain. I'll temper that by saying that with my mix of 80mcg/ml alprostadil, if I depress the plunger too quickly it can cause some pain. I always depress the plunger slowly in several short pulses. You can't control that with an auto injector.

I'm sure others can suggest other things that constitute poor technique.

bldoink wrote:

Frenchie wrote:What is considered bad injection technique that may contribute to scarring?

In my non-medical expert opinion (I have NO medical training or expertise.), it is my opinion that bad injection technique would be:

Using dulled needles. It doesn't take much to bend the near microscopic tip so that more damaged is cause during needle insertion.

False starts where you're jabbing multiple times.

Other than adjusting depth, moving the needle around after it's already in your flesh.

Poor placement where you're having misses or partial misses where the drugs are being dispersed into the wrong tissues. Generally I experience pain if this is happening and immediately adjust the depth. Never force the plunger and never continue if depressing the plunger causes pain. I'll temper that by saying that with my mix of 80mcg/ml alprostadil, if I depress the plunger too quickly it can cause some pain. I always depress the plunger slowly in several short pulses. You can't control that with an auto injector.

I'm sure others can suggest other things that constitute poor technique.

I agree with all brother bldoink has to say with a minor exception. Personally I tried my best to be a good injector, but found it very difficult to do it right every single time -- especially with proper placement and smooth insertion into the right tissues. Nonetheless I felt I did pretty well and yet after 8 months, I was obliterated with scarring according to Eid. So I would say, in my very non-medical opinion, there can be two primary causes of scarring -- either poor technique, or individual susceptibility to the injection's content itself OR both -- especially with Trimix. If I had it to do over again, I would go for pure PGE as bldoink uses. According to Eid, it's the papaverine in Trimix that does the damage.