Botox Trials

[Markc2008]

I’m basing my comments off the studies already mentioned where men had success in trials. My Ed and flaccid shrinkage or tightness is from antidepressants so I think physically I’m still in good shape, so I hope the Botox works. I will keep you posted.

[phallus]

However, there needs to be a sufficient amount of working smooth muscle in the erectile tissues for this treatment to work. So in the case of advanced fibrosis, which is the loss of smooth muscle and replacement with collagen, the effect may not be as good and CVOD will still occur, which is a venous leak.

What about other types of occlusion issues, e.g. faulty veins?
The hope for me is botox being able to increasing the inflow just enough for it to overcompensate for the outflow
so one can switch from needing injections to only having to take pills when having sex.
That would be a fair expectation from the treatment, right?

Finally a ED treatment worth being excited about!

[BrokenPiston]

One thing that's not clear so far in this thread (or from any of the links herein) is how often would you get your penis injected with botox using it as an ongoing treatment. In the trial, it was a single injection but that's probably because they are doing research and trying to understand the durability of the treatment. Cosmetic botox is actually pretty durable - it lasts three to four months.

[JohnSmith]

Interesting, going to look into trying this and report back.

[passerarf]

Very curious if anything came of this...

[passerarf]

And thanks in advance for reporting back!

[Simbarn]

However, there needs to be a sufficient amount of working smooth muscle in the erectile tissues for this treatment to work. So in the case of advanced fibrosis, which is the loss of smooth muscle and replacement with collagen, the effect may not be as good and CVOD will still occur, which is a venous leak.

What about other types of occlusion issues, e.g. faulty veins?
The hope for me is botox being able to increasing the inflow just enough for it to overcompensate for the outflow
so one can switch from needing injections to only having to take pills when having sex.
That would be a fair expectation from the treatment, right?

Finally a ED treatment worth being excited about!

Sorry I missed this.
The veins on the outside of the penis are generally not the problem with ED, these will not affect venous occlusion to any great degree. The tiny emissary veins that pass through the tunica get compressed if the tunica is working properly AND the two big cylinders underneath them called the corpus cavernosum (erectile bodies) are able to expand sufficiently to enable this compression. This is where the fault usually lies, these two big cylinders fail to expand due to many complex reasons. Sometimes it’s the failure of the NO pathway due to endothelial damage or aging and or a loss of smooth muscle (the actual mechanical structure than performs this task) in these tissues and the replacement of this crucial mechanism with a non-compliant structure such as collagen. This can also occur due to an increase in adrenergic activity or expression in these same erectile tissues. Often all of these undesirable things may be occurring at the same time, especially as we get older.
Botox may help if there is sufficient healthy smooth muscle in the penis and if the cause is more to do with a slightly compromised NO pathway and or an increase in adrenergic inhibitive function. To what degree it will help if these conditions are advanced is yet to be seen.
Once again it may work for a period of time like PDE5i and IC injections until the conditions advance in severity.

Where Botox may hold substantial promise, is with sympathetic hyperactivity (hyper-adrenergic) in the penis itself and also stubborn psychogenic ED, resistant to other forms of treatment. Psychogenic ED is in effect also stimulating the adrenergic and another inhibitive pathways excessively to maintain the penis in a flaccid state. Botox may lessen the power of these mechanisms just enough if administered correctly to allow the NO pathway to once again have the upper hand when sexual stimulation occurs and maintain this power until this stimulation stops.
These inhibitive pathways increase in power as we age and may also increase in younger individuals from other disorders in the body. The past and current research of this part of erectile function is very interesting.

[passerarf]

FYI, I am getting more and more serious about trying Botox for my ED. The issue is that there are VERY FEW doctors that have any experience with it. I'm located in NY and I've only found 2-3.

If anyone else has any practical experience with Botox for ED, please do share!

I'll keep you all posted if I end up deciding to try it.

[TwoStep]

FYI, I am getting more and more serious about trying Botox for my ED. The issue is that there are VERY FEW doctors that have any experience with it. I'm located in NY and I've only found 2-3.

If anyone else has any practical experience with Botox for ED, please do share!

I'll keep you all posted if I end up deciding to try it.

Given that you’re in New York are you looking into trying it at Centers for Sexual Medicine? What other places are offering it?

The rationale for this treatment seems to make some sense, but the intended effect (blocking norepinephrine to relax smooth muscle) seems quite different from the standard pathway that Botox is supposed to work on (blocking acetylcholine at the neuromuscular junction in skeletal muscle). The trials do seem to suggest that it could be useful.

[TwoStep]

One thing that's not clear so far in this thread (or from any of the links herein) is how often would you get your penis injected with botox using it as an ongoing treatment. In the trial, it was a single injection but that's probably because they are doing research and trying to understand the durability of the treatment. Cosmetic botox is actually pretty durable - it lasts three to four months.

Here is the small placebo-controlled trial with results. See sections 3 (SHIM score before treatment) and 5 (SHIM score after treatment). It suggests some effect at 6 weeks till 12 weeks. So frequency may be every 3 months.

https://clinicaltrials.gov/ct2/show/results/NCT03102762

The improvement of 4.5 points at 6 weeks is not nearly as great as that from sildenafil when it was trialed (around 10 points), but then again that’s maybe asking too much.