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Trimix Injections Seattle

trimix injections Seattle

Seattle trimix injection users may not tell you how they maintain their erections but if you are a diabetic or have tried oral medications like Viagra® with little success then you need to know there are more options to improve your erections.

In addition, some patients are unable to take Viagra®, Levitra®, and Cialis® due to drug interactions (ie nitrates) or severe side effects such as headache and blurred vision.

While Viagra®, Levitra®, and Cialis® are popular treatments for erectile dysfunction. For many men these can sufficient to improve erection firmness when the problem first starts.

If the cause of the problem is not effectively treated (ie low testosterone) then these oral medications (ie Viagra®) can lose their effectiveness. Many men notice over time that these medications work sometimes but not others or just stop working all together. Luckily, there are many other options.

Trimix Injections Seattle

Trimix injections, Seattle, are considered “the most effective medical therapy for diabetic erectile dysfunction.”1 Many men are unaware that trimix is even an option.

Trimix is combination of phentolamine, papaverine, and prostaglandin(E1) in an injectable form that has been around for over 20 years. This medication is so effective that when used you can have have an erection without ANY sexual stimulation and the firmness is even more increased when sexual stimulation is added.

How are trimix injections used?

Just before sexual activity, using a medical applicator device, you apply the medication directly to the penis. Basically, you place the applicator near the base of the penis, press a button, and a little needle comes out and puts a little medication just under the skin. Then, about 7 minutes later you will have a very firm erection that will last about 1-2 hours depending on the dose that we use.

We can change the dose to control firmness and duration. This mixture of 3 medications is customized to meet your needs.

What if my erection lasts too long?

While Viagra® and similar medications rarely cause erections to last too long, trimix injections, Seattle, can very easily do this and with our approach this is rarely a concern.

Innovative Men’s Health starts with a low dose, a test dose, that is applied my one of our doctors at the clinic. Based on your response to this very low dose we know what dose to send you home with so when you use it at home you get the results you are looking for.

We can do this test dose of trimix in the clinic because this medication requires NO sexual stimulation to see an effect.

What are the side effects of trimix injections

We rarely see any negative side effects when this medication is used correctly, unlike Viagra® and similar medications that often have negative side effects. The most common side effect with trimix injections, Seattle, is a good, firm erection.

Some men who have used Viara&reg with success still prefer trimix injections because they are so effective at maintaining firmness and duration.2 An additional benefit of trimix injections, Seattle, is that when you ejaculate, you keep your erection.

Still, some men fear injections and even more they fear injections in the penis. The needle is VERY small and barely penetrates the penis. The Cleveland Clinic did a study and found that discomfort is minimal and we add a little lidocaine usually that prevents any discomfort.3

Learn more about erectile dysfunction causes and treatments

Call now to learn about ALL your options – (425) 455-1700

  1. Expert Opin Pharmacother. 2008 Feb;9(2):257-66
  2. BJU Int. 2003 Aug;92(3):277-80
  3. J Sex Med. 2005 May;2(3):428-31

{ 63 comments… read them below or add one }

Brian March 29, 2014 at 3:56 pm

Hello,

I’ve been using Trimix off and on for a few years. I understand that the medication loses its effectiveness if it’s not refrigerated, and I store the vial in my refrigerator. However, I was wondering if the medication would still work after being unrefrigerated for 4 or 5 hours (perhaps using a higher dosage than usual to compensate for any loss of effectiveness). There are times when I would like to carry a single dose in a syringe with me and then use it at the end of the night.
Thanks
Brian

Reply

Dr. Barry Wheeler April 4, 2014 at 8:55 pm

Hi Brian,

Trimix is unlikely to lose very much potency in just 4-5 hours. You should ask the doctor who prescribed it or speak with your pharmacist though as trimix is a custom compounded medication.

Cheers,
Dr. Barry

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Jim February 25, 2014 at 8:48 pm

About a year ago my urologist prescribed Trimix. At first the results were highly successful at a .3 dose. The problem was I was only able to get about 3 cc’s from the 5cc prescription. The pharmacy had no answers to my inquiries. After 3 vials with the same result, I changed pharmacies. I had to increase the dose to .6 to be successful, and still I could only get 3 cc’s from the 5cc prescription. I’m on the 3rd pharmacy, now requiring .7, and still only getting 3cc’s. Is this a common problem? My urologist says it’s between me and the pharmacy, and I’m thoroughly frustrated.

Reply

Dr. Barry Wheeler March 2, 2014 at 9:28 pm

Hi Jim,

When patients are continually needing to increase their dose there are several possible causes:

  • Low testosterone (other hormone deficiencies) without treatment can cause erections to decline over time and result in higher doses of ED medication needed
  • Trimix requires refrigeration and will potency if not kept refrigerated
  • Improper appliation of trimix can effect the response

Your urologist could prescribe a more potent trimix medication or send the prescription to a different pharmacy. Trimix typically comes in 3-4 mL because it should be discarded 28 days after first use. A 5ml vial should have 5mL so either you were using more than you thought or they didn’t put 5mL in the vial.

Best of luck,
Dr. Barry

Reply

Eladio February 16, 2014 at 12:02 pm

I am on a quad mix formulation ( includes Atropine) . Can this combination of drugs cause a sore on the penis gland ( head) ?

Reply

Dr. Barry Wheeler February 23, 2014 at 6:55 pm

Hi Eladio,

It is more likely due to increased friction on the head of the penis but you need to follow up with your doctor to determine the cause.

Cheers,
Dr. Barry

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Kelly February 7, 2014 at 11:03 pm

Dr. Barry ,

I was in a crush injury in June of 2013. I fractured three vibrates( L2,L3, & L4). Also had a varicocele vein on my right side. I am doing injection therapy now. I started with trimix at .35 and still no success. We have done ultrasound with a dose of .5. It is only getting semi erect. So he gave me a .6 to try. My question is how long could this take to repair or will it ever? I know implant is option but is that a true option. Urologist told us he had a man that got crushed and he took trimix for over two years before regaining his normal state. Please any suggestions would help! Thank you for your time and help!!

Kelly

Reply

Dr. Barry Wheeler February 16, 2014 at 8:17 pm

Hi Kelly,

I suggest you ask your doctor for a more potent trimix as the medication can be customized to be much more concentrated and there is also a quad mix that can be more effective in some men.

It is impossible to comment on how long it may take you to regain your erectile function without seeing you in my clinic. Low testosterone levels and other hormone imbalances can be major barriers to regaining erectile function. I suggest you ask him to check your thyroid (TSH, Free T3), growth hormone (IGF-1, IGF-BP3), testosterone (total and free testosterone), estradiol (estrogen), and discuss with him the option of combining something like Viagra® with your trimix injection to improve results.

Never change your treatment or combine Viagra® or similar medications with your trimix injection without talking to your doctor first. Combining Viagra® with trimix can cause a prolonged erection that will require immediate medical treatment. If your erection lasts more than 3 hours call your doctor and seek immediate medical attention.

Best of luck,
Dr. Barry

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Marty January 17, 2014 at 12:52 pm

Dr. Barry: Have heard that use of tri-mix over time can result in scarring. Can you elaborate on this condition and describe what scarring is and why it may occur. Had da vinci prostate surgery about a year ago and Cialis 20mg. is ineffective. Tried Edex but it is a painful experience for me.

Reply

Dr. Barry Wheeler January 30, 2014 at 3:45 am

Hi Marty,

Scarring from trimix injections is very rare. Some men may develop temporary nodules at the injection site. You should discuss your concerns with your doctor before beginning trimix injections.

“[Trimix injection] therapy is associated with very high success rates even in men with high comorbidity profiles; however, the discontinuation rates, even in men who had not undergone [prostate removal], by the end of the third year are significant. • Of note, the recorded priapism rate was extremely low (0.5%).1

“Most fibrotic alterations that develop during the course of self-injection therapy are mild or moderate and concern small nodules in the tunica albuginea or in the penile septum. In this case, the patient should be re-instructed in the correct injection technique and taught to avoid the affected area when performing future injections. In the event real fibrotic plaques with or without penile curvature develop, self-injections should temporarily be discontinued for 3 ± 4 months.2

Cheers,
Dr. Barry

  1. A review of outcomes of an intracavernosal injection therapy programme. Coombs PG, Heck M, Guhring P, Narus J, Mulhall JP. BJU Int. 2012 Dec;110(11):1787-91. doi: 10.1111/j.1464-410X.2012.11080.x. Epub 2012 May 7.
  2. Current perspectives on intracavernosal pharmacotherapy for erectile dysfunction. Porst H. Int J Impot Res. 2000 Oct;12 Suppl 4:S91-S100.

Reply

Christian January 15, 2014 at 11:23 pm

Dr. Barry,
First, thank you for your candor and willingness to help guys that clearly need to see a LOCAL doctor.
I went to a local uroligust who adverised on the radio for ED. Unfortunately, while his office prescribed a Trimix alternative to Viagra, et al, that simply resulted in my being in the emergency room and about $2K in expenses.
My issue is that the results of my Trimix are highly variable. And I have spent considerable time discussing same with my urologist (the doctor who responded to the call from the ER), who, like a carpenter and nails, as a surgeon, wants to slice and dice.
My problem is that while I trust my urologist, clearly he is not completely comfortable with pharmacological solutions… To the best of my ability to get info, I am injecting properly. To the best of my ability to determine, I am handling the drug properly. To the best of my ability to determine, I only get erect 49% of the time (trust me I have records on each injection. And yes, that Excel spreadsheet goes to the Dr.’s office each visit.)
HOW IN THE HELL DO I FIND HELP???
Please tell me there is a National Registry of Doctors Board certified to help!!!
And if not, could you start one? $20 a year for a doc to be certified???? Okay $3K… Just a tought.
BTW, the original Urologist was clearly basing his clinic on how condo’s are sold.
THx
Christian

Reply

Dr. Barry Wheeler January 30, 2014 at 3:16 am

Hi Christian,

Have you tried asking your urologist for a referral to a more experienced doctor? Without seeing you in my clinic and looking at your medical history etc it is difficult to say what may be going on to cause your unpredictable results.

I suggest you ask your doctor to check your testosterone level and ask him to suggest a medical applicator device to make the application easier for you.

Best of luck,
Dr. Barry

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Todd December 15, 2013 at 8:37 pm

After using caverject over a decade ago for my MS, I noticed that the pills have been on and off over the years. I went back on injection therapy, tried trimex at 30. Wow, it lasted all night and I had to call dr. the next day and go into office and get it drained! Only thing good about that was the two pretty physician assistants in the room…but it was way too high a dose and not very fun to have it drained. Going to reduce to .5, I think.

Question I have is this: I left the vial of trimex on the counter over night. When I saw it, I put it back in the refrigerator, but it must have been 12 hours at least out of the fridge. Is it now unusable? Or just ineffective? Or is it a matter of testing it? Thanks,,,

Reply

Dr. Barry Wheeler December 22, 2013 at 10:27 pm

Hi Todd,

Caverject® and trimix can have very different results. Caverject® contains only alprostadil as an active component. Trimix injections typically contain a mixture of three active components: alprostadil, phentolamine, and papaverine. These three active components work synergistically to increase duration and firmness. Trimix is a compounded medication and it can be made to only contain alprostadil.

Your doctor should be advising you what dose to administer. Every patient is different and at our clinics we customize the dose to meet the patient’s needs. Please ask your doctor what dose he recommends. There are a number of different formulations we use and it is possible your doctor will want to reformulate your dose based on the results (priapism) that you had at home. Also, never combine Viagra®, Levitra®, or Cialis® within a 48 hour period unless instructed to do so by your doctor.

Trimix containing alprostadil will lose potency if left outside the refrigerator for too long. Please tell your doctor and ask him what you should do.

Cheers,
Dr. Barry

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Randy November 12, 2013 at 5:10 am

I used Viagra for years,then went to 5mg Cialis.and that stopped.Today seen a …urologist he gave me the shot of papveine He did not give me the shot. that I was reading on because I did my homework, on it for a month ,he gave me my shot around my hairline real close to the top part of the shaft …when reading on it….It tells me the middle part

of the side of the shaft……Tens minutes later I had a erection, a deformed looking erections swollen on the side where he gave me the shot he was at 4cc. plus I did not have a full erection….So he prescribed me the tri mix ….told me to start at 4cc…. Which will be tomorrow but not taking it to Wednesday I hope to have a better experience…..y is the medicine not fda approved?

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Dr. Barry Wheeler November 18, 2013 at 11:28 pm

Hi Randy,

In general, we usually recommend apply trimix about a thumb’s width from the base on the shaft of the penis. However, sometimes there are too many superficial veins near the base that need to be avoided so going more towards the middle of the shaft is needed. Also, if there is a lot fat around the base sometimes it gets in the way. You should ask your doctor for clarification before using your trimix again.

Most often when my patient get the response you did when you were at your doctors office, with the swollen look rather than erect look, the needle most likely went through one of those superficial veins and caused some blood to pool under the skin. Generally, with good technique and avoiding those veins the results are much better. You should ask your doctor what caused that to be clear and let him know about any discoloration on the penis or concerns you have.

In terms of FDA approval, all the components of trimix are FDA approved (papaverine, phentolamine, alprostadil) and the pharmacies that compound trimix are required to use FDA approved sources typically. Because trimix is customized to the patient’s needs it is compounded and therefore there is no standardized FDA approved formulation. There is a medication called Caverject® that is FDA approved but it only contains alprostadil. All our trimix that we order from the pharmacy is tested for sterility and only released from the pharmacy after that sterility test is completed. You should ask your doctor for further clarification.

Cheers,
Dr. Barry

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bob November 9, 2013 at 2:00 am

Dear Dr,
Viagra and Cialis no longer work on me and Levitra never did. I live in Queens, New York just outside of Manhattan. I would like to know if you could suggest or recommend a Urologist in my area that deals with TriMix as I have had no luck navigating the internet and there simply MUST be a Dr. who uses this treatment somewhere in the NYC area.
Thank you for your time and I honestly do hope that you can provide me with a referral to such a urologist or other specialist that deal with this.
Very truly yours,
Robert

Reply

Dr. Barry Wheeler November 10, 2013 at 11:12 pm

Hi Bob,

I am, unfortunately, not familiar with any doctors who prescribe trimix injections in New York. I suggest you ask your primary care physician for a referral.

Cheers,
Dr. Barry

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Justin November 7, 2013 at 5:08 pm

Hi Dr. Barry,
I used tri-mix for the first time yesterday. My urologist started me on a really low dose and I am to increase till I find what works. I did experience firmness for about 20 minutes with my first dose. My question would a higher dose increase the size of my erection or just the length?

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Dr. Barry Wheeler November 10, 2013 at 11:07 pm

Hi Justin,

Increasing the dose will typically improve the duration and firmness but it really depends on the person. We can typically modify a trimix dose so that it improves firmness without increasing duration too much. I suggest you contact your urologist to clarify what dose you should increase to in order to avoid a prolonged erection. If you erection lasts too long, several hours, it can lead to discomfort and an expensive trip to the emergency room if your urologist is unwilling to treat you in his office.

Cheers,
Dr. Barry

Reply

Dr. Barry Wheeler October 28, 2013 at 11:16 pm

Hi Marc,

That is a bad idea. You should discard your trimix as it is expired. Better safe than sorry. I’m sure your pharmacy didn’t intend you to keep it for years anyway. There is no research on the safety of storing trimix in this manner. Perhaps our pharmacy can give you smaller amounts at a time to make it more cost effective.

Also, please follow up with your doctor about what you’ve been doing with your trimix as he should know as well.

Cheers,
Dr. Barry

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Ruffskins October 25, 2013 at 2:42 am

I just started Trimix about a month ago and it worked better than anything i have used. I’m a T-7 paraplegic for the past 7 years and its my first erection. I’m 46yrs old and before my incident I had no problem and very active, should I take any type of testosterone boosters? Will my body respond to those as well? And even if I’m not having sex how often should i use it?

Reply

Dr. Barry Wheeler October 28, 2013 at 11:48 pm

Hi Mr. Ruffskins,

I’m glad you’re getting good results with your trimix. My patients who are paraplegic have gotten good results as well.

Those are good questions you have an you should discuss them with your doctor. If your testosterone levels are low you may benefit from testosterone therapy. Testosterone is an important hormone in terms of the health of the penis. It is important to keep sexually active as well to maintain healthy penis function. Please ask the doctor who prescribed your trimix how often they recommend you use it as I’m unable to advise you without seeing you in my clinic.

Cheers,
Dr. Barry

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Mario October 12, 2013 at 11:34 am

Dr Barry:
I have been using caverject 40mc, which comes several vials in the package. Each vial = 100mg, I use 50mg one night, 50mg the next night, using one vial. I repeat the process the next weekend. I pay $50.00 per package, It has worked great.
Now I have to switch insurance and it is not covered at all. My best alternative is to go the Trimix way. How do I or the doctor determines the right amount of the 3 ingredients to arrive at the 50mg of Caverject I am currently using.
Thank you
Mario

Reply

Dr. Barry Wheeler October 19, 2013 at 5:07 pm

Hi Mario,

Caverject® is measured in micrograms (mcg). I think you are saying that you use half of 40 mcg and get good results. That dose would be 20mcg. Any doctor experienced using trimix would be able to order a similar dose from a compounding pharmacy for you. The biggest risk is not that trimix is not going to work for you but rather than it will work too well and you’ll get a priapism.

Trimix is a mixture of three different active components: phentolamine, papaverine, and alprostadil. Caverject® only contains alprostadil. In my experience, alprostadil tends to give more firmness with less duration and when combined with the other components (phentolamine and papverine) patients experience increased duration and firmness. The trick is to get the firmness good without casing too much duration.

Your doctor needs to determine the prescription to replace your Caverject®.

Best of luck,
Dr. Barry

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tazmo September 15, 2013 at 11:42 pm

From what I read it sound like the trimix come in a flexpen.
I have always had to draw it out of a bottle. this is the first time I have read of a applicator like that. Is this new? and can you get from your drug store?

Reply

Dr. Barry Wheeler September 15, 2013 at 11:52 pm

Tazmo,

There are different trimix applicators out there but the one we use I have never seen at any drug stores and as a medical device it may require a prescription in some states.

Dr. Barry

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Dave September 13, 2013 at 6:10 pm

I have done 2 doses of Trimix in the office was a .4cc didnt do much and then home tried .7 but still not enouph for penatration how far do I go up to was thinking .10cc but dont want to much. cant just call the Dr. have to schedule a visit.$$ and the trimix is expencive enouph.
Thank you.

Reply

Dr. Barry Wheeler September 13, 2013 at 10:55 pm

Hi Dave,

Without seeing in my clinic I am also unable to give you medical advice.

Also, it sounds like your dose is getting pretty voluminous. When you go in to see your doctor you may want to ask about a more potent medication. We typically increase the potency to avoid such large doses. I suggest you also review your injection technique with your doctor as well.

Best of luck,
Dr. Barry

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Eric August 27, 2013 at 5:17 pm

I’ve used Trimex a few times. The first time it worked great! Unfortunately, I was by myself. The next 3 times I’ve tried it it seems to extravasate. My Penis gets soggy and bloated looking (as if I’ve pumped too much). The corpus cavernosum is not firm. And it’s painful. A day later it’s still lumpy and terrible looking. Is the mixture too old? Am I doing something wrong?

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Dr. Barry Wheeler August 28, 2013 at 10:38 pm

Hi Eric,

I suggest you contact the doctor who prescribed your trimix. I have had patients have similar problems with their trimix. The patients that have had this problem have typically been sexually inactive for some time and have low testosterone and elevated estrogen levels. It is also possible the corpus cavernosum has reduced in size and you are injecting outside the corpus cavernosum blood vessels. This would also lead to the pain your experiencing. It is also possible you have a sensitivity to the alprostadil as this can happen and cause discomfort. Also, alprostadil loses its potency if it is kept outside the refrigerator. Trimix is usually a mix of phentolamine, papaverine, and alprostadil.

If the mix is over 28 days old you need to discontinue use and tell your doctor. Most trimix are only good for up to 28 days. Without knowing more about your medical situation its hard to say what’s going on exactly and I’d need to meet you at my clinic to be specific. If you’re in the Seattle area please give us a call to schedule an appointment.

Best of luck,
Dr. Barry

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Eamonn July 13, 2013 at 7:46 pm

my urologist has said that I can not take more then 10 mg of tri mix it seems as though I am so close to being where I need to be can i increase to 12 mg also I am a diabetic 50 years old exercise regular

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Dr. Barry Wheeler July 17, 2013 at 4:26 am

Hi Eamonn,

Trimix is a combination of 3 components, typically. These components are phentolamine, papaverine, and PGE1. These are measured in milligram (mg), mg, and micrograms (mcg), respectively. The total dose is usually in milliliters (mL). Not knowing your entire medical situation is difficult to know why he is not wanting you to increase your dose.

Generally, with our patients, we increase the dose gradually as long as there are no side-effects and if we still need a boost we have the patient use a small amount of Viagra® or similar to enhance the effects. All this requires supervision from an experienced physician. If you were my patient, I would want to ask your urologist why, specifically, he doesn’t want to increase your dose. I would probably check your testosterone and estrogen levels as these are both important factors, especially in diabetes where we see a lot of conversion of testosterone to estrogen. Too much estrogen can lead to erection problems and in particular, venous leakage.

Cheers,
Dr. Barry

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Eamonn September 16, 2013 at 11:01 am

Thanks dr Barry if I did come to Seattle how long would I need to stay there can I get my testoronne. And estrogen levels checked before and bring test results with me what do I need to take to boost testoronne and reduce estrogen levels I would like to know more about expense and cost of treaatment with your clinic.

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Dr. Barry Wheeler September 16, 2013 at 8:10 pm

Hi Eamonn,

Please call our clinic at (425) 455-1700 and we’ll be happy to assist you with coordinating your lab testing in advance. We can also review all your cost options on the phone before you come. The cost will really depend on the treatment. For example, our erectile dysfunction treatment range from 1 month to 6 years and include medications and doctor’s visits with costs starting at just $300. Please call for further details.

We typically check your testosterone level using a CLIA-certified method during your visit. Results are ready in just 15 minutes.

Cheers,
Dr. Barry

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Willie July 10, 2013 at 1:11 am

I’ve had my trimex for two years. I tried it the other day, and got the worse UTI infection. In fact I’m still got the infection in fact. I tried my trimes twice. I know now I should not have.

The reason I tried after so long was the fact I always used caverject. Trimex is much better though.

I should point out I have used the trimex within the two years with no problem, even after exp. date. I suspect the old trimex is a problem. Still worked though. I just notice the bottom said exp. in 3 months. My cost for 5 MG was 50 dollars. T-4 break many years ago but still have a lot of function left.

For men with ED this is a wonderful drug. Highly recommended.

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Dr. Barry Wheeler July 12, 2013 at 10:13 pm

Hi Willie,

Trimix cannot cause urinary tract injections unless you somehow stuck the needle in your urethra. More likely your got a UTI from having sex if you indeed have a UTI. That is why it is important to urinate after sex so that any bacteria at the head of the penis is washed out with urine.

I;m glad you like trimix and we have found it to be very effective as well. This is because it can be customized to the patient’s needs by combining the three components of the medication in different amounts. Expired trimix should not be used. We recommend patients take their medication in no more than one month supplies.

You should contact your primary care doctor about your urinary symptoms and to get treatment if needed.

Cheers,
Dr. Barry

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Ed June 13, 2013 at 3:41 am

I take trimix and love it. I keep a few injections at home in my refrigerator and I plan on keeping a few injections at work where I have a small refrigerator. I noticed that the temperature inside the small refrigerator is only 50 degrees.
Is 50 degrees adequate for storage?
If not, what is the recommended temperature?
What is the impact to the trimix if stored at 50 degrees?

Thanks,
Ed

Reply

Dr. Barry Wheeler June 18, 2013 at 7:43 pm

Hi Ed,

Our pharmacist recommends storing trimix between 36-46 degrees Fahrenheit in sealed container in the refrigerator. If it is stored above 46 degrees it can increase the risk of bacteria growing or lose potency over time. Be sure to ask your pharmacist or doctor these questions before using your trimix again. Trimix vials should generally be discarded 28 days after first use and that’s why we generally give our patients one month supplies and monthly refills.

Cheers,
Dr. Barry

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Gary May 26, 2013 at 2:56 am

I am a 72 year old man and am being treated with multiple medications for high blood pressure. I was having a very hard time (no pun intended) maintaining an erection. I made an appointment with a local urologist and he asked me if I had tried Cialis or Viagra. I told him I had and that I had very spotty results with it. He gave me a small shot of trimix in his office and it was like the old saying “Stand back boys, we just don’t know how big this thing is going to get”. I was absolutely amazed. I asked him about Caverject and he told me that it was very expensive and he felt trimix was more effective because he could adjust the mixture as needed. I have been using it for two years, and I feel like a teen ager. It is incredibly easy to administer, and the results are perfect. I would recommend this to absolutely anyone..

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Mark May 18, 2013 at 7:48 am

I have been using Trimix for 4 months now with good results. However, I have noticed that I am having to increase the amount and the dosage almost every month. It seems like my body gets used to the formulation and requires more. Is this normal?

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Dr. Barry Wheeler May 18, 2013 at 4:07 pm

Mark,

Generally, when a patient tells me their ED medication is working less effectively than in the past it is likely due to one of the following:

  1. The cause of your ED has not been treated and the problem is getting worse. For example, if low testosterone is the cause then when testosterone levels are improved the medication becomes MORE effective often and we may need to decrease trimix dosage.
  2. The trimix has lost potency. Proper storage and use will help maintain potency.

You need to talk to the doctor who prescribed your trimix and make sure he has determined the TRUE cause of your problem as “old age” is an inadequate explanation in my opinion. Checking testosterone end estrogen levels is a good place to start often. Please make sure any treatments you’re doing are being supervised by a licensed physician.

Cheers,
Dr. Barry

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Douglas May 4, 2013 at 6:35 pm

Had prostate cancer surgery removal over a year ago. Viagra or Cialis does not work. on .3 mi of Tri-Max. Does not work for me. I can hold an erection for about a minute then it goes. What do you suggest?

Reply

Dr. Barry Wheeler May 18, 2013 at 5:48 pm

Hi Douglas,

It sounds like you have a venous leak but there are certainly other possible causes of your problem. There is likely some nerve and vascular damage as well. However, with our progressive approach to ED we can almost always find a treatment that works.

Trimix can come in many different combinations of phentolamine, papaverine, and alprostadil. It’s called trimix because its a combo of these three medications. There is also a quadmix that contains atropine. I am not sure what the concentration of these medications is in your 0.30ml dosage so it is best for your doctor to advise you.

Some doctors tell their patients to just keep increasing the dose until it works. This can be a problem if the patient is misapplying the medication. Please ask you doctor if you should increase your trimix dose or if it would be safe for you to combine your trimix with a Viagra® or something similar.

It is very important to ask the doctor who prescribed your medication what to do next. Successful use of trimix requires doctor assistance and our success rate is very high because we offer 24 hour support and highly trained doctors to supervise treatment.

The research I have read related to venous leaks shows that a poor testosterone to estrogen ratio may be the cause. A venous leak is like a balloon with a hole in it and you’re filling it with air and the air keeps coming out through the hole except in a venous leak the balloon is the penis and its filling with blood.

Testosterone therapy may be helpful in the case of a venous leak but generally you need to wait until 3 years after surgery to consider it and it requires your urologist’s approval. Not all prostate cancer survivors qualify for testosterone therapy but those who had surgery instead of seed implants are more likely to qualify.

Cheers,
Dr. Barry

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Tom October 21, 2013 at 3:04 am

Reading your site with interest. Trying to learn about different outcomes and treatments related to prostate cancer and ED. I thought I had read that testosterone replacement has become more of an accepted protocol after sustained recovery from prostate cancer. Could you explain more about the different criteria in surgery vs. seed implant patients? Also – is there a correlation between prostate cancer treatment and decreased testosterone? (except of course, when the treatment is hormonal)
Thanks

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Dr. Barry Wheeler October 28, 2013 at 9:51 pm

Hi Tom,

Prostate cancer treatment and erectile dysfunction are really going to depend on your specific situation so be sure to discuss this and any other concerns with your urologist.

Testosterone therapy and prostate cancer is still controversial for some doctors. Abraham Morgantaler, MD, a Harvard urologist wrote an article earlier this year that was published in the peer-reviewed Journal of Urology. He concluded, “although no controlled studies have been performed to date to document the safety of testosterone therapy in men with prostate cancer, the limited available evidence suggests that such treatment may not pose an undue risk of prostate cancer recurrence or progression.1

Dr. Morgantaler’s review of research found that “worrisome features of prostate cancer such as high Gleason score, extracapsular disease and biochemical recurrence after surgery have been reported in association with low but not high testosterone.” The research shows that low testosterone increases the risk of more aggressive forms of prostate cancer. This makes sense because we get prostate cancer when we’re old, not when we are young and have higher levels of testosterone.

Some research shows that following prostate removal surgery testosterone levels tend to decline.2 Many men often have low testosterone before they are even diagnosed with prostate cancer.

There are different opinions of when it is safe to consider testosterone therapy following prostate cancer treatment. Some research recommends years while other guidelines are more vague. An article published in the Spanish journal Archives of Spanish Urology, stated, “In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy)…3” Thus, its important to discuss your options with your urology including what happens after cancer treatment with respect to erectile dysfunction and low testosterone treatment options.

  1. Testosterone therapy in men with prostate cancer: scientific and ethical considerations. Morgentaler A. J Urol. 2013 Jan;189(1 Suppl):S26-33. doi: 10.1016/j.juro.2012.11.028.
  2. Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study. Gacci M, Tosi N, Vittori G, Minervini A, Corona G, Cai T, Morelli AM, Vignozzi L, Serni S, Maggi M, Carini M. Oncol Lett. 2013 Aug;6(2):529-533. Epub 2013 Jun 21.
  3. [Patient with testosterone deficit syndrome after external beam radiotherapy]. [Article in Spanish] Estrada Dominguez F, Borque A, Rodriguez Vela L. Arch Esp Urol. 2013 Sep;66(7):669-74.

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David April 15, 2013 at 7:18 pm

I’ve been using Trimix for a couple months now with good result. My only frustration is that it’s very difficult to achieve orgasm when I use Trimix. Oddly, I can reach orgasm easily with Viagra, but I find Viagra to be hit-and-miss effective at allowing me to get a firm erection.
From what I’ve read on discussion boards, difficulty with orgasm is somewhat common in men who use injection therapy.
Any suggestions?
Thanks!

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Dr. Barry Wheeler April 22, 2013 at 11:13 pm

You should ask your physician to reformulate your trimix dose and ask him about sublingual medications that are similar to Viagra®.

Trimix at the correct dose typically will prolong the time before you ejaculate. I suggest you tell the doctor who prescribed the trimix for you. It may be that you have low testosterone and that if your testosterone levels were safely increased the Viagra® would work a lot better. Our goal is always to treat the cause of the problem.

In this situation it is very important for you to discuss this with your doctor. There are many potential causes of difficulty ejaculating and these needs to be addressed with a licensed physician. If you are in the Seattle area you should come to one of our clinics for a consult.

Cheers,
Dr. Barry

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Randy Roe April 4, 2013 at 3:41 pm

I wish I lived in your area but live just west of Chicago Illinois. That said could you tell me how to find a doctor that prescribes trimix in my area? Thank you if possible to give an answer.

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Dr. Barry Wheeler April 22, 2013 at 11:23 pm

Hi Randy,

Sorry, I’m not familiar with any clinics in Chicago that provide this service. I imagine there’s a doctor who can treat you in Chicago. You could also come to our clinic as we can treat you after seeing you one time in our clinic in Seattle. As we are not familiar with any of the clinics in Chicago that may provide treatment with trimix I can not recommend anyone there.

Some urologists know how to prescribe trimix but some are more focused on surgical treatments. I have had a few patients who received surgery for their erectile dysfunction and were never even given the option of trimix.

Cheers,
Dr. Barry

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Patrick February 19, 2013 at 11:34 pm

I used Trimix with small reaction at 3mlg but getting a useful erection at 10mg with stimulation, however as soon as I stopped stimulation it subsided (still able to hold for about 20 minutes and probably could have longer but I was curious to see if without stimulation it would hold) BTW very happy I haven’t had an erection that hard for months. This is all dry run before I try with a girl I am seeing, it will be tough to explain to her the whole thing but if the sex is great I’m sure it will be fine. So I am wondering if it is good idea to go up further as I’d like to have a guaranteed erection for at least an hour – should you go up until you have an “unstimulated” hard erection?

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Dr. Barry Wheeler February 20, 2013 at 3:17 am

Patrick,

The doctor who prescribed your trimix should be helping you determine your dose. I look at a patient’s entire medical history when I’m determining what dose to increase to for more firmness or duration.

The three things you should report to your doctor are:

  1. Firmness
  2. Duration
  3. Discomfort

By increasing or decreases the different components of trimix your doctor can modify the above aspects of your erection. In general, trimix works a lot better with stimulation so your doctor should keep that in mind when determining the dosing of your trimix.

Be Well,
Dr. Barry

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CB February 17, 2013 at 12:33 am

I understand that your answers are general and not directed to me. Thank You.
I’m using a standard 29g1.2 1cc syringe that I had loaded with .4 cc but recapped because I was waiting to use a little later. I think I must have slightly bent the needle when I recapped. Also, I was applying to the left side which is harder since I’m right handed. So, I think I missed the mark or something because nothing has happened. So, as you said, I’ll wait.
The doctor showed me how to load and apply using a model that made things very clear. The questions I asked did not cross my mind at the time since it seems very easy to do and I was not expecting these types of complications so I thought I would ask for myself and anyone else that might need to know.
Thank you very much for your answers, again the answers are a GENERAL reply and as the Doctor states, should be addressed to your doctor.

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CB February 16, 2013 at 9:05 pm

I have several questions…
1. How often can you use trimix?
2. The second time I used it the needle looked a little bent so I don’t know if it was injected correctly because nothing seemed to happen. The first time I used it was 2 days ago. Making up for lost time :)
3. If nothing happens should I try again or wait. I don’t want to overdose.
4. What happens if I do overdose and what should I do?

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Dr. Barry Wheeler February 16, 2013 at 9:28 pm

Hi CB,

Those are all questions you should ask the the doctor who prescribed your trimix. I will do my best to respond to your questions but these are just general answers that are NOT patient specific and you should ask your prescribing doctor before changing any of your treatments.

  1. In general, trimix can be used every other day but this depends on the person.
  2. It sounds like you are having some application problems. You should review your technique with your doctor. Are you using an applicator device?
  3. If nothing happens you should wait to use it again for at least 24 hours. Some men have a delayed response and if you apply it twice your erection may last too long resulting in a priapism.
  4. If you overdose you should call your doctor. There are different ways to reduce an erection. If you are unable to contact your doctor and your erection is very firm and lasting too long you will need to seek emergency medical help to prevent any problems.

These responses are generalizations and these are all questions that your doctor needs to answer. We offer 24/7 support to our patients but not all clinics provide this. Did your doctor not provide you with instructions or address these issues when they prescribed your trimix?

Cheers,
Dr. Barry

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Dr. Barry Wheeler January 12, 2013 at 10:41 pm

We typically do a test dose in the office. After treating of thousands of patients I have found that it is best to start with a conservative dose and increase as needed. A 4 hour erection sounds like fun but when you have one it gets a little old. Thus, we customize each dose to the patient’s needs. We can control duration and firmness relatively easily. Trimix is a mixture of three medications but we can also make bimixes, monomixes, and quadmixes with additional medications to control comfort.

To learn more, please call us at 425-455-1700. We look forward to helping you get more from life!

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robert December 4, 2012 at 10:14 am

whats the cost ??

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Irving September 4, 2013 at 2:59 pm

I’m interested in the cost and how does it come. If its in a vial, how many doses are there?

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Dr. Barry Wheeler September 13, 2013 at 10:29 pm

Hi Irving,

We have a number of different options in terms of cost. Please call us at (425) 455-1700 and we’ll be happy to go over all your options. Other clinics may be unwilling to discuss treatment cost with you. We are very happy to do and because it is really depends on your treatment needs, it is best explained over the phone or at our clinic.

Cheers,
Dr. Barry

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anonymous October 27, 2012 at 6:59 pm

hello i am a 53yr. old male about to start timix i have been using caverject
for the past year. my urologist hasn”t given me much info on the dose,I can
get two doses from the single dose with satisfactory results, erect for usually 1.5 hrs.

I live winnipeg manitoba canada. Even when I started caverject i was never
injected in his office. I don’t know if its just him but they seem do test runs
in canada. any advive would be most appreciated. please e-mail me
Best regards,
ron

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Roger October 6, 2012 at 8:31 pm

I would like to learn more about penil injections for ED

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Dusty March 27, 2013 at 9:40 pm

Roger, did you find out what you wanted on injections?

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Dr. Barry Wheeler March 27, 2013 at 11:06 pm

Dusty, we contacted Roger directly so hopefully his questions were addressed. I imagine he’ll appreciate you asking though :)

Dr. Barry

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