Acoustic wave therapy for erectile dysfunction: the ultimate guide

Acoustic wave therapy, also called shockwave therapy, used for the treatment of erectile dysfunction is fairly new but yields very promising results.

Since 2015, the clinical trials using shockwave therapy for ED have increased significantly.

Since the 1980s, shockwaves of different intensities have been used therapeutically in medicine.

• High-intensity shockwaves have been used in the treatment of urolithiasis (to break up kidney stones).
• Medium-intensity shockwaves have been used to treat arthralgia, tendonitis, plantar fasciitis and bursitis.
• More recently low-intensity shockwave therapy has been used in the treatment of ED.

Although low-intensity shockwave therapy doesn’t have FDA approval in the United States (yet), many clinics still use it with great success.

The Importance of Proactively Treating Erectile Dysfunction

80% of erectile dysfunction is of vascular origin. And getting ED is a sign that you might get heart disease in the next 10 years.

The blood vessel diameter in the penis is roughly 1-2mm, whereas that of the heart is 3-4mm. The blood vessels in the penis will get compromised first and then 10 years later, the blood vessels of the heart.

Loss of nocturnal erections and spontaneous erections, when aroused, is a sure sign that something is wrong. It can be related to obesity, diabetes, sleep apnea, inflammation, low testosterone, nutritional deficiencies, etc.

That’s why it’s important to find the root cause of ED as fast as possible before something worse happens. Else, 10 years later and you might end up in the hospital for open heart surgery.

Benefits of Acoustic Wave Therapy for Erectile Dysfunction

• It treats the cause (vascular dysfunction), not just the symptoms (like Viagra)
• Enables spontaneous erections when the mood arises
• Results within 3-4 weeks (3-6 treatments)
• No drug administration is required (except perhaps a topical numbing cream)
• Long-term results (2+ years)
• Completely safe with no side effects
• Non-invasive procedure
• Triggers natural repair mechanisms by stimulating the growth of new blood vessels
• Restores penile health to roughly 10 years younger according to Dr Judson Brandeis.
• 60-70% success rate in making men responsive to Viagra and even helping men get off Viagra.
• Doesn’t interfere with other treatments

What is shockwave therapy and how it works

Shockwave therapy is therapy induced by a device that creates sound waves / acoustic waves.

A shockwave is generated when a wave travels faster than the speed of sound. Shockwaves produce an abrupt spike in pressure over a very short time period (R). As you can see in the graph below, a shockwave has a high amplitude and short wavelength. Ultrasound for example has a low amplitude and longer wavelength.

There are multiple different kinds of medical devices that create shockwaves all showing positive results (R). Research has shown that:

• The ideal energy density frequency of the shockwave should be is between 0.09 and 0.10mJ/mm² (R). Less than that and the results will be non-existent or disappointing.
• The ideal number of pulses per session is 1,500 to 3,000 (R).

Key takeaway: you want to make sure you go to a clinic with the right device.

How acoustic therapy improves erections

The exact mechanism of action is not completely clear.

But from what we know, shockwaves produce mechanical stress and microtrauma at the cellular level, thus generating a series of biological cascades that favor the release of angiogenic factors leading to neovascularization (R). Meaning, shockwave therapy enhances blood vessel regeneration as well as the formation of new blood vessels in the corpus cavernosum (vascular-rich penile tissue), which causes a significant improvement in penile blood flow.

As you can see, in the flaccid state, the vein on top of the penis is maximally dilated. Once blood starts pooling into the corpora cavernosa, it expands and compresses the veins, thus inhibiting blood flow out of the penis. This allows you to maintain an erection.

If the blood vessels in the corpora cavernosa become unhealthy/shrunken, the tissue cannot expand to pinch the veins close, thus you cannot maintain an erection.

Also, if the corpora cavernosa smooth muscle tissue starts to become fibrotic (due to lack of blood flow and low androgens), the tissue cannot expand to pinch the vein closed either.

Shockwave therapy can help to improve blood vessel health, which provides oxygen and androgens to the corpora cavernosa to help restore proper function.

Shockwave therapy also promotes the release of nitric oxide and stem cells. Stem cells are used for creating new tissue and tissue repair, such as blood vessels and smooth muscle tissue.

How effective is acoustic wave therapy for erectile dysfunction?

In 2016, Assaly-Kaddoum et al showed that shockwave therapy improved erectile function to the same extent as sildenafil in rats. Furthermore, they showed that the effects of shockwave therapy were potentiated with sildenafil (R). 

Despite the effectiveness of PDE5i (such as Cialis or Viagra) for ED, 40% to 50% of patients do not respond to this drug therapy, even after optimizing their protocol. Plus, the discontinuation rate of PDE5i is between 30-60% even if it still works! (R)

What got me very interested in shockwave therapy is the fact that it can reverse erectile dysfunction even in people with severe ED.

Let’s look at the stats

Shockwave therapy for Viagra non-responders

• 45% success rate (R). Meaning 50% became responsive to PDE5i and were able to get an erection hard enough for penetration and sexual intercourse.
• 50% success rate (R).
• >50% success rate (R).
• 63.5% success rate (R).
• 55% success rate (R).
• 60% success rate (R).
• 72% success rate (R).

Shockwave therapy for PDE5i responders

• >50% success rate (R)
• 78% success rate (R). They received 12 sessions.
• 60% to 75% success rate (R).

Shockwave therapy for Peyronie’s disease

• Success rates of 47% (R).

Who does acoustic wave therapy work for

It works mainly for men with vasculogenic ED. Erectile dysfunction induced by poor vascular health and blood flow.

Other types of ED, such as psychogenic (performance anxiety) or neurogenic (e.g. induced by prostate surgery) will not respond to shockwave therapy.

But fret not, roughly 80% of have vasculogenic erectile dysfunction. 

Does shockwave therapy affect testosterone and fertility?

Although shockwave therapy is done on the penis and perineum (above and below the testes) it doesn’t influence testicular function. Shockwave therapy is never done on the scrotum as it’s not needed and will hurt a lot.

According to this study, shockwave therapy didn’t affect testosterone or sperm after 3 months of use (R).

How to make shockwave therapy even better

One modality is good, but stacking them together is even better. Dr. Judson talks about his protocol in the podcast linked below.

Penis pump

Shockwave and penis pumps are effective, more effective than either one alone (R).

The success rate of:

• The Penis pump was 14.7% after 4 weeks, 14.7% after 8 weeks and 17.6% after 12 weeks. The penis pump was used for 15 min x3 per week.
• Shockwave alone was 36.4% after 4 weeks, 39.4% after 8 weeks and 36.4% after 12 weeks.
• Shockwave plus penis pump was 36.4% after 4 weeks, 51.5% after 8 weeks, and 66.7% after 12 weeks.

Cialis

Using daily 2.5g arginine and 5mg Cialis and doing shockwave therapy yields better results than shockwave alone (R).

Who should not use low-intensity shock wave therapy

Shockwave therapy is very safe for most people, but might be problematic for those with a blood clotting disorder and/or who take blood-thinning or anticoagulant medications.

👇Must listen to podcast on shockwave therapy👇

Shockwave therapy for erectile dysfunction: how to get a young penis again with Dr Judson Brandeis

Podcast questions summary

Why should someone care about acoustic wave therapy for erectile dysfunction?

Shockwave therapy as mono treatment has a 50-70% success rate at significantly improving erectile function. It has been shown to make Viagra non-responders respond to Viagra again and some men are even able to stop using PDE5 inhibitors altogether.

How does shockwave therapy work?

Shockwave therapy stimulates the growth of new blood vessels, which helps with erections. As we age, vascular function decreases and erections get worse.

Shockwave therapy can also stimulate the release of stem cells, which helps with the regeneration of the whole penis.

How does growing new blood vessels help?

As we age, blood vessel help declines, which can lead to hypertension, ED, varicocele, heart disease, etc. Shockwave therapy helps to improve the health of existing blood vessels and helps grow new ones.

Does shockwave therapy have side effects?

There are no side effects to shockwave therapy. It doesn’t cause harm as it doesn’t cause an actual injury. It only makes your body think there is an injury, which then upregulates recovery factors.

Who does shockwave therapy work for?

It works mainly for men with vasogenic ED. Meaning, ED that is caused by an unhealthy circulatory system. A common cause of ED is venous leak. This is when the vein that transports blood out of the penis cannot be sealed off sufficiently, due to insufficient dilation of the artery that brings blood into the penis.

Shockwave therapy improves the health of these blood vessels so that that process can happen as it should.

How long do the effects of shockwave therapy last after the last treatment?

Usually up to 2-3 years and sometimes longer. Younger individuals maintain the benefits longer than someone that’s older and unhealthier.

According to this study, 91.7% of patients maintain the benefit 12 months after their last treatment (R).

Which is better, shockwave therapy or viagra?

They work via different mechanisms. Viagra potentiates the effects of nitric oxide, thus prolonging vasodilation. Acoustic wave therapy for erectile dysfunction promotes the growth of new blood vessels.

If your blood vessels are unhealthy, then Viagra will lose its effect. Shockwave therapy and PDE5 inhibitors like Viagra or Cialis work best together.

For acoustic wave therapy treatment protocol, what are the ideal session duration, frequency, and number of sessions?

Typical acoustic wave therapy for erectile dysfunction treatment session duration is 20 minutes, done once or twice per week for a total of 6 to 12 sessions (twice a week is better than once a week) (R). As few as 4 sessions per week have also been shown to be sufficient (R).

After the 3-6 weeks of treatment is over, someone can take a break for 3-6 months and then redo the 6-12 sessions until the desired outcome is reached.

Is there anything you shouldn’t do after acoustic wave therapy for erectile dysfunction?

After acoustic wave therapy, don’t use anything that’s anti-inflammatory. This includes NSAIDS or steroids, such as dexamethasone, hydrocortisone, methylprednisolone, prednisolone, etc.

How long does it take to see results from acoustic wave therapy for erectile dysfunction?

You can notice significant lasting benefits in as little as 3-4 weeks, but most treatments are 6 weeks in length. The unhealthier someone is, the more treatments they might need to see benefits.

Younger men (aged <45 years), short ED duration (<2 years), and moderate ED severity responded better to shockwave therapy (R).

Does acoustic wave therapy work for people with finasteride-induced erectile dysfunction?

Yes, shockwave therapy works for finasteride-induced ED. Dr. Judson uses everything at his disposal to improve finasteride-induced ED, such as penis pumps, PDE5 inhibitors, nitric oxide boosters, shockwave therapy, PRP (platelet-rich plasma) injections, etc.

Does shockwave therapy work for Peyronie’s disease?

Extracorporeal shockwave therapy has been shown to reduce plaque in the penis and reduce pain in men with Peyronies disease (R). However, according to research studies, shockwave therapy doesn’t change the penile deviation angle (R).

Additional treatments include Xiaflex (collagenase enzyme) injection into the lesion, blood flow boosters and penis pumps.

I’ve personally helped a client, who has an hourglass penis, reverse it in 3 months using topical DHT. Dr. Judson might start using it in his practice as well.

Can shockwave therapy work for delayed ejaculation?

Shockwave therapy has been shown to improve penile sensitivity because of better erections. However, it doesn’t seem to improve nerve function, which is responsible for ejaculation. Dr. Judson’s clients haven’t yet reported improvements in that regard.

Is there anything you can take to supercharge shockwave therapy?

Shockwave therapy works even better with synergistic ingredients, such as:

• Nitric oxide booster
• PDE5 inhibitor (Cialis, horny goat weed, Tongkat Ali, etc.)
• Penis pump
• PRP injections
• TRT (if someone is hypogonadal

How much does acoustic wave therapy for erectile dysfunction usually cost?

The average price for one shockwave therapy session is $500.

Is the home device Phoenix pro good for erectile dysfunction?

$500 per session of shockwave therapy is expensive. Other treatment options include the Phoenix pro, which is a device that you can use at home. It costs under $900 and will save you a lot of money long term.

Summary

Shockwave therapy is a proven and successful ED treatment and can reverse sexual dysfunction.

If you don’t respond to Viagra anymore, I would definitely give shockwave therapy a try. It’s very safe and has roughly a 70% success rate of completely restoring erectile function back to normal, or at least making you responsive to Viagra again.

Plus, you can combine shockwave with nitric oxide boosters, penis pumps, etc., to get even better results.