Erectile Dysfunction FAQ
Erectile dysfunction affects millions of men, yet most suffer in silence for years before seeking answers. At Kass Precision Medicine, we believe every man deserves a complete, honest conversation about what's happening and what can be done about it. Dr. Kate Kass and her team have spent over a decade specializing in men's sexual health and ED treatment in the greater Seattle area, offering some of the most advanced, evidence-based therapies available anywhere in the Pacific Northwest. The questions below reflect what men most commonly ask - and the answers they deserve to hear.
FREQUENTLY ASKED QUESTIONS
What is erectile dysfunction, and how common is it really?
Erectile dysfunction - the inability to achieve or maintain an erection firm enough for satisfying sex - is far more common than most men realize. Research shows ED affects roughly 40% of men by age 40, and up to 70% of men over 70. Even among men under 40, the prevalence is around 26%. In other words, if you're dealing with this, you are in very good company. The bigger issue is that most men wait years before seeking help - and there's no reason to.
What are the most common causes of erectile dysfunction?
While stress and anxiety can play a contributing role, the vast majority of ED cases in men over 40 have identifiable physiological causes. The single most common is vasculogenic ED - erectile dysfunction driven by age-related changes in vascular health. As men age, arterial walls lose elasticity, blood flow decreases, and nitric oxide production - the biochemical trigger for erections - naturally declines. When circulation to penile tissue is compromised, reliable erectile function follows.
Beyond the aging vascular system, other frequently identified contributors include:
Hormonal decline - particularly falling testosterone levels, which affect libido, nitric oxide production, and penile tissue health
Metabolic conditions - including diabetes, pre-diabetes, and insulin resistance
Cardiovascular risk factors - high blood pressure, elevated cholesterol, and systemic inflammation
Thyroid dysfunction - an often overlooked variable in men's sexual health
Medications - antidepressants, beta-blockers, and certain blood pressure drugs are common culpritsPDE5 inhibitors like Viagra and Cialis are highly effective medications and remain a valuable part of many men's treatment plans.
At Kass Precision Medicine, we prescribe and even compound customized formulations when appropriate. Our goal, however, is to pair pharmacologic support with a thorough investigation of underlying causes - vascular health, hormonal balance, metabolic function - because addressing root drivers optimizes outcomes, enhances medication responsiveness, and helps prevent further decline. Learn more about our personalized diagnostics approach.
Can erectile dysfunction be an early indicator of cardiovascular disease?
ED is increasingly recognized as an early warning sign of cardiovascular disease. Research has shown that erectile dysfunction often precedes a cardiac event by three to five years, because the small blood vessels of the penis are frequently the first to show signs of systemic vascular decline. At Kass Precision Medicine, we take this seriously. Our workup includes cardiovascular biomarkers, lipid panels, lipid particles like Apolipoprotein B and Lp(a), blood pressure evaluation, and metabolic screening. Learn more about our comprehensive approach to men's sexual health and ED. Treating ED well means treating the whole man, not just the symptom.
Is Viagra or Cialis enough to treat my ED, or is there a more comprehensive approach?
PDE5 inhibitors - sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) - remain among the most well-studied and effective interventions in men's sexual medicine. At Kass Precision Medicine, we prescribe them enthusiastically, including specialty compounded formulations of them at times, and for many men they are a highly effective and foundational part of treatment.
That said, PDE5 inhibitors work by enhancing an existing physiological response - they require a reasonably intact vascular and neurological substrate to do their job effectively. For men with underlying vascular compromise, hormonal decline, or metabolic dysfunction, that substrate may be insufficient - which is why approximately 30 - 40% of men experience suboptimal responses to oral medications alone. It is also worth noting that ED in your 40s or 50s frequently represents an early biomarker of systemic cardiovascular disease. A pharmacologic intervention alone, while valuable, does not address that underlying trajectory.
This is where a comprehensive, multimodal approach becomes clinically meaningful. Identifying and addressing root causes - vascular health, hormonal balance, metabolic function - can improve medication responsiveness, optimize outcomes, and help prevent further decline. Investigational treatments such as low-intensity shockwave therapyand platelet-rich plasma (P-Shot)show promising evidence for operating at the physiological level, stimulating angiogenesis, improving endothelial function, and promoting tissue regeneration. Used as adjunctives alongside standard pharmacologic care, they may work synergistically to restore more natural erectile function over time.
The goal at Kass Precision Medicine is not to choose between conventional medicine and progressive care - it is to use both intelligently, guided by your individual physiology and health trajectory.
What ED treatments does Kass Precision Medicine offer?
We take a multimodal approach, because ED is rarely caused by a single factor. Depending on your evaluation, your treatment plan may include:
Low-Intensity Shockwave Therapy (GAINSWave™)- acoustic wave therapy that stimulates new blood vessel growth and improves vascular function
The P-Shot (Platelet-Rich Plasma) - uses your own growth factors to regenerate penile tissue and improve blood flow
Testosterone Replacement Therapy (TRT)- for men whose ED is tied to hormonal decline
Therapeutic Botox- an emerging, evidence-backed injection that relaxes smooth muscle in the penis to improve blood flow
PDE5 Inhibitors - including Viagra, Cialis, and specialty compounded formulations (sublingual, rapid dissolve)
Intracavernosal Injectables - Trimix, Bimix, and Alprostadil for men who don't respond to oral medications
Vacuum Erection Devices (VEDs) - used as a standalone or complement to regenerative treatments
PT-141 - a centrally-acting option that targets libido and arousal pathways in the brain
At KPM, we believe that most patients benefit from a combination of these approaches rather than a single treatment in isolation. Please reach out if you’re interested in learning more about our approach to treating ED.
How do I get started with ED treatment at Kass Precision Medicine in Bellevue, WA?
Contact Kass Precision Medicine. The team will walk you through the next steps and get you scheduled for a comprehensive initial consultation. Dr. Kass's clinic is located in Bellevue, Washington, and serves men throughout the greater Seattle area, including Kirkland, Redmond, Issaquah, Mercer Island, Renton, and Bothell. Taking that first step is the hardest part - everything after is in expert hands.
Interested in learning more?
What is shockwave therapy for ED, and does it work?
Low-intensity shockwave therapy (EDSWT) - offered at KPM as GAINSWave™- uses high-frequency acoustic waves to stimulate the growth of new blood vessels (angiogenesis), improve endothelial function (the inner lining of blood vessels), and support nerve regeneration in penile tissue. Multiple randomized controlled trials have demonstrated meaningful improvements in erectile function, particularly in men with mild to moderate vascular ED. It is non-invasive, requires no medication, and involves no downtime.
What sets Kass Precision Medicine apart in the Seattle area is the combination of clinical depth and technology. Dr. Kass was among the earliest adopters of GAINSWave therapy in the United States, has been performing shockwave treatments for over ten years, and has completed thousands of procedures at her Bellevue clinic. KPM uses medical-grade shockwave equipment - the same class of technology used in rigorous clinical trials - rather than the lower-powered devices that have proliferated in med spas and non-specialist clinics. Read more about the technology we use on our Technology Matters blog.
The difference in equipment translates directly to the depth and quality of treatment outcomes. You can also learn about how effective shockwave therapy is on our shockwave therapy success rates for ED blog post. Shockwave therapy is considered investigational by the American Urological Association, though it is extensively studied and widely used globally.
What is the P-Shot, and how does it work for erectile dysfunction?
The P-Shot (Priapus Shot)uses platelet-rich plasma (PRP) - derived from your own blood - to stimulate tissue regeneration and new vascular network formation in the penis. A small blood draw is spun in a centrifuge to concentrate your body's own growth factors, which are then precisely injected into penile tissue. Results include improved blood flow, firmer and more frequent erections, enhanced sensation, and in some cases improvements in size. The procedure takes under an hour and involves minimal discomfort - no surgery, no synthetic drugs, and results that can last a year or longer.
The P-Shot and shockwave therapyare frequently combined at KPM because they work through complementary mechanisms: shockwave primes and stimulates the vascular environment, whilePRPaccelerates tissue repair and regeneration within it. This combination protocol reflects Dr. Kass's broader philosophy - that synergistic, multimodal treatment consistently outperforms any single intervention.
What is Therapeutic Botox for ED, and is it right for me?
Most people associate Botox with cosmetic applications, but there is a growing and compelling body of clinical evidence supporting its use for erectile dysfunction. Therapeutic Botox for ED works differently than oral medications or shockwave therapy: when injected into the smooth muscle of the penis (the corpus cavernosum), Botox inhibits the release of norepinephrine - a chemical that causes blood vessels to constrict. By reducing that constriction, blood can flow more freely into the erectile tissue, resulting in improved erections.
A notable placebo-controlled trial involving 176 men found that a single intracavernosal Botox injection significantly improved erectile function, enhanced responsiveness to existing ED medications, and showed positive effects on both flaccid and erect penile dimensions. For men who haven't responded fully to oral medications, or who want to enhance the results of regenerative treatments, Therapeutic Botox may be a meaningful addition to their protocol. Dr. Kass consults individually with each patient to determine candidacy.
Learn more about Therapeutic Botox for ED- it is considered an investigational treatment and is not a first-line therapy, but in the right patient, the results can be significant.
Does low testosterone cause ED?
Sometimes - but it's one piece of a larger picture. Testosterone plays a meaningful role in libido, nitric oxide production, penile tissue health, and arousal. As men age, testosterone levels naturally decline - a process accelerated by weight gain, chronic stress, diabetes, and poor sleep. Men with ED often simultaneously notice low drive or motivation, fatigue, mood changes, difficulty reaching orgasm, loss of morning erections, and shifts in body composition. These are signs that testosterone may be a contributing factor.
That said, testosterone replacement alone is not always sufficient to resolve ED, because the condition is multifactorial. At KPM, we evaluate testosterone as one important variable within a comprehensive diagnostic workup - and when TRT is indicated, we manage it with precision and individualization.
How does Kass Precision Medicine approach diagnosing ED differently than a typical doctor's office?
Most primary care encounters for ED result in a prescription for Viagra or Cialis and not much else. At Kass Precision Medicine, the diagnostic process is genuinely comprehensive. We evaluate cardiovascular biomarkers (including inflammatory markers like CRP, homocysteine, and lipid panels), a full hormone panel (testosterone, SHBG, LH, FSH, estradiol), thyroid function (including Free T3, Free T4, and reverse T3), metabolic markers (HbA1c, fasting glucose, fasting insulin), and a review of all current medications for potential contributions to erectile dysfunction. We also assess lifestyle factors - exercise habits, diet, sleep quality, and stress - because these are directly modifiable and often overlooked. The goal is not to mask a symptom but to understand and address its source or pathophysiology.. Visit ourPersonalized Diagnostics pageto learn more about our precision lab programs.
What should I expect at my first appointment at Kass Precision Medicine?
Your first visit is a thorough consultation - not a quick in-and-out. Dr. Kass and her team review your medical history, current medications, lifestyle, and goals in depth. A comprehensive lab panel is ordered to evaluate cardiovascular health, hormones, metabolic function, and thyroid status. From there, a personalized treatment plan is developed based on your specific physiology and priorities. No two men's plans look alike - that's the precision medicine difference, and it's why patients who have tried generic approaches elsewhere often find a meaningful step forward here.
Schedule a consultationto get started.
Are these treatments covered by insurance?
Most of the innovative ED treatments offered at KPM - including shockwave therapy, the P-Shot, and Therapeutic Botox - are not covered by insurance, as they are considered investigational or elective. PDE5 inhibitors and some diagnostic testing may have coverage depending on your plan. As a concierge practice, KPM prioritizes depth of care and personalization over what insurance guidelines permit. We're happy to discuss pricing and package options during your consultation.
Is it awkward to talk to a female doctor about ED?
We hear this question often, and it's completely understandable. Dr. Kass and her team have spent years specializing in men's sexual health - it is one of the central pillars of this practice. Men consistently report that the KPM environment feels professional, comfortable, and compassionate. Many patients find that working with a clinician who approaches these issues with both clinical rigor and genuine empathy - rather than the dismissiveness they've encountered elsewhere - is exactly what finally moves the needle. You deserve a provider who takes this seriously. Dr. Kass does.