Hormone Replacement Therapy
The male hormone that gives men their characteristic 'maleness' - hairy chests, chin stubble and beard, deep voices - is testosterone. But with age, the level of testosterone in males decreases. This is the andropause stage in a man's life and is similar to the menopause stage in a woman's life.

Low levels of testosterone is rarely the cause of erectile dysfunction / male impotence, as testosterone is responsible for the process of desire, not for erectile dysfunction. However, the lack of desire may be the cause of erectile dysfunction. If the desire is absent in the first place, it is difficult to either obtain or maintain an erection.

Therefore, the decrease in testosterone levels in men may have an adverse effect on men's sexual performance which in turn may lead to erectile dysfunction. In certain cases of andropause, testosterone therapy may improve an ageing man's sex drive and sexual potency. Testosterone therapy is only available under expert medical supervision as there is the danger of side effects.

External Vacuum Devices
Vacuum therapy involves the use of an external vacuum device, and one or more tension rings. This method is effective for over 90% male users and are generally used by elderly men with erectile dysfunction / impotence.

Most men can technically master the use of this device in one day. Even after ejaculation and / or orgasm, most of the men who use the device can maintain erections for up to 1/2 hour. The side effects of using this device include petechiae (pinpoint-size reddish dots) and bruising. Happily, these effects are not serious or painful, and only occur during the initial learning period.  

Penile Injections
Since the advent of oral erectile dysfunction / impotence drugs like Viagra, the need and use of penile injections has declined dramatically and not many injections are administered nowadays. 

Combinations of the drugs Phentolamine, protaglandin E1, Papaverinedrugs can be self-injected into the penis using a fine, small gauge hyperdermic needle. Some men combine penile injections with an external vacuum device.

About 75 - 80% of men who opt for penile injections experience good quality erections that usually last 1/2 to 1 hour. However erections obtained using this method may continue even when the man has had an orgasm or has ejaculated.

An overdose of the injected drugs can cause a painful and prolonged erection that may require medical or surgical intervention. Frequent use of penile injections can result in a build-up of scar tissue in the penis which can further complicate the process of effecting an erection.


Penile Implants
An implant, a penile prosthesis, is a mechanical or fixed device that is implanted surgically into the two corpora-cavernosa of the penis. This implant allows a man to have a erection as often as he wishes. Penile prosthetic implantation surgery has low complication and high satisfaction ratios when performed by competent surgeons. The results are good, with a low incidence of side effects.

Penile protheses exist in semi-rigid, self-contained 2-piece and 3-piece inflatable models. More advances have been made in implant design that have resulted in reduced complication and increased satisfaction rates in the men who opt for this treatment method for erectile dysfunction / impotence.

Microsurgery
Microsurgical procedures for erectile dysfunction / male impotence include penile revascularisation and venous ligation. These procedures are similar in technical complexity to a heart-bypass surgery although they do not have anywhere near the same mortality risk. Nowadays with the advent of modern medical oral drugs like Viagra for erectile dysfunction / male impotence, the need and demand to microsurgical intervention is less frequent.

Some men will request a microsurgical procedure rather than resort to having silastic devices inserted into their penises, prefering to have penile protheses implants only as a last and desperate resort to getting rid of erectile dysfunction / male impotence.