Dan practices a unique blend of conventional and holistic medicine, drawing on his extensive experience with integrative techniques like healing touch, guided imagery and yoga. By fostering an understanding of the deep connections between body, mind and spirit, Dan seeks to help every patient unlock his or her own innate healing ability. He received his MD from the Hahnemann College of Medicine and completed his residency in family practice through UCSF. Dan is a fellow of the Wilderness Medical Society, is a clinical instructor at UCSF, and is certified with both the American Board of Family Medicine and the American Board of Holistic Medicine. Dan is a One Medical Group provider and sees patients in our San Francisco offices.

SSRI's *sinus tachycardia, * myocardial infarction, * junctional rhythms and * trigeminy * anhedonia * apathy * nausea/vomiting * drowsiness or somnolence * headache * bruxism * extremely vivid or strange dreams * dizziness * fatigue * mydriasis (pupil dilation) * urinary retention * changes in appetite * changes in sleep * weight loss/gain (measured by a change in bodyweight of 7 pounds) * increased risk of bon

How common is impotence? According to findings from several studies, including “The Massachusetts Male Aging Study,” overall prevalence for men between 40–70 years old is around 52 percent (or around 30 percent of all men between 18–60 years old). That’s right — nearly half of all men over 40 experience erectile dysfunction symptoms at some point. Not surprisingly, research demonstrates that impotence is increasingly prevalent with age. Around 40 percent of men in their 40s experience sexual dysfunction. Up to 70 percent of men in their 70s experience ED. (1) Every year more than 617,000 new cases of impotence occur in the United States alone.


Impotence, or erectile dysfunction (ED), is the inability for a man to sustain an erection long enough for normal, satisfying sexual intercourse.  To understand the underlying causes of impotence, it helps to know the basics about how an erection develops, along with potential problems that get in the way. Erections begin in the brain with a thought related to sexual desire. Then a chemical message travels from the brain to the penis. Blood flow to the penis increases as blood vessels leading to the reproductive system relax and allow for increased circulation.

Dan practices a unique blend of conventional and holistic medicine, drawing on his extensive experience with integrative techniques like healing touch, guided imagery and yoga. By fostering an understanding of the deep connections between body, mind and spirit, Dan seeks to help every patient unlock his or her own innate healing ability. He received his MD from the Hahnemann College of Medicine and completed his residency in family practice through UCSF. Dan is a fellow of the Wilderness Medical Society, is a clinical instructor at UCSF, and is certified with both the American Board of Family Medicine and the American Board of Holistic Medicine. Dan is a One Medical Group provider and sees patients in our San Francisco offices.
A study published in the journal Fertility and Sterility that analyzed the effect of various fruit and vegetables on sperm quality discovered carrots had the best all-round results on sperm count and motility — a term used to describe the ability of sperm to swim towards an egg. Men who ate the most carrots saw improved sperm performance by 6.5 to 8 percent. The Harvard researchers attribute the boost to carotenoids, powerful antioxidative compounds in carrots that help the body make vitamin A.

Researchers at Johns Hopkins University last year looked at 3,400 healthy Americans and found that men who were vitamin D deficient were 32% more likely to have trouble getting it up than those with sufficient levels, even after adjusting for other ED risk factors. In fact, the connection is so common, Walker says D levels are something he always checks in ED patients. Why? The sunshine vitamin is crucial for keeping the endothelial cells that line blood vessels healthy. Without enough of the stuff, blood flow is inhibited, affecting everything from your heart to your hard-on.
The fowl most associated with belt-loosening feasts is lean, high in protein and the single best food source of arginine, the amino acid. Researchers at the NYU School of Medicine gave L-arginine to a group of impotent men, and found that six out of 15 men receiving the amino acid claimed an improved ability to achieve erections, while none of the 15 men in the placebo group reported any benefit. Additionally, the bird is rich in DHA omega-3 acids, which have been shown to boost brain function, improve your mood and turn off fat genes, actually preventing fat cells from growing! Just make sure you buy white meat only, as dark contains too much fat. And steer clear of prepackaged, sliced lunchmeat—those turkeys are strictly jive.
Penile vibratory stimulator is a battery operated device with oscillating discs that can provide excitation of afferent penile nerves at various regulated frequency and amplitudes. PVS has been utilised to activate the ejaculatory reflex for patients with spinal cord injury above T10 seeking to collect retrogradely ejaculated semen in fertility treatment (10). The Viberect is a vibratory stimulation handheld device approved by FDA for treatment of ED. It is clamp-shaped with two oscillating discs facing each other near the tips, and the glans penis is placed between the two oscillating discs to receive concurrent dorsal and ventral stimulation at adjustable frequencies and amplitudes.
Supplement factsAmount500mg*Serving size: 1 Capsule 500mgServings per container: 1Cordyceps Sinensis 50mgAged Garlic extract 40mgMushroom Extract 40mgCodonopsis 60mg Proprietary Blend 310mg Proprietary Blend: Carthamus, Cinnamon Bark, Ginko Biloba, Red-Berried Weeds, Rehmannia, Tribulus Terrestris extract, Wild Yam extract.Other ingredients:Magnesium stearate, silicon dioxide, Gelatin, Glycerin. *Daily values not established.

There are currently two models of the inflatable penile prosthesis (IPP), namely, the two-piece IPP vs. the three-piece IPP. The three-piece IPP consists of a pair of corporal cylinders, a scrotal pump and an abdominal reservoir filled with saline. Owing to the presence of the reservoir, the corporal cylinders can be completely deflated to give the patient the physiological flaccid state when not in use, and likewise a maximally turgid state when inflated (21). The two-piece IPP lacks an abdominal reservoir and is often offered in patients with whom placement of reservoir is challenging or not possible such as following radical cysto-prostatectomy with orthotopic ileal neobladder creation, or patients who had previous open book fracture of the pelvis with metal implants. The concept of ectopic reservoir placement has allowed many of these men the option for three-piece IPP placement (22). Technological advances have improved mechanical reliability, reduced prosthesis infection risk and offered excellent patient and partner satisfaction rate (23).
While Western medicine emphases the link between cardiovascular function and ED, TCM places importance on liver and kidney ailments as causative factor for development of ED. Western medicine involves a step-wise approach by targeting the relevant organ systems to treat various clinical symptoms; but TCM focuses on restoring the balance between various organs to achieve harmony and holistic approach to inner sense (4). The following article reviews our current understanding regarding the philosophical approach, and evaluates the evidence surrounding various ED therapies between mainstream Western medicine and TCM (see Table 1).
Lycopene is one of those phytonutrients that is good for circulation and good for sexual issues. Lycopene is found in deep red fruits like tomatoes and pink grapefruits. Some studies show that lycopene may be absorbed best when mixed with oily foods like avocados and olive oil. So you might want to make yourself an ED-fighting salad. Research also shows that antioxidants like lycopene help fight male infertility and prostate cancer.
Double down on the marinara to protect your manhood. Men who eat over 10 servings of tomatoes each week have an 18 percent lower risk of developing prostate cancer — the result of lycopene, an antioxidant which fights off toxins that can cause DNA and cell damage — a study in the journal Cancer Epidemiology, Biomarkers and Prevention found. A previous study found the garden vegetable could also improve sperm morphology (shape); men with the highest tomato intake contributed to between 8 and 10 percent more ‘normal’ sperm.
Jacka, Felice N.; O’Neil, Adrienne; Opie, Rachelle; Itsiopoulos, Catherine; Cotton, Sue; Mohebbi, Mohammedreza; Castle, David; Dash, Sarah; Mihalopoulos, Cathrine; Chatterton, Mary Lou; Brazionis, Laima; Dean, Olivia M; Hodge Allison M; Berk, Michael. “A randomised controlled trial of dietary improvement for adults with major depression.” BMC Medicine. Jan 2017.
ED can be caused by a handful of things, but one thing’s for sure: You need a healthy supply of the neurotransmitter nitric oxide (NO) to get and maintain an erection. NO is produced in nerve tissue and helps jolt your Johnson by relaxing the smooth muscle so blood can fill the penis. After the initial release of NO, your body releases a cascade of chemicals—including more of the neurotransmitter—to help keep you hard and happy, according to a study in the Proceedings of the National Academy of Sciences.
According to historians, ancient Egyptians used garlic to boost their stamina. While they didn’t have modern-day science to confirm that it actually worked, they were most certainly onto something. Researchers have confirmed that consuming the plant helps stop the formation of new fatty deposits, called nanoplaques, inside arterial walls. Yup, that includes the arteries leading to your penis, too. Keep your heart healthy and your erections strong by adding the kitchen staple to your weekly dishes.

A recent study in the journal Circulation found that flavonoids in dark chocolate improve circulation. That could be good for erection problems that are due to poor circulation. Flavonoids are naturally-occurring antioxidants that protect plants from toxins and help repair cell damage. Studies show that flavonoids and other antioxidants have similar effects on people. They may help lower blood pressure and decrease cholesterol, both of which are factors that contribute to erectile dysfunction.
This tasty green nut may be more than a great snack. A study published in the International Journal of Impotence Research examined how eating pistachios affected ED. Measurements were taken before men were put on a nut-heavy diet and after. Consuming pistachios for several weeks showed improvement in several parameters of ED, including improved International Index of Erectile Function scores for study participants.
The same device is considered a vacuum erectile device (VED), when it is used to increase inflow of the blood to the penis without a constriction band. Regular use of VED in post-prostatectomy patient increases penile oxygenation and is accepted as a valid option in penile rehabilitation. Recent study reported transient increase in oxygenation to the glans penis and corporal bodies were detected by oximetry after VED was applied, providing proof for possible role for VED to counter the early penile hypoxia, cavernosal fibrosis and long-term ED after radical prostatectomy (9).
Peanuts contain a trove the amino acid L-arginine, which is one of the building blocks of nitric oxide, which aids your efforts under the covers. They also help reduce cholesterol levels. The less cholesterol you have in your system, the easier it is for blood to circulate throughout your body and down, which can help you maintain a firmer erection longer.
Cherries are rich in anthocyanins, plant chemicals which clean your arteries of plaque, keeping them open for business. That has a direct effect on blood flow below the belt. So make them a regular snack: One cup clocks in at fewer than 100 calories and boasts B vitamins, cancer-fighting flavonoids and three grams of fiber. For more essential fat-blasters for your kitchen, stock up on these 9 Best Flat-Belly Superfoods!
Penile prosthesis implant remains the most effective and permanent treatment for ED. Penile prosthesis implants can be broadly divided into malleable and inflatable prostheses (20). Malleable penile prosthesis, also known as semi-rigid prosthesis, does not allow for (physiological) flaccid state of the penis. The patient can bend the prosthesis upwards for sexual intercourse and downwards for concealment. Although the angle of prosthesis concealment has improved with recent devices, however due to the constant rigid state of the penis, they are still less comfortable compared to their inflatable counterparts, are more likely to cause social embarrassment and associated with higher risk of implant erosions (21). However, malleable prosthesis still has its place for the treatment of ED as these implants are easier to handle, easier to place and would benefit patients with impaired manual dexterity.
"This is the first study to look at the association between flavonoids and erectile dysfunction, which affects up to half of all middle-aged and older men," said lead researcher, Professor Aedin Cassidy. "Men who regularly consumed foods high in these flavonoids were less likely to suffer erectile dysfunction. In terms of quantities, we're talking just a few portions a week."

In TCM, the meridian system is thought to represent a path through which the life energy qi flows and as discussed in earlier section, the “Jing” (kidney) qi plays an important role in penile erection. Acupuncture helps to correct the imbalances to relieve physical symptoms by stimulating various meridian points. The Shensu (BL23), Zusanli (ST36) and Neiguan (PC6) points represents important acupoints for penis stimulation and thus has a positive homeostatic effect on the autonomic nervous system, and potentially modulate NO release (55,56). While some studies have showed up to a third of patients reported improvement in penile erection and sexual activity, systematic review showed insufficient data to conclude that acupuncture is an effective intervention for treating ED (56,57). Therefore, further scientific research is required to investigate whether there are specific benefits of acupuncture for men with ED before acupuncture can be accepted as evidence-based practice.
The Aztecs referred to avocados as testicles because of their scrotum-like appearance. They were onto something. The green fruit is rich in potassium, vitamin B6 and vitamin E, nutrients that have been associated with increased libido. Plus, avocados’ good monounsaturated fats protect your heart and boost circulation, while their abundant minerals and carotenoids supply energy and stamina. For some creative ways to consume the fruit, check out our 10 avocado recipes for weight loss.
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Ginkgo biloba. Known primarily as a treatment for cognitive decline, ginkgo has also been used to treat erectile dysfunction -- especially cases caused by the use of certain antidepressant medications. But the evidence isn't very convincing. One 1998 study published in the Journal of Sex & Marital Therapy found that it did work. But a more rigorous study, published in Human Pharmacology in 2002, failed to replicate this finding. "Ginkgo has come out of fashion in the past few years," says Ronald Tamler, MD, assistant professor of medicine and codirector of the men's health program at Mount Sinai Medical Center in New York City. "That's because it doesn't do much. I can say that in my practice, I have not seen ginkgo work -- ever."

A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be broken and choices reconsidered. What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.

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