Erectile dysfunction is one of the most common concerns men bring to a physician, and one of the least often discussed out loud. It is a medical condition with medical causes, and for most men it can be improved. At Atlanta Medical Institute on Roswell Road in Buckhead, we approach it the way we would approach high blood pressure or a thyroid problem: with a real evaluation, appropriate lab work, and a plan matched to what is actually happening in your body.
ED is rarely traceable to a single cause. Blood flow, nerve signaling, hormones, medication side effects, sleep, alcohol, stress, and relationship strain all contribute, and most men have more than one factor in play. The vascular piece is the most common. The arteries supplying the penis are narrower than the coronary arteries, which is why difficulty with erections can appear years before any chest symptom does. Reviews in journals including Circulation, and patient-facing summaries from the Mayo Clinic, describe erectile dysfunction as an early marker of generalized vascular disease. That makes your first ED visit a reason to look at your cardiovascular health, not only your sex life.
For that reason, your first appointment here is an evaluation rather than a prescription. We take a full history, review every medication and supplement you already take, and order labs where they are warranted — testosterone, blood sugar or A1c, lipids, and thyroid among them. What we recommend afterward depends on what those findings show. Whether you are a candidate for any particular treatment, and what dose would be appropriate, is decided by one of our physicians after that evaluation. It is not something to determine from an online questionnaire.
We also think you deserve a straight answer about evidence. Some ED treatments are FDA-approved and supported by decades of trial data. Others, including acoustic wave therapy and regenerative injections, remain investigational. We will tell you plainly which category a treatment falls into before you spend anything on it.
Program Benefits
- A physician-led evaluation that looks for the underlying cause rather than treating the symptom alone
- Lab work where indicated, including testosterone, blood sugar, lipids, and thyroid
- Screening for the cardiovascular and metabolic risk factors that frequently accompany ED
- A full review of your current medications for interactions and for drugs that can contribute to ED
- Candid discussion of which options are FDA-approved and which remain investigational
- Private, unhurried appointments at our single Buckhead office, with follow-up built into the plan
Why Erectile Dysfunction Happens
Occasional difficulty with erections is ordinary and happens to nearly every man. Erectile dysfunction describes a persistent pattern — trouble getting or keeping an erection firm enough for satisfying sex, often enough and long enough that it has become a problem for you. That distinction matters, because a persistent pattern usually has an identifiable physical or medical contributor worth finding.
Broadly, the contributors fall into a few groups: vascular, hormonal, neurological, medication-related, and psychological. Most men we see have some combination. Identifying which ones apply to you is the point of the initial workup, and it changes what treatment makes sense.
- Vascular: atherosclerosis, high blood pressure, high cholesterol, diabetes, smoking
- Hormonal: testosterone deficiency, thyroid disease, other endocrine conditions
- Neurological: diabetic neuropathy, spinal injury, effects of pelvic or prostate surgery
- Medication-related: certain blood pressure drugs, antidepressants, and others
- Lifestyle: heavy alcohol use, sleep apnea, obesity, sedentary patterns
- Psychological: performance anxiety, depression, chronic stress, relationship strain
Treatment Options and Where Each One Stands
Four oral medications are FDA-approved for erectile dysfunction: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra). All four are approved for as-needed use, and tadalafil is additionally approved for once-daily dosing. These drugs improve the blood flow response to arousal — they do not produce an erection on their own, and they work best alongside the lifestyle and vascular factors being addressed.
When oral medication is not appropriate or has not worked, other approved options exist. Alprostadil is FDA-approved both as an injection (marketed as Caverject and Edex) and as an intraurethral suppository (MUSE). Compounded injection mixtures commonly called Trimix are a different matter: they are not FDA-approved, and papaverine, one of their components, has never received FDA approval on its own. If a compounded product is ever discussed with you here, we will say clearly that it is compounded and what that means. Vacuum erection devices remain a useful drug-free option, particularly for men who cannot safely take PDE5 inhibitors.
Testosterone therapy is worth addressing directly, because it is frequently misunderstood. Testosterone is approved to treat confirmed testosterone deficiency diagnosed by symptoms and by blood testing — it is not an approved treatment for erectile dysfunction by itself. If your labs show a genuine deficiency, correcting it may help energy, mood, and libido, and in some men it supports erectile function as well. If your testosterone is normal, testosterone is not the answer, and we will say so. Some men are better served by referral to a urologist, including those considering a penile implant or those recovering from prostate surgery, and we will make that referral when it is the right call.
Acoustic Wave Therapy and GAINSWave: An Honest Assessment
GAINSWave is a brand name for a low-intensity acoustic wave protocol, sometimes called low-intensity shockwave therapy. Here is the part many clinics leave out: it is not FDA-approved for erectile dysfunction. The American Urological Association's Erectile Dysfunction Guideline classifies low-intensity shockwave therapy as investigational, a conditional recommendation supported by Grade C evidence. That is the AUA's own language, and we are not going to soften it.
The evidence is genuinely mixed rather than simply absent. Sham-controlled randomized trials, including work published in the Journal of Urology, have reported improvement in men with moderate ED, and the 2024 AFU/SFMS French urology guidelines state that low-intensity shockwave therapy may be offered to men with mild or moderate ED, alone or combined with a PDE5 inhibitor. At the same time, studies differ substantially in the device used, the energy settings, the number of sessions, and how long patients were followed, which is a large part of why the overall evidence grade remains where it is. A Cochrane systematic review of this literature has been undertaken, reflecting how actively the question is still being examined.
Our position is straightforward. We offer acoustic wave therapy, and we think it is a reasonable option for some men to consider. We do not present it as a cure, a permanent fix, or a replacement for approved treatment, and we do not recommend it as a first step for a man who has not yet been evaluated. If you want to try it, you should go in knowing exactly what the evidence does and does not show.
Who Is a Candidate, and Who Is Not
Most men with persistent erectile difficulty are appropriate candidates for evaluation, including men whose oral medications stopped working or caused side effects they could not tolerate, men who cannot take PDE5 inhibitors for medical reasons, and men who suspect a hormonal component. Being a candidate for evaluation is not the same as being a candidate for any specific treatment — that determination comes after the workup.
Some situations call for caution or for a different path. PDE5 inhibitors are contraindicated for anyone taking organic nitrates in any form, including nitroglycerin, because the combination can drop blood pressure dangerously; this is stated explicitly on the FDA labels. Men with unstable cardiac disease may need cardiology clearance before treatment for ED begins. Men on anticoagulants, men with an active genital infection, and men recovering from prostate surgery each need individual review, and in the post-surgical case, co-management with the treating urologist. Your physician here will work through all of this with you before anything is prescribed or scheduled.
What to Expect at Your Visit
Your first appointment is a conversation, conducted privately and without rush. We will ask about onset and pattern, about morning erections, about your medical history and every medication you take, and about stress, sleep, and alcohol. These questions are clinical, not judgmental — the answers genuinely change the diagnosis. Lab work is typically drawn the same day when it is indicated, and we review results with you rather than sending a portal message and leaving you to interpret it.
If acoustic wave therapy is part of your plan, sessions are performed in our office, take well under an hour, require no anesthesia, and are generally delivered as a series rather than a single visit. Most men describe the sensation as a light tapping. Your physician will set the number of sessions based on your evaluation. We will not quote you a guaranteed result or a guaranteed duration of benefit, because no one can honestly provide either.
Follow-up is part of the plan, not an upsell. Erectile function is a moving target that responds to blood pressure control, blood sugar, sleep, weight, and medication changes, so we reassess and adjust rather than prescribing once and disappearing.
Safety, Monitoring, and How This Fits With Our Other Services
A few safety points are worth knowing before any ED treatment. Beyond the nitrate contraindication, the FDA labels for PDE5 inhibitors warn about interactions with alpha-blockers and other blood pressure medications, and about rare but serious events including sudden vision loss and sudden hearing loss — if either occurs, stop the medication and seek care immediately. An erection lasting more than four hours is a medical emergency called priapism and requires emergency treatment, not a wait-and-see approach. We review all of this with you rather than handing you a leaflet.
ED rarely travels alone, and our other services often connect to it directly. Because testosterone deficiency is a common contributor, many men benefit from our <a href="/services/low-testosterone-treatments">low testosterone evaluation</a>. Because excess weight and insulin resistance affect both vascular health and hormones, our <a href="/services/weight-loss-atlanta-ga">medical weight loss program</a> is frequently part of a long-term plan. Men interested specifically in the acoustic wave protocol can read our <a href="/services/gainswave">GAINSWave</a> and <a href="/services/acoustic-sound-wave-therapy">acoustic sound wave therapy</a> pages, and men dealing with penile curvature or with early ejaculation can look at our <a href="/services/peyronies-disease">Peyronie's disease</a> and <a href="/services/premature-ejaculation">premature ejaculation</a> pages. Regenerative approaches using <a href="/services/stem-cells-exosomes-therapy">stem cells and exosomes</a> are discussed with some patients, and the same honesty applies there: these are not FDA-approved for erectile dysfunction and remain investigational.
Atlanta Medical Institute has served Atlanta from one Buckhead location since 2010. Dr. Elbridge Bills, Dr. Jeff Semel, and Dr. Leslye Pace see patients here at 5009 Roswell Road NE, Suite 201. To arrange a confidential evaluation, call (404) 264-9553 or use our <a href="/contact">contact page</a>. We are open Monday through Thursday from 9 to 6 and Friday from 9 to 4.
Frequently Asked Questions
Is my visit confidential?+
Yes. Consultations and treatment are private and protected by the same medical privacy rules that cover any other condition we treat. We ask direct questions because the answers affect the diagnosis, not because we are making judgments about you.
Does erectile dysfunction mean something is wrong with my heart?+
Not necessarily, but it is a reason to check. The arteries supplying the penis are narrower than the coronary arteries, so vascular trouble can show up there first. Cardiology reviews in journals including Circulation describe ED as an early marker of generalized vascular disease. That is why our evaluation includes cardiovascular and metabolic risk factors rather than just the erectile symptom.
Is GAINSWave or acoustic wave therapy FDA-approved for ED?+
No. Low-intensity acoustic wave therapy is not FDA-approved for erectile dysfunction, and the American Urological Association's Erectile Dysfunction Guideline classifies it as investigational, with a conditional recommendation at Grade C evidence. Some sham-controlled trials, including work in the Journal of Urology, have reported benefit in men with moderate ED, and the 2024 French AFU/SFMS guidelines allow for offering it in mild to moderate ED. Studies vary widely in device and protocol, which is why the evidence grade is where it is. We will walk you through that before you decide.
Can I take ED medication with my other prescriptions?+
That depends entirely on what you take, which is why we review your full medication list at the first visit. One rule is absolute: PDE5 inhibitors are contraindicated with organic nitrates in any form, including nitroglycerin, because the combination can cause a dangerous drop in blood pressure. Interactions with alpha-blockers and other blood pressure drugs also need review. Never start an ED medication obtained outside a physician's care without that check.
Will testosterone therapy fix my ED?+
Sometimes it helps, and sometimes it is beside the point. Testosterone is FDA-approved to treat confirmed testosterone deficiency, not to treat erectile dysfunction on its own. If your bloodwork shows a genuine deficiency, correcting it may improve libido, energy, and in some men erectile function. If your testosterone is normal, testosterone therapy is not the right answer and we will tell you that rather than prescribe it anyway.
The pills did not work for me. Is there anything else?+
Yes, and this is a common reason men come to us. Sometimes the medication was never given a fair trial or an underlying factor such as untreated diabetes or sleep apnea was driving the problem. Beyond oral medication, FDA-approved options include alprostadil as an injection or intraurethral suppository, and vacuum erection devices remain effective and drug-free. Some men are best served by referral to a urologist for options such as a penile implant. Your physician will go through the realistic paths based on your evaluation.
How do I get started?+
Call (404) 264-9553 or reach us through our contact page to schedule a consultation at our Buckhead office at 5009 Roswell Road NE, Suite 201. Plan on a full appointment rather than a quick stop, since the first visit includes a detailed history and usually lab work. We have one location in Atlanta and have been here since 2010.
Costs and appointment planning
Review pricing questions, insurance and coverage information, and telehealth visit planning before booking. Confirm the costs and services that apply to your individual care.
Ready to Get Started?
Call us at (404) 264-9553 or book a telehealth consultation. New patients qualify for our 1st month Semaglutide special — $399 (regularly $450).