In this solo podcast episode, Dr. Anne Truong examines a real case of a 78‑year‑old man who, despite being physically fit, having normal blood pressure, excellent blood work, and a high serum testosterone (864 ng/dL), has suffered moderate erectile dysfunction (ED) for five years. Dr. Truong walks through her systematic evaluation: she administers the ADAM questionnaire (showing three positive symptoms of low testosterone) and the IIEF (score 19/25), orders a CT scan that reveals atherosclerotic plaque in the iliac artery, and performs penile Doppler ultrasound confirming reduced penile blood flow. She concludes that the primary etiology is vascular—atherosclerotic compromise of blood flow—augmented by symptomatic testosterone deficiency despite high circulating levels (receptor variability). Dr. Truong then outlines a staged treatment plan: (1) lifestyle changes (Mediterranean diet, antioxidant‑rich foods, daily aspirin), (2) low‑dose testosterone injections (≈120 mg/week), (3) daily nitric‑oxide supplement taken before sex, (4) mechanical aids (penis pump, constriction ring, Kegel exercises). If insufficient after six weeks, she recommends escalation to in‑office regenerative options (stem‑cell therapy, platelet‑rich plasma, Botox, low‑intensity shockwave, electromagnetic therapy). Throughout, she promotes her premium “Get Hard Protocol” (a $16,000 Virginia‑based program combining the above modalities) and the subscription‑based “Modern Man Club” (noedman.com) for ongoing support. The episode emphasizes that ED is not an inevitable consequence of aging and can be reversed with targeted evaluation and therapy.
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Most people assume that ED at 78 years old is just part of aging. But what do you do when a patient has normal blood pressure, very healthy, good blood work, but yet have moderate ED for about 5 years? In today's episode, I'm going to analyze the real cause as to why this patient has ED and what to do about it.
This podcast is for you, the modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and bestselling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website at sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside.
I'm Dr. Anne Truong. I'm a board-certified medical doctor. I've treated over 7,000 men with ED. In today's episode, we're going to talk about a 78-year-old male who had moderate ED for about 5 years now and is very healthy. He's 6 feet. He weighs 169 pounds. He has no diabetes and not even high cholesterol at all. He runs 3 miles a week and he eats well. All his blood work is fairly normal. In fact, at 78 years old, his total testosterone is 864. That's pretty at the top 10 percentile because testosterone runs from 300 to 900 nanograms per deciliter. And he's at the high 800s. So he's up there, and this is without testosterone replacement therapy. So that tells me that he's fairly active, he's fairly healthy. That's why his testosterone level is high, but yet he still has ED. Why does he have ED? Well, let's break that down today. So we know that there are causes of ED. What if everything you've been told about fixing performance issues, it's backward. No pills, no surgery, just a medically proven path to getting your confidence and edge back for good. Discover what thousands of men are doing inside the private brotherhood of the Modern Man Club. Go to noedman.com. I'll see you there. And let's go over why he has ED. I'm going to show you a slide here. ED is multifactorial. Mainly 90% of ED is physical and 10% is Psychological, but the physical part is due to blood flow or nerve damage or hormones and drug-induced or lifestyle. Drug-induced meaning the medication you take may be affecting it, like smoking or vaping or porn. So that's how you kind of think about it. If it is physical, is it blood flow, which is the most common organic causes Or is it nerve damage, or is it hormone or drug-induced? Quick note before we go any further. If you're a high-income man, usually the age between 45 to 85, and you're ready to invest to fix your ED without relying on pills or surgery, I have the Get Hard Protocol, in-office program where we treat you in Virginia. We combine stem cells, shockwave, Botox, Hormones, and lifestyle to help restore natural erection. It's not for everyone. You must be able to travel to Virginia and be comfortable investing around $16,000 for your health. If that's you, pause this video for a moment, click the link down below in the description that says Get ED Breakthrough with Dr. Anne and complete the application. If you're not in that position yet, no problem. Keep enjoying this video. And check out our Modern Man Club at noedman.com.
Those are the things.
So why does this patient— let's just call him John today, 78 years old, very healthy— he had ED for 5 years? I always do questionnaires when I evaluate patients. So I give him a questionnaire which is called the ADAM test, meaning the Androgen Deficiency Test, and it shows that he does have Symptoms of low testosterone. He answered that his erection is not as firm. He also said that he feels fatigued. He lost height. Three out of ten questions is positive. Therefore, he has symptomatic positive of low testosterone. He on the erectile dysfunction scale, IIEF, he scored nineteen out of twenty-five, which put him at moderate ED. Let's go through what is causing his ED. Could it be that he's symptomatic in low testosterone even though his blood level of testosterone is 864? So what is the cause of his ED? Could be symptomatic low testosterone, but not high level testosterone. Remember I said that testosterone level is genetically determined. So the receptor for testosterone is different in every man. And every man is happy in a different zone. So John may be happier if he's in maybe 900 area, but he's also 78 years old. He had a CT scan of his abdomen, and it does show that he has some atherosclerotic heart disease around the iliac artery, which is the one that goes down to the groin that provide all the blood vessel.
Mm-hmm.
In the groin and also in the penis. So he's starting to have atherosclerotic heart disease in the big blood vessel that may be compromising blood flow going down to the penis. But you don't see that in his blood work, but you see that on just abdominal tests and also in Doppler ultrasound of his penis where he does have some slight decrease in blood flow. Blood flow to the penis. So you have decreased blood flow, that's from doing the test called the Doppler ultrasound. And then he's symptomatic in low testosterone, though his testosterone level is high. The bottom line is that he has ED mainly from decreased blood flow, but you have to do a test called Doppler ultrasound to see that, even though his blood work looks good. And then it's just a little bit of low testosterone affecting it as well. Now, he does have morning wood. And he tells me that if he uses a penis ring, he's able to maintain his erection and a little bit of weed. Having said that, how do I get him to functioning again? Well, this is the case I love. A very healthy male, about 5 years of ED. And in fact, he doesn't want to take medication. He starts to have a headache if he tries to take Viagra or Cialis. So how do we approach this case? So first of all, we know it's due to blood flow and maybe from a little low testosterone, atherosclerotic heart disease. Well, he already had good cholesterol and good blood pressure, and he's also exercising. So right now, I would recommend that he eat more fruits and vegetables to add more antioxidants to his diet to improve the atherosclerotic heart disease, which will affect his blood flow. I would advise him to take an aspirin a day. In fact, he doesn't take medication at all. His blood pressure is fine. He's literally a healthy man. And I recommend that he gets on a little bit of testosterone injection, about maybe 120 milligrams total in a week. And then do penis pumping, do penis pumping every day, twice a day, and take nitric oxide, which is the one that we have, the nitric oxide. Check it out in our store at ednomore.com. And also the Libido Plus would also naturally increase his testosterone as well. And that I suggest that he take nitric oxide about 30 minutes before sexual activity because it works like Viagra. So just by recommending that and him using the penis ring, he's able to function now. He's able to get an erection. For activities. And he's actually now starting to notice morning wood now as well too, with just a tweak in his diet a little bit. He's already eating well, but we're adding more fruits and we're adding more vegetables to his diet to have that antioxidant effect, which then help with the inflammation and also help with the endothelial healing. So in this case, it's a very mild case. of ED from the look of it in a very healthy male who's 78 years old, who's 6 feet and weighs 169 pounds. So my point here is that you have ED, go see the doctor, get blood work, get a Doppler ultrasound, let your blood flow of your penis get analyzed. And sometimes just a little tweak in what you need to do on a daily basis will really get you working again and having good firm erection. And for him, he doesn't need a lot at this point. Now, I would recommend that if he does that for about 6 weeks and doesn't see much improvement, then we would do the stem cell therapy with platelet-rich plasma, Botox, and shockwave, along with doing electromagnetic therapy and Kegel. Now, I would recommend that he also do Kegel along with penis pumping and using the penis ring. But the whole point here is that ED is reversible even at the age of 78, and that ED is not an inevitable part of aging. You just need to know that there are solutions. You don't have to live with it. So having said that, you are not alone. Do not suffer in silence. And we have a program to get you out of ED within 90 days if you follow it step by step and working together with us called the Modern Man Club. Check it out at NoEDMan.com. And that my whole point here is to let you know that there are alternatives that you can reverse your ED. I'll see you next episode. Okay, modern man, if you're struggling with weak erection, low energy, the food you eat could be the big part of the problem. One of the best research-backed ways to boost circulation, support healthy testosterone, and improve sexual performance is the Mediterranean diet. It's packed with food that open up your blood vessel, lower inflammation, and fuel your hormone naturally. I've seen men notice real improvement in both energy and erection within weeks when they shift to this style of eating. So check out this Mediterranean diet link right here below and get that as soon as you can. Stronger testosterone and better erection.
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