What is TriMix and How to Use it? | Dr. Anne Truong

What is the good and the bad of Trimix?

I'm going to dive deep into it in this episode. Hello there.

In this episode, we're going to talk about Trimix, the good, the bad and ugly. So what is Trimix? Trimix is really three medication that is put together in a liquid. It's in a solution and comes with a powder, and you have to mix it with a sterile water and you have to inject it into the penis. What? So it's three medication that has to be compounded from a specialized pharmacy, so you can't just go to CVS or Walgreens to buy it, and you can't get it over the counter. It has to be prescribed by a medical doctor. Okay. And what's interesting about it is that it can come in Bimix, which is only 2 of the medication, or Trimix, which has three different medication that works together. It's considered the next step. If you take Viagra or Cialis and you're not responding to it or that you've been taking those medications for a while and it stopped working. Now, you know I'm a big proponent of treating your ED without medication.

Nice.

And checking your blood work and looking at your diet and exercise and stress reduction and lifestyle modification first. But I wanted to address Trimix because there's been a lot of questions about it. And I use Trimix to do a penile Doppler ultrasound where I inject it into the penis and wait for about 15 to 30 minutes. And while the penis is erect, I can use an ultrasound machine to look at the blood flow from the arteries and look at the veins and look at the penis muscle while it's erect. So it works well as inducing an erection, and it has a high satisfaction rate.

Nice.

But it also has some side effect as well, too, which I'm going to talk about. So Trimix is an injection.

All right.

And it has to be compounded. And the first medication is called pentolamine. Pentolamine belongs to a class of drug called the alpha adrenergic receptor antagonist. So essentially how it works is that it blocks the action of epinephrine and norepinephrine mainly on the corpus cavernosum of the penis because it's injected locally in there. And norepinephrine and epinephrine cause constriction of the blood vessels of the penis, and. And therefore it prevents an erection. So pentolamine blocks the effect of norepinephrine and epinephrine and therefore help with erection Nice. As I mentioned before in my previous episode that in order for you to get an erection, your mind has to be relaxed and your penis has to be relaxed. Because when you get an erection, that means that the penis muscle is actually in a relaxed state. And when your penis is flaccid, it's actually in a contracted state. It's opposite what you normally think. And norepinephrine. Epinephrine is produced when you're in stress or when you're in an emergency state. So when you're stressed, you have a higher level of norepinephrine epinephrine. And that's the reason why when you're stressed, it's hard for you to get an erection. So it has a rapid onset and between 5 to 20 minutes and it peaks at around 10 minutes and it goes away at around 30 minutes or so. But it can also last as long, anywhere between one to four hours. When I say it goes away, half of it, the concentration is gone by about 30 minutes. But it could last longer. Like I mentioned earlier, the second medication is called Alprostatil and I'll put all that name of the medication underneath is known as a group of medication called prostaglandin. E1 is a drug that a potent vasodilator or opens up blood vessels. And how it works in the corpus cavernosum or the penis muscle is that it relaxes the smooth muscle of the penis by opening up the arteries that lies within the penis. However, it is quickly metabolized. So it goes away quickly. 80% of it is being metabolized in about 5 minutes and the half life is about 5 to 10 minutes. The third medication is called Papaverine. It is an alkaloid opens up the blood vessel. It's the vasodilatory effect on the smooth muscle. And it works very similar to Viagra or Cialis in that it inhibits the breakdown of cyclic GMP and amp and it also inhibits the calcium channels on the cell as well. And therefore so it help with smooth muscle relaxation, allowing more increasing blood flow. So how these three medications work is hypovolarin work on the smooth muscle relaxation, apostatal work on on opening up the blood vessels of the penis. And pentolamine works on blocking the effect of epinephrine and norepinephrine, again opening up the blood vessel as well. So they work synergistically together most of the time. If you're going to do Bimix, it's pentolamine and Alprostatal Trimix is three of them working together. So who needs Trimix? Usually men that has ED or is refractory to taking Viagra or Cialis or sensitive to Viagra and Bialis. So how safe is it? You shouldn't be using Trimix if you have a sensitivity to the injection as well. If you're on blood thinner or medication that may affect blood clotting, or you had a history of priapism in the past, or you have a deformity of the penis such as Peyronie's disease, or you have leukemia, sickle cell anemia or multiple myeloma, or you have an infection in the penis or open sores. Now, there's no conclusive study regarding the risk of Trimix injection while taking ED medication, but generally it is not advisable to take ED medication at the same time as doing trimix, especially within 18 to 24 hours of each other, because you could have the side effect of lower blood pressure. Then you will have possibility of heart attacks, strokes and even passing out and dizziness. Oh, snap, this is getting interesting. So trimed usually comes what they call a freeze dry. And so it has to be mixed with sterile water. And once it's mixed, you have to refrigerate it again. Once you mix it, that bottle shouldn't be reused after 28 days because there's risk of infection anytime a bottle is punctured for the first time through the rubber. So you have to label the date that you use it, you put it in the refrigerator, and after 28 days you have to throw it away and trimix it odorless, colorless, sometimes it's white, sometimes a little bit yellowish color. And what you do is you self administer it, you withdraw it in insulin syringe, the orange insulin syringe. And the prescription can be from 20 units to about 30 units. But please do not self adjust. You have to talk with your doctor about it, what dose you should be on. You don't want to inject too much, too much. You run risk of priapism as well. So the benefits of TriMips are that it works, it has a high rate of satisfaction, but it involves injection with a needle. Now, one thing I want to say is that when you're injecting the penis with a needle repetitively, and I've seen this in my patients that had tried Trimix, is that you tend to have scar tissue in the corpus cavernosum and you start developing Peyronie disease and you may have the bending of the penis and it will actually even cause ed, even though you use it for ed. But prolonged use, you can have developed ED because of the scar tissue that gets developed. And most of the time you see it on the right side because most men are right handed, they inject on the right side of the penis. So you should really switch side on the side of the penis. But there are so many times you can inject the penis and it's going to start developing scar tissue, who develop it, how fast it is, how often you use it, where you inject as well. There's also side effects of pain at the injection site or I cringe at every time you have set. You inject yourself is quite painful. And then I recommend three times a week of sex. So that's a lot of injection. And there's also risk of bleeding, like having bleeding if you inject into a vein. And also the risk of swelling and bruising as well. And then there's prolonged erection or priapism. And priapism is usually defined as an erection lasting more than four hours. And astral priapism can actually lead to ED because of the damage of smooth muscle and the blood vessels as well. And if you do have priapism, go to the ER immediately. I'm calling the ambulance. So you can get an injection that reverses the priapism or injection that reverses the vasodilatation effect. Now, Trimix should not be taken lightly. It is a medication with serious side effects. If taken too much of a dose, your blood pressure can drop and you can feel dizzy as well as passing out or using it repeatedly will cause scar tissue development and not to mention bruising. So I suggest that if you're going to use Trimix, it should try to also use pumping as well along with that. And add lifestyle modification to at diet, exercise, sleep, moderate your alcohol and stopping smoking. And also explore other treatment out there that is not surgery. Okay, Such as, you know, platelet rich plasma injected into the penis works like Trimix, actually increasing blood vessel development and repairing injured blood vessels as well. Shockwave does the same thing, increases more blood vessel density and repairing blood vessels in the penis. And then Botox. Botox works like Papaverin or even Viagra by relaxing the smooth muscle of the corpus cavernosum as well as even working on the nerve as well. So just know that there are other alternative, but if you have to use Trimix, make sure that you use it under your doctor's guidance and don't over dosage and just be careful. Change the injection site and you start to feel that you have some scar tissue that develop, then probably a good time to explore other options because scar tissue or Peyronie's disease is difficult to treat and require intensive treatment, sometimes even surgery as well, and sometimes even surgery with complication of ed. And you don't want to have one treatment that treat ED and then end up having ED because of the complication of that treatment? Not a chance. Not this time. And you know how I feel that I'm a big proponent of natural restoration of your sex life and your erection. And if you start early, you can definitely do that. And I hope you enjoyed this episode. Let me know you have any questions and I'll see you in the next episode. Hello there.

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Until next time.