ED myths vs one urologist’s verdict: highlights from our conversation with Dr. Daniel Martinez
Erectile dysfunction may be the most searched, worst-explained topic in men’s health.
For our latest menMD Focus webinar, Dr. Daniel Martinez, a fellowship-trained specialist in sexual medicine, andrology, and male infertility at Urology Specialty Care of Miami, joined us for a frank conversation around fact vs fiction on 14 of the most persistent ED myths in circulation.
Where the bad information comes from
“Between social media and YouTube and now ChatGPT and all the AI out there, unfortunately there’s a lot of myth,” Dr. Martinez said as he set the stage.
“You walk into a gas station and right then, right there, there’s about 18 different things you can take that’ll make your penis longer and larger and make you have sex like you were 18 years old despite being a 70-year-old man with diabetes, high blood pressure, and high cholesterol.”
His framing for the night: some claims are fact, some are fiction, and a surprising number sit in what he calls the gray zone.
We polled the audience live on each myth before revealing his verdict. The room did well overall. Three questions exposed exactly the kind of misinformation that keeps men from getting treated.
The three myths that tripped up the room
Building a tolerance to ED pills
Asked whether you can develop a tolerance to sildenafil or tadalafil, 49 attendees said you can. Only 21 got it right.
The answer: you cannot.
“You do not grow a tolerance or a dependence to these phosphodiesterase inhibitors,” Dr. Martinez said. He hears the worry constantly from younger patients who want to delay treatment so the medication still works later in life. The pills stop working for a different reason.
“Ten years ago your penis was a lot healthier than it is now,” he said. Arterial flow, venous trapping, and nerve conduction all decline with age, diabetes, and cardiovascular disease. The drug did not fail. The tissue, however, changed.
Penile implants and size
The room split nearly down the middle, 46 to 26. The verdict on day one is fiction.
“What you got is what you got,” he said. An inflatable penile prosthesis fills the corpora and produces reliable rigidity. It does not add length on the operating table. He teaches patients to check their stretch length, pulling the flaccid penis out as far as it goes, to set expectations before surgery.
There is a longer arc. The device works as a tissue expander, and men who cycle it daily regain size over the years. At revision surgery a decade later, many measure one to three centimeters longer than they did originally.
Whether injections hurt
Sixty-four percent said intracavernosal injections are tolerable. Dr. Martinez agreed, with a caveat.
“The worst part is the anticipation,” he said. “The moment I show them how to do these injections, they come back and say, ‘Oh, that’s not bad. I can do this with my eyes closed.'”
Technique carries most of the outcome, which is why the AUA requires an in-office test dose. Men who report burning are often reacting to the prostaglandin in TriMix, and many of them do fine switching to BiMix, which does not contain it.
What actually causes ED
No single culprit exists, and Dr. Martinez pushed back on patients who arrive asking to be fixed like a broken bone.
“This is a blood flow issue, nerve issue, hormonal issue, lifestyle issue, stress, mental issue, medication issue,” he said.
The audience unanimously rejected the idea that ED is all in your head, and he took the answer a step further. Psychogenic ED is real, and it is still physical. Stress and anxiety trigger epinephrine and cortisol, which pull blood away from the penis as part of the fight-or-flight response. Those are the same compounds emergency rooms inject to end a priapism.
On the biggest contributor, he was frank.
“Diabetes is the biggest assassin to a man’s penis.” Elevated blood sugar drives a fibrotic, inflammatory response in the corpora that damages blood flow, architecture, and nerve conduction at once. He uses that as leverage with patients: a better A1C produces better erections.
Why ED deserves attention beyond the bedroom
Ninety-nine percent of the room knew ED affects younger men too. Dr. Martinez wanted them to understand why that matters.
“Sexual health is a mirror into the overall health of a man, and so if you’re having issues in the bedroom, there may be some other underlying issues going on,” he said. Undiagnosed diabetes, sleep apnea, and cholesterol problems all show up first as a change in erections.
That logic extends to screening. Guidelines put the first PSA and rectal exam at 45 for men without a family history and 40 for those with one.
It also applies to prostate cancer treatment, which 93 percent of attendees correctly called a myth. Robotic prostatectomy and focused radiation have both improved nerve preservation, and recovery is the norm rather than the exception. Dr. Martinez added one condition: see a sexual medicine specialist before and after treatment.
“You don’t just run a marathon. You train for the marathon,” he said. Penile rehab with vacuum devices and daily tadalafil sets men up to recover function. His larger point on screening was harder to argue with: “Worse than treating prostate cancer is actually dying of prostate cancer.”
What the shelf can’t do
Ninety-four percent of the audience already knew gas station ED pills are risky. The mechanism behind that risk comes down to quality control. Without oversight, a manufacturer can print any claim and include any ingredient at any dose, including undisclosed pharmaceuticals and outright impurities.
“They’re taking advantage of desperate men,” he said.
Over-the-counter testosterone boosters got the same treatment. Eighty-five percent called them fiction, and the AUA guidelines back that up. He also corrected a related misconception: testosterone influences libido and nocturnal erections far more than it governs the mechanics of getting and staying hard, which come down to blood flow and nerve conduction.
He saved his sharpest line for the marketing term that drives all of it. “Nothing is natural unless you yourself are pulling it out from your backyard or the ground.”
The last myth, and the only verdict that matters
The final question asked whether there is nothing you can do about ED. One hundred percent of the room said fiction, and Dr. Martinez agreed without qualification.
He walked through the full range, working from least to most invasive: lifestyle changes, daily tadalafil with a higher dose before sex, vacuum erection devices, intraurethral gel, injections, shockwave therapy, and a penile implant as the reliable endpoint.
Realistic expectations still apply. Ninety-five percent of attendees knew they will never feel exactly the way they did at 18, and he made no promises otherwise. What he does promise is function.
“I’m just a guide,” he said. “You guys are the captains when you’re in the office with me. My job is to explain to you what I can offer and to give you the options.”
If any of the 14 myths sounded familiar, that is the point. The information gap is the problem, and it is the easiest part of ED to fix.
