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List of Implant Surgeons

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Hawk

This is a beginning list of high volume (well over 100 per year) implant specialists with very positive patient feedback.  Keep in mind that there can be and there are complications including infection with every surgeon.  The rate of these complications is, however, substantially reduced with a high volume surgeon as is size loss.  By the same token, there are low volume doctors that produce satisfactory results in many patients but the rate of complication is greatly increased.

Possible complications include but is not limited to: Infection (always requires removal of the implant), Size loss, instability of erection (points down, wobbles), Visible or palpable tubing, Over-sizing ( requires surgery)

This list is not an endorsement but is provided as a beginning point for patients to do their own research and choose their surgeon wisely.

California

Edward Karpman,  MD.
San Francisco Bay Area
Mountain View, CA
https://www.elcaminohospital.org/doctors/edward-karpman

Massachutes

Andrew Kramer, MD
UAACC ( Urology Associates Of Cape Cod)
110 Main Street
Hyannis MA 02601
Office: 508-771-9550
Fax: 508-862-6358
A high-volume implant surgeon. He posts videos on youtube very often so you can see the whole process.


New York

Dr. Francois Eid
Manhattan, NY
https://www.edcureonline.com/doctors/detail.php?ID=82
He has likely performed more inflatable implant surgeries than any surgeon in the world.  Dr. Eid is known for developing the no-touch technique to greatly reduce the risk of infection. Has famously low infection rates (under 1%) -----  Seldom can one find a world renown surgeon who is so kind, friendly, and accessible to his patients?  He is a doctor that is so interested in his patients.  He gives them his cell phone and personally returns calls on the weekend.  Also does verapamil injections and other treatments for Peyronies Disease, and erectile dysfunction. - Covered by Medicare and most insurance.

North Carolina

Dr Aaron Lentz
Last year, 145 implants
Raleigh NC, Duke Hospital
Website: https://www.dukehealth.org/find-doctors-physicians/aaron-lentz-md?utm_source=google&utm_medium=organic&utm_campaign=Directory%20Management
See Stepone's implant journal for more info:
https://www.peyroniesforum.net/index.php/topic,11742.0.html

Canada Ontario
Dr. Gerald Brock
St. Joseph's Hospital
268 Grosvenor Street
London, Ontario, Canada  N6A 4V2
Phone:  519.646.6042  Fax:  519.646.6037
Email:  [email protected]
Dr. Brock is the author of over 225 publications, 25 book chapters, numerous abstracts and more than 20 research awards from national and international research organizations.  Dr. Brock's work in urology and erectile dysfunction is acknowledged by his role as Andrology section editor of the CUA Journal, as well an editorial board member of multiple other scientific journals. Dr. Brock is the immediate Past-President of the Canadian Urology Association. Dr. Brock is the Secretary General of the International Society for Sexual Medicine, as well as past chair of the Guidelines Committee of the CUA, Chair of the Office of Education for the CUA and CUA Scholarship Foundation Administrative Chair and served as Chair of the IVth International Consensus Conference of Sexual Medicine in Madrid.


United Kingdom
United Kingdom

Dr. David Ralph
London
https://www.uclh.nhs.uk/OurServices/Consultants/Pages/MrDavidRalph.aspx
Possibly the highest Volume implant surgeon in the U.K. - some have indicated a higher satisfaction rate among patients that see him privately rather than through the NHS

Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

2Oldfords

    Would you consider Dr. L D knoll, Nashville Tn. for your list?
Age - 65
Peyronies of unknown length of time
70 Deg curve 10-11 o'clock
first 2 uro's offer for xiaflex and referral
incision/grafting 12/18/18, Implant 9/11/20

Alibaba

I have no idea how many implants he does a year. I do know he is a straight shooter that tells it like he sees it and will spend whatever time is needed to discuss the issues. Doctor James Rybak in Belleville Illinois. Not only did he show my wife and I the AMS LGX and the Titan side by side and explain the differences and why I should have had a Titan to start with, he told us that so many things were wrong with my implant that I should see a doctor with more skill than he had. Doctor Eid was the top on his list he suggested. Very few doctors are that sincere with a patient. When local doctors refused to see me for follow-up, he said no problem. He didn't care who did my implant, he would still do follow-up care if I needed it. A truly nice guy.   St. Louis Missouri urologists have a very bad reputation of being complete assholes.  I know many who have and have seen many there. Most of us end up going out of state for implant surgery because of their petty bickering and quackerie.   St. Louis has 2 good medical schools but the urology departments are a train wreck.  Belleville Illinois is just across the river.   I would recommend Doctor Rybak to anyone and at the very least, he would be a fair, honest first assessment.   

Rybak is one of Levine of Chicago's students but without the attitude of Levine. I have not doubt he learned some good skills but also knows his limitations experience wise or a least proceeds with caution. Cheers.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

csm101

I can confirm Dr Brock...He was my surgeon...his staff are the poster boy for professionalism and empathy

hope794

Anyone in Italy, as far as you know?
26 yo from Italy.
Peyronie's since abt 2014
Abt 20-25° bend, w/ a moderate twist to the left
Erectile Dysfunction for 4 years and getting worse
From pornstar-like to moderately depressed - still fighting for a solution.

Yardbird

Has anyone on the forum had any experience with Dr. Suh in Indianapolis, Indiana? Prononunced like 'duh'. I was originally sent to him by my first urologist to confirm my lump was benign, since I have a metastatic history. I was told that 'all he does is penises'. He jfelt the lump, said it was peyronies, said my only option was implant surgery. That's about all I know about him. Anybody have any experience with him?

Thanks.
Age 63
T1 diabetic. Scarring is circumferential, causing narrowed bendable erection & 1.5" length loss, and 70° bend to left. Also have bilateral Dupuytren's, bilateral Lederhosen's, and rt side adhesive capsulitis (had left side ten yrs ago).

Hawk

I don't think so.  I have not seen his name here.  I assume this is him https://www.urologyin.com/providers/ronald-s-suh-md-facs

I notice he is listed as prostate cancer and general urology as well.  That does not eliminate him but there are doctors who are more specialized.  I would want one who does over 100 per year.

Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Yardbird

Yes, that is him. He was pretty 'high speed' with the one appointment that I saw him. No test other than palpating the scarring. This was early in the scarring process, as the bend and narrowing hadn't even happened. This was actually at the point when the plaque had actually straightened my congenital curve. He said implants would be my only option. After seeing pentox on the forum, I recalled that he did prescribe it. However, I distinctly remember him telling me it was only to help with the pain and inflammation, as it was quite painful at the time. I had a drug interaction or contraindication that made pentox kind of iffy, so I just let it go, since he told me it WAS JUST FOR THE PAIN. Now, I know better, and holy crap. This guy is off the table, as he dropped the ball for me.

Thanks for looking him up and your opinion.
Age 63
T1 diabetic. Scarring is circumferential, causing narrowed bendable erection & 1.5" length loss, and 70° bend to left. Also have bilateral Dupuytren's, bilateral Lederhosen's, and rt side adhesive capsulitis (had left side ten yrs ago).

Bud luck

What about the Doctor from Brazil, Dr Egydio?
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My Erectile Dysfunction is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

Hawk

None of our members have ever used his services to be able to recommend him.  We do not recommend surgeons based on their own web pages or youtube videos.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

postrocker

Quote from: Hawk on December 17, 2020, 06:14:34 PM
Non of our members have ever used his services to be able to recommend him.  We do not recommend surgeons based on their own web pages or youtube videos.

Please correct me if I am mistaken, but I remember seeing the case of a member from Canada who travelled to Brazil to do with Dr. Egydio. He even posted pictures of his recovery process. No?
36yo
Congenital curvature plus injury during sex - dec.2019
Curve to the left increase plus pain ~35degrees - nov.2020
Pentox (400mgx3) + Cialis (2.5mg/day) + supplements - dec.2020
Traction - jan.2021 onwards (curve now ~22/25degrees)

Hawk

Hmmmmmmm!

If so I think it was a one-time post of someone I asked to post from another forum.  I will look when I get time.  If you find it first let me know.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

anon1986

Has any one used Dr Blick in Phoenix AZ? In one of his videos he references a recent year in which he did "130 to 140" implants, this would constitute high volume correct? I might plan a consultation with him but curious to see if any guys have experience with him
__________________________________
Developed 50° curve to the right at 33 years old, narrowing, mild Erectile Dysfunction
implanted at age 34, 3/2/2021, Titan 20 cm + 1 RTE
Dr. Hakky, ATL

mmiku

who are the best doctors in europe? and in Italy?

Hawk

Unfortunately, we have no reports out of Italy so I cannot answer that.

The only ones we have good reports for in Europe are:

Dr. Michael Fraser
Glasgow
Link ->Michael Fraser

Dr. David Ralph
London
https://www.uclh.nhs.uk/OurServices/Consultants/Pages/MrDavidRalph.aspx
Possibly the highest Volume implant surgeon in the U.K. - some have indicated a higher satisfaction rate among patients that see him privately rather than through the NHS
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Jack1909

The best surgeon in Italy is that one you don't pick...
31 yrs old
Severe congenital curvature. 3 straightening surgeries
Big lump/stitch w/ left deviation after 2012 surgery
Severe Erectile Dysfunction after last one in 2014. Still crooked
Slightly improved w/ shockwave therapy
Looks like only one side of my penis works

alejelq

in Italy we don't have as high a number of cases as in the USA, but I think the best is Doctor Diego Pozza, he has the highest number in Italy, besides I have seen many successful cases and satisfied people, and the photos and videos showed perfectly manicured penises both functionally and aesthetically. If I have to operate soon, I will definitely go to him.
26 years from Italy
Injury from Jelqing in 2018
Diagnosed with Peyronies disease in February 2021, after many visits and treatments.

alejelq

Another Italian doctor from whom I have heard many positive comments is Dr. Pescatori. Unfortunately I do not know if I will be able to have the operation outside Italy, but if I had to have the prosthesis (most likely within this year unfortunately), I would consider whether to go to Pozza or Pescatori.
26 years from Italy
Injury from Jelqing in 2018
Diagnosed with Peyronies disease in February 2021, after many visits and treatments.

Jack1909

I would never go to any of them, surgeons who install 20 implants per year.  Stay large with numbers...that's the best way to get complications. My story should warn anyone in here...especially italian people. 
31 yrs old
Severe congenital curvature. 3 straightening surgeries
Big lump/stitch w/ left deviation after 2012 surgery
Severe Erectile Dysfunction after last one in 2014. Still crooked
Slightly improved w/ shockwave therapy
Looks like only one side of my penis works

DJWinters

I did a brief google search on Dr. David Ralph (London) where members wrote:

"Possibly the highest Volume implant surgeon in the U.K. - some have indicated a higher satisfaction rate among patients that see him privately rather than through the NHS"

Dr. Ralph gets very bad reviews by 7 different guys on Google.  I do not have first hand knowledge, but the reviews were rather damning. 

Hawk

Can you post a link to the reviews you saw so we can see them in context with other reviews?
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Clamatoislife

I didn't see any Texas docs on the list. Any insight if there are any in Texas worth their salt?
Started with mild Erectile Dysfunction in my 30's and progressed from there.
diagnosed with Erectile Dysfunction in 2012 and diagnosed with Peyronies Disease (hourglassing) in 2018
Tried staxyn first (awful) moved to 5mg Cialis, Pentox 3x daily,  L-Arginine  1000mg. Seriously considering IPP
Married

Benraycamp0

@Clamatoislife:

Dr. Clavell in Houston, Texas! - https://houstonmenshealth.com/
We've had 2 members get implanted by him I believe - you can search "clavell" on the search bar on the forum to find the posts.
26 years old. 20 degree upward curve with slight clockwise twist. Symptoms onset Dec 20.
Dr. Levine says it's not Peyronie's Disease but a slow healing wound. Saw him Mar 21 and May 21.
Traction (PMP) and supplements per Dr. Levine's recommendation.

TPat

Are there anymore doctors in NY that be added to this list? Thanks
Age 53, Peyronies diagnosed 5 years ago
Went through a cycle of Verapamil and Xiaflex and used traction. Curvature is upwards and I have lost length and substantnial girth
Bothers me tremendously. I want implants and length and width back

Hawk

Why would you want more doctors in New York when arguably the best implant surgeon in the world is in NY??
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

westerntown

20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe Erectile Dysfunction- floppy unstable erections that feel like water balloon .

Hawk

I have read your posts.  I don't think you are interested in a close surgeon who does implants.  You are interested in the best surgeon who does implants.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

westerntown

Hahah the professor has spoken
20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe Erectile Dysfunction- floppy unstable erections that feel like water balloon .

Henry1953

Does anyone have any recommendations for high volume surgeons near the Portland, Oregon area who specialize in Peyronies symptoms and surgical procedures? I like my urologist but he's relatively young and I can't find his statistics online. I'm halfway through the 12 week Restorex run with no visible changes to my curvature or decreased length yet. Thanks!
68 years old. 
Curvature started Jan 2021.
35-40 degrees to the left.

DJWinters

Does anyone know of any high volume implant surgeons in Southern California?  I live in Switzerland and will visit southern California to see family in November 2021.  My urologist here only does about 3-4 implants a year, so I'm skeptical of his experience. 

Hawk

I would be far more than skeptical.   A high-volume surgeon does that many a day.

Did you look at the 1st post on this topic?  It shows Dr. Karpman in San Francisco.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

JB999

If it helps, Karpman is in the South Bay, south of San Francisco, so a little closer to so cal.
59 years old. 
1st pain from Peyronies Nov 2019
Curvature started Jan 2020.  45 degree upward w/ narrowing
10/26/21 Dr. Karpman, excision/grafting surgery - Titan implant

Henry1953

How do I go about finding the best male health surgeons in my area who have a successful track record performing various surgeries related to Peyronies? Medicare doesn't show any listings other than general urology, and I haven't been able to find anything online. Any advice would be most appreciated.
68 years old. 
Curvature started Jan 2021.
35-40 degrees to the left.

Hawk

The only way I know of is through this forum's surgeon's list and asking specific questions on the forum.  You can check a surgeon through various sites that rank them by patient evaluations and malpractice suits but not by surgery. 

Your best bet is to find a surgeon who specializes in only 2 or 3 surgeries with good results.  When it comes to your only penis, it is worth it to travel if necessary to a good surgeon.

I see you joined 3 1/2 months ago.  I have not noticed many posts.  Have you discussed your situation, general location, etc. on the forum?
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Henry1953

Thanks for the information in your reply, as well as from your many other posts.

I got Peyronies Disease in January 2021. I was told by my first urologist to take lots of vitamin E and wait 6 months before I came back, and it probably would be healed by then on its own. After a bit of research I decided to find a new and better informed urologist. My new urologist referred me to Restorex, as I indicated I wanted to start with a more conservative treatment first before jumping into plication, incisions, implants, etc. I started Restorex three months ago. After 4 weeks I started to get blisters and a possible genital wart, probably due to the self adhesive tape. My urologist put me on Imiquimod and it cleared everything up. At this time I can have intercourse, and that's with a 90% erection and a 30 degree curvature. I just started Restorex again today and hopefully will be able to complete the full three month treatment without any further issues. I'm hoping that at the end of three months I won't have to have any type of corrective surgery, but if I do, I'll just do some due diligence on high-volume and successful surgeons. If does get to that point, I'm currently leaning towards Dr. Karpman in California, as he appears to be pretty highly rated and isn't that far from my location.
68 years old. 
Curvature started Jan 2021.
35-40 degrees to the left.

JB999

Henry, if it means anything, if/when you do decide, Karpman is fantastic.  Highly recommend him
59 years old. 
1st pain from Peyronies Nov 2019
Curvature started Jan 2020.  45 degree upward w/ narrowing
10/26/21 Dr. Karpman, excision/grafting surgery - Titan implant

Henry1953

Thanks for the tip. So far I'm halfway through my Restorex run and the results are promising. As soon as I'm done I'll write up my opinion on how it went, but so far so good.
68 years old. 
Curvature started Jan 2021.
35-40 degrees to the left.

DJWinters

Quote from: Hawk on May 17, 2021, 04:00:23 PM
Can you post a link to the reviews you saw so we can see them in context with other reviews?

Sorry for such a long delay in responding to your request for the Google reference.  I don't visit this forum that regularly.  go to google and enter Dr. Ralph UK urologist and his name pops up with only 6 Google references, none of them good, mostly in reference to his personality.  I have no experience with this surgeon so take the Google references at face value only. (https://www.google.com/search?q=dr.+ralph+uk+urologist&sxsrf=ALiCzsaHQuM1twF6kIDPpOEOFk771asZUA%3A1657265136582&source=hp&ei=8NvHYoHsHob-a_LkrtAM&iflsig=AJiK0e8AAAAAYsfqADzMUNORK2_ngpLwo59QUCRfBHjL&oq=Dr.+Ra&gs_lcp=Cgdnd3Mtd2l6EAMYADIECCMQJzIFCAAQywEyBQguEMsBMgUILhDLATILCC4Q1AIQyQMQywEyBQgAEMsBMgUIABDLATILCC4QxwEQrwEQywEyBQgAEMsBMgUILhDLAToLCC4QgAQQxwEQ0QM6CwguEIAEEMcBEKMCOgUIABCABDoECAAQQzoHCC4Q1AIQQzoECC4QQzoICC4QgAQQ1AI6CgguEIAEEIcCEBQ6CggAEIAEEIcCEBQ6BQguEIAEUABY-QZg-BBoAHAAeACAAW2IAe0EkgEDMi40mAEAoAEB&sclient=gws-wiz)

DJWinters

Quote from: alejelq on March 29, 2021, 06:49:36 AM
Another Italian doctor from whom I have heard many positive comments is Dr. Pescatori. Unfortunately I do not know if I will be able to have the operation outside Italy, but if I had to have the prosthesis (most likely within this year unfortunately), I would consider whether to go to Pozza or Pescatori.

In a brief search for Dr. Pescatori, I see four Dr. Pescatoris in Italy.  Can you say in which city this person operates in order to narrow down the search?

Bud luck

 Anyone had an implant with Dr Ralph in London?
My first symptoms started early in 2019
I tried Traction device, Pentofixiline, Q10, TRT, L-Argenine, cialis
I have narrowing/dent/hinge on the left side of my shaft
My Erectile Dysfunction is getting worse
Had a PRP shot Aug 2021
I have a girlfriend
Age 46

Hawk

Yes, look at the Implant index at the top of that board and scan the journal index.  Surgeons are listed.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Clamatoislife

Would Dr. Leroy Jones in San Antonio, TX be considered a high volume implanter?
Started with mild Erectile Dysfunction in my 30's and progressed from there.
diagnosed with Erectile Dysfunction in 2012 and diagnosed with Peyronies Disease (hourglassing) in 2018
Tried staxyn first (awful) moved to 5mg Cialis, Pentox 3x daily,  L-Arginine  1000mg. Seriously considering IPP
Married

Hrvat21

Is Serbia's Dr. Djinovic considered a high level implant surgeon? He talks about giving back lost size and even enhancement of penis during implant procedure. He is very close nearby, so what is opinion about him around here?

Dent4ever

Question for the vets,

I have read that Dr Faysal Yafi of UCI in CA, is supposed to be very good. Ive seen in several posters signature they used him. Would anyone be able to comment on his volume? I don't mind traveling but he is on the younger side and local to me should I run into problems down the line.

Thank you!
Age 41. Onset of mild hourglass 2010 semi erect. No progression until 2022. Slight pain & hourglass when flaccid. Considering Titan due to on/off Erectile Dysfunction for years.

LWillisjr

Actually I have not seen much posted about this doctor posted on this forum.
Developed peyronies 2007 - 70 degree dorsal
Traction/MEDs/Injections/Surgery 2008
66y/o  14 years Peyronies free
[URL="[url="http://www.peyroniesforum.net/index.php/topic,895.0.html"]http://www.peyroniesforum.net/index.php/topic,895.0.html[/url]"]My History

IwillbeatPD

I've definitely heard of him, Dent, but don't know much otherwise. I do also feel the same about finding a doctor who has some time left. I hear Dr EID is great but he's also pretty old. I'm cautious about that because with age, hands can be less steady, not as sharp, etc. Respectfully, I'm just not trying to catch someone right before they retire. I'd rather get someone in their prime who's incredibly sharp.
36/Male/No underlying conditions: Symptoms began Sep 2022. Indentation mid-shaft right next to plaque. Mediocre erections with hinge effect. Taking Pentox 400mg 3x/day, Tadalafil 5mg daily, L-arginine, using heat, manual traction and VED.

Dent4ever

Thanks for your responses, that's my thoughts as well _IwillbeatPD. when it does come time for a revision, considering my age, it would be easier to have the same doc handle it. Eid would be my #1 choice but I've heard so much about him retiring soon. Ive seen a few signature lines with his name in it and most seem to be happy.

Also Ive heard some very well known personalities got implanted by him, hope I'm not breaking any rules saying that
Age 41. Onset of mild hourglass 2010 semi erect. No progression until 2022. Slight pain & hourglass when flaccid. Considering Titan due to on/off Erectile Dysfunction for years.