It is past time for me to write up my DIY experiences.  Spoiler alert: It’s working!

Each session:

Large applicator (about 41.3mm diameter); 90mJ energy; 3Hz.  I used ultrasound gel.

400 shocks at the base of the penis
500 shocks mid-shaft
500 shocks near the top, just below the glans
400 shocks applied to left side the glans (glans bent to the right), pointing applicator straight down.
400 shocks applied to right side of the glans (glans bent to the left) pointing applicator straight down.

Starting shocks at the bottom and working my way up tended to keep the slippery gel out of the way for most of the session.

All shocks were delivered with the penis stretched so it was under tension with the applicator very firmly pressed against it.   Shocks to the shaft were delivered with the applicator pointing away from my body.  With shocks to the glans I was attempting to deliver shocks right “down the pipe” (i.e., the corpora cavernosa) at a 90 degree angle to the first three sets of shocks.

No shocks were delivered to the crura.  I tried to avoid delivering shocks that might hit the prostate or other internal organs.  The short and long term effects of shocks to the prostate are unknown.  None of the ED shockwave studies has the slightest interest in finding out.  So my feeling is if you can get benefit and sidestep this unknown, you are better off.  Even if I didn’t have prostate cancer, I would want to avoid shocking internal organs in the genital area.

While delivering shocks to the glans I was also getting some shock in my index finger and thumb which were wrapped around the penis below the glans and providing tension to the penis.  I can see why studies avoid shocking the glans – special equipment would be needed to do this otherwise a technician would be shocking him or herself with each patient.  Also, for study purposes there could be a need for consideration of differences between circumcised and uncircumcised men.  However, I’m not running a study, these shocks seemed useful, and there were not enough shocks to bother my hand.

Background on my ED

My feeling is that my ED was due to more than one factor: Age, mild hypertension, a few extra pounds, as well as my prostate cancer (Gleason 6, non-aggressive, thankfully).  So my self-evaluation was that just slamming my penis with shockwaves was probably not going to get me maximum benefit.  It would take a whole training program with DIY shockwaves as the centerpiece.  Having the machine and the ritual of twice a week shocks was a mental boost providing support for changes in my diet and exercise.

My philosophy

Which brings up a point – the medical establishment categorizes pretty much every problem with a body as a “disease”, and the remedy as a “treatment.”  People who have participated in sports might look at a problem like ED and conclude the issue is the person (patient?) is out of shape and what’s needed is a training program.  My feeling is that depending on the nature of the ED, it could be one or the other, or some combination of both.
Doing bicep curls will cause growth of veins in the arms.  Bodybuilders have thick veins in their arms.  This takes years of work to achieve.  So the idea that six sessions with a shock wave machine reaches the limit of angiogenesis is laughable.  The studies that repeated six sessions after a three week break reported further patient improvement.  One of the studies I read speculated that a third round of six sessions might continue improvement, but the study protocol did not include this.

From what I can tell, the studies are paid for by equipment manufacturers.  They have an interest in successful study outcomes, but also in a treatment plan that is in an affordable price range.  There will be a lot fewer takers for a plan that costs say $12,000 than a $3,000 one.  Peak performance is not the goal – “just good enough” is perfect.
So it seems to me that we DIYers are hugely advantaged in that however long it takes to get whatever benefit we are after, there is no additional cost.  We are in training as well as treatment.

My self-evaluation was that as much as anything else, my body and private parts were out of shape so I needed a program to work on everything.

My program

After reading everything I could find and viewing many YouTube videos I arrived at some goals:

• Lose weight – both diet and exercise
• Increase the strength of my PC muscles
• Do shockwave sessions
• Relax, avoid stress

I adopted an “Intermittent fasting” diet.  I am eating two meals a day, about eight hours apart.  These are fairly large meals.  I am emphasizing protein and fats but not eliminating carbs.  I am seriously trying to cut down on sugar, which I have come to believe does serious damage – it’s a bit of a stretch for me to call it castration by cakes and cookies, but only a bit.  I’m walking 3 to 4 miles per day, and working out a couple of times per week.  Result: lost 8 pounds in 4 weeks.

PC exercises: Dr. Jennifer Berman teaches Conan male kegel exercises

https://www.youtube.com/watch?v=JJAZqDSa93o
Also:
https://www.wikihow.com/Do-PC-Muscle-Exercises

Thinking through my shockwave program

My program was informed by the research studies I read, plus my intuition, which I acknowledge could be totally wrong.  But considering the lack of information about shockwave therapy for ED, each of us has to make decisions that are, at best, just guesses.

HopefulID posted a link to an interesting study that used high speed imaging to analyze radial shock waves:

https://www.researchgate.net/publication/283305826_Radial_Shock_Wave_Devices_Generate_Cavitation

On page 9, there is:

“Both devices produced larger cavitation bubbles at 1 Hz than at 15 Hz, irrespective of the devices’energy settings.”

Figure 5 on page 11 shows the cavitation bubbles at these two settings.  Studying this figure went a long way to convincing me to use a low Hz setting.  At the higher Hz setting, it looks like the shocks are so rapid that they interfere with cavitation bubbles fully forming.

There is also intuition: shock waves are acoustic waves.  They reflect off of surfaces - the harder the surface, the better the reflection.  Also, surfaces that are struck can vibrate.  When struck, a guitar string or a drum will vibrate for some time.  However, if there is no tension (a loose guitar string) there will be very little, if any vibration.
While the ED studies describe number of shocks and frequencies which allows us to calculate the time of treatment, none of the studies considers time as a factor.  I think it’s possible – in fact likely – that the studies are all missing this boat. 

It seems to me that a treatment session that is three minutes likely has a different effect than one that is twelve or fifteen minutes if both sessions use the same number of shocks and energy setting.  The longer session uses a lower frequency.  If signal attenuation is slow enough, and the rate of reflection is high enough that there is no “dead”, non-beneficial period between each shock at the lower frequency then it seems likely to me that the longer time period session will provide more benefit.

My impression is that I was somewhat able to confirm this intuition.  Delivering shocks at low frequency (3Hz) while stretching the penis so it is under tension, my feeling was that shock signal bounces around between shocks.  Vibration seemed less evident with no penile tension.  I had to keep the applicator still to feel this.  Moving the applicator seemed counterproductive to getting a vibration going.

Several studies stated that higher frequencies were less painful for patients.  As far as I could tell, these studies also used focused shock waves.  Frankly, I don’t get using focused shock waves for ED.  Focused waves are used to break up kidney stones or other unwanted tissue.  I can understand that focused waves could be painful, but if it’s painful it may be killing tissue, and that’s certainly not what we want.  But if that’s the machine that pays the researcher, that’s what the researcher uses.  Scoundrels!

I tried as much as 120mJ with the largest applicator for my machine - slightly over 41mm diameter.  The only pain I felt was in my testicles when I applied the applicator at the base of my penis so the shocks went in that direction.  I quickly concluded this was not a good idea.  But I should note that I had no pain in the penis.  My research indicated that higher energy settings mean that shock waves penetrate deeper.   With 120mJ shocks appeared to zoom right through the penis and out the other side.  Probably this is not optimal.  So I backed energy down to 90mJ, and kept using the large applicator.

Treatment results

Do you remember the original Star Trek saying, “He’s dead, Jim?”  Immediately after my first treatment I looked down and that thought came to mind.  I exaggerate.  Somewhat.  The next day there was a bit of soreness, and my penis felt warm, as though there was some inflammation.  By two days after treatment there was no detectable soreness although the warmth was present.  There also seemed like there was a bit of a pulse down there.
This was the pattern that continued through three weeks and six sessions.  After four sessions I wondered if this was going to help – it wasn’t clear yet.  But after five sessions I got a sense that this could actually work.  A day after the sixth session I was sure.  Yeah, it worked.  I’m not like a twenty year old, but I’ve rolled back the clock at least twenty years.   I think every part of the program is helping, but the shocks really made it happen.

I’m in the between sessions period now and plan to go another six sessions after a three week break.