Erectile dysfunction (ED) is the inability to gain and maintain an erection. There’s no shame in having it, but thankfully, multiple effective treatment options are available.

One of the available treatments options are oral ED medications. Oral ED medications may help with symptoms of ED including poor erections and decreased sexual function.

In order to optimize your sexual performance and provide longer-lasting benefits which oral medications may not be able to achieve, Dr. Truong and the Truong Rehabilitation Center also offers the P-Shot – a cutting edge sexual enhancement procedure. 

To learn more about these ED treatment options, read on below or contact us online.

Blue Steel for ED

Blue Steel is a combination of both Tadalafil and Apomorphine. The medication is a one-two punch that addresses both the physical and mental aspects of erections respectfully.

By stimulating the genitals and relaxing the brain, Blue Steel may be a better combination than Tadalafil or Viagra alone.

Blue Steel is a troche – you place the small lozenges under your tongue, which bypass the stomach and are absorbed systemically and directly into the bloodstream. It may be the utmost productive form of oral medication application available.

Tadalafil (Cialis)

Also known as Cialis, Tadalafil works by preventing the action of the chemical phosphodiesterase type 5. Tadalafil helps to relax and widen blood vessels, helps blood flow into the penis, and thus may help you maintain an erection.

The medication may only work if you are sexually aroused. It may take 1-2 hours for you to experience Tadalafil’s full effects, potentially helping to encourage spontaneous sexual activity.

Tadalafil results may be longer-lasting than other ED treatments like Viagra, providing you with a 36-hour period of achievable erections.

Side effects of taking Tadalafil may include:

  • Abnormal vision in a small number of patients

  • Back and muscle pain (usually appearing within 12-24 hours and disappearing within 48 hours)

  • Flushing

  • Headache

  • Indigestion

  • Stuffy nose

A serious but rare side effect that requires immediate medical attention is priapism (painful, prolonged erections).

Do not take nitrates like nitroglycerin tablets or patches with Tadalafil, as the combination may lower blood pressure and cause fainting. Do not take Tadalafil if you have the following conditions:

  • Heart failure

  • Heart pains (angina)

  • Recent heart attacks or stroke

  • Retinal eye problems

  • Severe liver disease

  • Uncontrolled blood pressure

  • Uncontrolled, irregular heartbeats


When applied under the tongue (sublingually), low and controlled doses of Apomorphine are used to help those with ED receive and maintain a painless erection.

Apomorphine stimulates dopamine receptor sites (often D (2)) within the brain involved in sexual function. Apomorphine aims to calm the brain to allow getting an erection easier and to help with performance anxiety. Apomorphine for ED may be beneficial for men who don’t respond to PDE5 inhibitors for erectile dysfunction.

Apomorphine typically starts working about a half-hour after administration. You may notice heightened success with each dose, and it may take several doses before you notice effects – Dr. Truong will work with you throughout the process.

Side effects include:

  • Lightheadedness from low blood pressure

  • Prolonged erection (priapism); requires immediate medical attention

  • Stuffy nose

  • Upset stomach

P-Shot Sexual Performance Optimization

Though not an oral protocol for ED, Dr. Truong provides Priapus Shot (P-shot) injections as a possible means of optimizing your performance.

The P-Shot may encourage the growth of new blood vessels, which might result in better sensitivity and powerful erections while also potentially enhancing the size of the penis.

The main ingredient of the P-Shot is platelet-rich plasma (PRP). The growth factors released from the concentrated platelets in PRP aid in soft tissue cell and blood vessel regeneration. During your 45-minute-or-less appointment, Dr. Truong will prepare the PRP by spinning a sample of your blood in a centrifuge.

The P-Shot aims to provide long-lasting erectile dysfunction symptom relief. You may see positive changes within days after your injection and full effects after a month that last for 2 years. Dr. Truong will discuss with you how frequently you’ll need the treatment.

Silver Steel

If you tried all the medications for ED without results, you have not tried Silver Steel. Our patients who failed typical tadalafil or sildenafil have a great response to Silver Steel. Silver Steel is unlike any medications for ED.

Silver Steel is the best of three medicine combined into one powerful medication with a unique delivery pathway that bypasses stomach absorption which will affect effectiveness.

Silver Steel has tadalafil, sildenafil, and apomorphine all in one medication. The medication is made as a troche, it is a small lozenge that dissolves between the cheek and gum over a period of about 15 minutes. As it dissolves, the hormones are gradually absorbed into the bloodstream, resulting in physiologically natural hormone blood levels. The effectiveness of Silver Steel is not dependent on what you eat.

Combining the short-acting sildenafil gives you a fast onset erection within an hour, the apomorphine puts you in the mood, and long acting tadalafil increases the activity of sildenafil to give you a head start to getting an erection and maintaining it for a longer duration. The troche can be only taken once a day 1 hour before activity.

Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection.

Sildenafil may cause side effects such as:

  • Changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green)

  • Diarrhea

  • Difficulty falling asleep or staying asleep

  • Erections lasting more than 4 hours

  • Flushing (feeling of warmth)

  • Headache

  • Heartburn

  • Muscle aches

  • Nosebleeds

  • Numbness, burning or tingling in the arms, hands, feet, or legs

  • Sensitivity to light

Dr. Truong will evaluate you for any medical contraindications and will prescribe a customize dosage for you.

It’s a WIN-WIN-WIN medication!

Request Your Appointment Today!

To request your appointment, please call (540) 374-3164 or contact us online today!

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Rehabilitation Medicine Physicians
4604 Spotsylvania Parkway, Suite 303
Fredericksburg, VA 22408

Phone: (540) 374-3164

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