In middle aged men, blood vessel problems are the most common cause of ED (1)  - between 70 and 80% of non-psychogenic ED is due to atherosclerosis and vascular dysfunction. Because atherosclerosis in the arteries feeding the heart (“coronary artery disease” or “heart disease”), the brain (“carotid artery disease”) and the legs (“peripheral artery disease”) may only cause symptoms when advanced, ED is often the earliest sign of generalized vascular disease. (2,3)

In fact, Erectile Dysfunction is as big a risk factor for future cardiovascular events as smoking and family history of heart attacks (4). Besides being a predictor of future heart attack, stroke, and heart failure, the presence of ED can predict death from all causes (5).

HormoneSynergy® Men's Optimal Health and Sexual Performance Package

At HormoneSynergy we recognize that treating erectile dysfunction effectively means treating the CAUSE and not just the SYMPTOMS. This is why we now offer Men seeking treatment for erectile dysfunction a FREE "HormoneSynergy® Optimal Aging Assessment with the purchase of SIX (6) Shockwave Therapy Treatments (Six treatments is the standard recommendation for ED).

This assessment may be the most comprehensive evaluation of your health that you’ve ever received. This option includes:

  • Lab work consisting of hormone evaluation, advanced cardiovascular risk assessment, and if indicated, genetic tests to detect variants in genes that may influence aging, cardiovascular disease, dementia, and cancer risk. You will receive a written interpretation of all results.

    Hormone evaluation includes adrenal function (DHEA-S and cortisol), thyroid function (TSH, free T4, free T3, and thyroid antibodies if indicated), sex steroids (estradiol and testosterone), and pregnenolone. Additional hormones (progesterone, IGF-1, PTH, gonadotropins FSH, LH) are tested if indicated.

    A comprehensive metabolic panel, hemoglobin A1c, insulin level and HOMO-IR helps determine diabetes risk, liver health, kidney function, and electrolyte levels.

    Homocysteine, inflammatory markers (hsCRP, and Lp-PLA2 and MPO if indicated) aids in assessing methylation status, inflammation, and blood vessel health.

    State-of-the-art cardiovascular tests including advanced lipid tests (LDL-P, apoB, small dense LDL, HDL subpopulations, apoA-1, Lp(a)) are measured. If needed, cardiac muscle function is assessed by measuring cardiac troponin-T and NT-proBNP.

    Fatty acids, vitamin B12, vitamin D, Coenzyme Q10, iron, and other nutrients (based on individual need) are tested.

    Genetic tests may include ApoE genotype, MTHFR genotype, and with a history or concern of blood clots, prothrombin and factor V Leiden genotype. SLOCO1B1 may be ordered to screen for possible statin-induced myopathy.

  • Computerized, validated neurocognitive testing helps assess memory and brain function.

  • Written interpretation with treatment suggestions is provided at your initial appointment.

  • Brain system questionnaire (developed by Daniel Amen, MD) screens for neurotransmitter imbalances, attention deficit, and mood disorders and helps determine treatment approach.

  • Seca mBCA 515 Body Composition testing provides a highly accurate assessment of fat (including visceral or “belly” fat) and muscle percentages and basal metabolic rate (calories burned at rest). After age 30, many people lose 3% to 5% of their muscle mass per decade. Body composition testing provides a foundation to develop a plan to rebuild and maintain muscle.

  • Optimal aging questionnaire provides a thorough lifestyle evaluation with written recommendations

  • Full 1.5 hour consultation with Dr. Retzler to review all results, answer questions, discuss testosterone therapy, prescription medication and supplement options.

Optional Testing (additional fee)

  • VO2 Max to determine your aerobic fitness. VO2 max is considered one of the best indicators of your lung and cardiovascular health and endurance.

  • Coronary artery CT with calcium score is a non-invasive CT scan of the heart. It will calculate your risk of having or developing heart disease by measuring the amount of calcified (hard) plaque in the coronary arteries.

  • Carotid artery ultrasound with carotid intima media thickness measurement detects plaque and can assess arterial thickness (carotid intima media thickness or “CIMT”). The carotid arteries provide a “window” to the coronary arteries (the arteries that feed the heart) since carotid plaque >1.5 to 2.0 mm usually correlates with plaque in the coronary arteries. Carotid plaque and increased CIMT may indicate increased stroke and dementia risk.

Concierge Membership

Concierge medicine is a patient-focused relationship between a doctor and his or her patient where the patient pays a fee for improved access and high-quality, individualized medical care. With concierge care the focus is shifted away from a symptom management, disease maintenance approach toward a preventive, health-centered one.

You are NOT required to become a patient of our office to receive Shockwave Therapy. However, If you want Dr. Retzler to monitor your health care and prescribe hormones and / or medication you MUST be a HormoneSynergy Concierge Member of our practice.

Men who do become concierge members of the practice will receive 50% off all follow up Shockwave Therapy® treatments.

We can discuss this option with you during your Shockwave Therapy or following your Optimal Aging Assessment.


If you have certain commercial insurance (United Healthcare, Moda, BlueCross BlueShield, Pacific Source) or Medicare ADVANTAGE, initial laboratory testing can cost between $0 and $318 depending upon the testing ordered, your individual policy as well as your insurance deductible.

If you do not have insurance or you if you have Providence, Kaiser, Medicare, Medicare supplemental, Medicaid VA or TriCare, initial lab testing can cost $300 to $500. 

In order to provide individualized, comprehensive care, we do not participate with any health insurance companies. We do not bill insurance companies or accept reimbursement from any insurance companies, nor are we a Medicare provider. You may attempt reimbursement for office visits by submitting a health insurance claim form with diagnosis codes to your insurance company (we will provide and help fill out this form for you).

Please note: Dr. Retzler makes NO profit on lab testing. All lab fees due will be provided directly to the lab that processes them.



1 Feldman HA, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61.

2 Cheitlin M. Erectile dysfunction: the earliest sign of generalized vascular disease? J Am Col Cardiol. 2004;43(2):185-186.

3 Billups KL. Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res. 2005;17 Suppl 1:S1924.

4 Thompson IM, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002.

5 Böhm M, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ON TARGET/TRANSCEND) Trials. Circul. 2010;121(12):1423-46


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