Biohacking Kompakt

Treatment & Procedure

Low-intensity shockwave therapy (Li-ESWT)

Biohacking

In low-intensity shockwave therapy, a device delivers weak acoustic wave pulses to the penis from the outside. It is supposed to make new blood vessels grow and thus address the cause of vasculogenic erectile dysfunction, instead of merely bridging it for a few hours like a tablet. In the biohacking scene it is also offered to men without symptoms as prevention or performance enhancement. There are no data for that; for erectile dysfunction itself there is a small, measurable effect.

In short

The Cochrane analysis of 21 randomized trials with 1,357 men found a short-term improvement of 3.89 points on the erectile function scale compared with sham treatment, just below the threshold of 4 points at which men notice a difference; after more than three months it was 5.25 points, with low certainty. The European Association of Urology gives the treatment a weak recommendation, for mild vasculogenic erectile dysfunction and for men who do not want tablets or respond poorly to them. A different, higher-dose shockwave therapy is covered by statutory health insurance in Germany for heel pain.

What it is and how it is supposed to work

Shockwaves are short, high-energy acoustic pulses. At higher energy they are used in orthopedics, among other fields, for example for heel pain. For erectile dysfunction, low energy is used; the device is applied at several points on the penile shaft and corpora cavernosa, usually over several weeks with several sessions.

The rationale comes from animal experiments: in diabetic rats, repeated shockwaves improved erectile function and partly restored nerve fibers, the inner lining of the vessels and smooth muscle in the penis, accompanied by more of the body’s own stem cells in the tissue (Qiu 2013). This gave rise to the idea of a regenerative treatment. In humans, this remodeling has not been shown: a meta-analysis found no differences from control in the vascular measurements on ultrasound (Cayan 2026).

What is well supported

There are more than 20 sham-controlled randomized trials, which is a lot for a device-based procedure. Pooled, erectile function improved in the short term and, with fewer trials, also after more than three months. Erection hardness increased by just over one point on the hardness scale. Side effects were no more frequent than with sham.

This is the basis for the weak recommendation in the EAU guideline, with or without PDE5 inhibitors such as tadalafil or sildenafil: for mild vasculogenic erectile dysfunction, as an alternative for well-informed men who do not want or cannot tolerate tablets, and for a poor response to PDE5 inhibitors.

What the studies show

Cochrane 2025 – 21 RCTs against sham treatment

1,357 men between 39 and 65 years of age, mostly with mild to moderate erectile dysfunction. In the short term, up to three months, the IIEF-EF erectile score was 3.89 points higher than with sham (15 trials, 937 men); the authors set the noticeable threshold at 4 points. After more than three months it was 5.25 points (5 trials, 276 men). Hardness rose in the short term by 1.06 points on the four-point scale. Dropouts and side effects did not differ. The certainty of all results is low, mainly because of inconsistent and imprecise data.

You 2026 – treatment protocols

19 randomized trials. Erectile scores improved significantly after one, three and six months, but most trials did not reach the clinically meaningful difference. More frequent sessions and more pulses per course were associated with a better response; a superior protocol could not be determined. The authors’ conclusion: whether the treatment brings a noticeable benefit is currently open.

Cayan 2026 – erectile scores and vessels

12 randomized trials. The IIEF-5 and IIEF-EF questionnaire scores rose more than in the control group. Hardness scale, diary questions on sexual intercourse, global satisfaction and the blood flow values on Doppler ultrasound did not differ. The authors see no reason for routine use.

Zhou 2026 – after prostate removal

5 randomized trials with 297 patients. After 8 and 12 weeks, erectile scores were 2.8 and 2.1 points higher than in the control group; at 24 weeks and later there was no longer any difference.

Where the data stop

On average, the effect lies at the threshold of what men notice, and the trials differ greatly: electrohydraulic, electromagnetic and piezoelectric devices, different energies, pulse counts and session schedules. No trial participant was treated for longer than three months, and data on the satisfaction of men and their partners are missing entirely.

For use in men without erectile dysfunction, as prevention, for stronger erections or as rejuvenation, there is not a single study; the Cochrane analysis included only men with erectile dysfunction. The regenerative mechanism has not been demonstrated in humans either; the blood flow values on ultrasound did not change.

Status, approval and legal

The EAU guideline on sexual and reproductive health gives a weak recommendation for certain men with vasculogenic erectile dysfunction. For erectile dysfunction, shockwave therapy is a self-pay service in Germany.

Heel pain is different: since the decision of the Federal Joint Committee (G-BA) of April 19, 2018, extracorporeal shockwave therapy for plantar fasciitis can be provided on an outpatient basis at the expense of statutory health insurance if the pain has restricted activity for at least six months and conservative measures such as stretching exercises and insoles have not helped, with up to three sessions per foot, performed by orthopedists or specialists in physical and rehabilitative medicine.

Safety

In the randomized trials, treatment-related side effects were no more frequent with shockwaves than with sham, in the short term as in the long term. However, the data cover only months, and the treatment duration was never longer than three months.

Erectile dysfunction can be caused by vascular disease, diabetes or hormonal factors. This clarification belongs before any treatment, including before a course of shockwave therapy.

BK-Score Supported, with caveats

Human evidence6
Mechanism4
Safety data6
Hype gap4
Track record of use6

Evidence 6, because 21 sham-controlled randomized trials with 1,357 men are available that, pooled, show 3.89 more points on the erectile function scale in the short term, just below the noticeable threshold of 4 points, with low certainty and great inconsistency between protocols. Mechanism 4, because the formation of new blood vessels comes from animal experiments and a meta-analysis in humans found no change in blood flow values on ultrasound. Safety 6, because side effects in 20 trials were no more frequent than with sham, but the data cover only months. Hype 4, because the treatment is marketed as a cure or rejuvenation and offered to men without symptoms, for which there is no study. Use 6, because shockwaves are established in orthopedics, have been covered by statutory health insurance in Germany for heel pain since 2018, and have been offered for years as a self-pay service for erectile dysfunction. Direction mixed.

The score rates the state of knowledge, not the substance. “Safety data 9” means well studied – not harmless. “Track record of use 9” means used long and widely – that is not proof of efficacy.
Subjective assessment by Biohacking Kompakt based on published scoring rules – not a scientific rating and not a medical recommendation. Rules and all ratings (German)

Frequently asked questions about shockwave therapy

Does shockwave therapy help with erectile dysfunction?

In 21 sham-controlled trials, erectile function improved in the short term by just under 4 points on the erectile function scale, at the threshold of what men notice. After more than three months the difference was somewhat larger, but the data are uncertain.

For whom does the guideline recommend shockwave therapy?

The EAU guideline gives a weak recommendation for mild vasculogenic erectile dysfunction, as an alternative for well-informed men who do not want or cannot tolerate tablets, and for men who respond poorly to PDE5 inhibitors.

Does the shockwave replace tablets such as sildenafil or tadalafil?

Not demonstrably. The effects of the shockwave are smaller than the well-supported effects of PDE5 inhibitors. The guideline sees it as an option with or without tablets, not as an equivalent replacement.

Does shockwave therapy do anything without erectile dysfunction?

There is no study on this. All studies included men with erectile dysfunction. No benefit has been studied for prevention, stronger erections or rejuvenation in healthy men.

Does health insurance pay for shockwave therapy?

Not for erectile dysfunction; there it is a self-pay service. For heel pain caused by plantar fasciitis, shockwave therapy has been covered by statutory health insurance since the G-BA decision of 2018, provided the pain has persisted for at least six months and other measures have not helped.

Does shockwave therapy have side effects?

In the studies, side effects were no more frequent than with sham treatment. Long-term data covering more than a few months are lacking. More important is to have the cause of erectile dysfunction clarified by a doctor beforehand.

Related

Sources

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Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-10-07.