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The ARBOUR Difference — What No Other Practice in SE Michigan Offers
Most medspas offer P-Shot and O-Shot as line items alongside Botox and facials. At ARBOUR, sexual wellness is assessed as what it actually is: a complex intersection of hormonal, vascular, neurological, and psychological factors. Gandhi Bhattarai is the only triple board-certified clinician in SE Michigan who addresses all four dimensions simultaneously.
Four dimensions most providers miss
What this means for your outcome
Each program is assessed individually at consultation. Most patients benefit from a coordinated approach across multiple programs — your clinician designs the sequence based on your specific anatomy, lab results, and goals.
P-Shot® · CMA Licensed
PRP + LiSWT + Botox + Fillers · Coordinated Sequence
The most clinically comprehensive male sexual wellness program available in SE Michigan. PRP regenerates erectile tissue. LiSWT restores vascular function. The combination produces IIEF improvement of 8.2 — published evidence. Available as standalone P-Shot or full four-step program.
O-Shot® · CMA Licensed
PRP · Clitoral + Anterior Vaginal Wall
PRP-based tissue regeneration for improved arousal, orgasmic function, lubrication, and stress urinary incontinence. Assessed within the hormonal context — estrogen optimization dramatically amplifies outcomes. 86% Worth It Rating on RealSelf from published patient reviews.
Peptide Support
Neurological Desire Activation · Men & Women
PT-141 activates melanocortin receptors in the brain — addressing desire at the neurological level. Kisspeptin stimulates the hypothalamic-pituitary-gonadal axis, amplifying endogenous testosterone and LH production. Together, the most comprehensive libido support available without pharmaceutical intervention.
"I've been dealing with ED for years. I tried every medication. The P-Shot at ARBOUR — combined with addressing my testosterone and doing the shockwave protocol — was the first thing that actually addressed the problem instead of just masking it."
"After my second child, intimacy was just different. Less sensation, less desire, and I'd accepted that as the new normal. The O-Shot — and getting my hormones sorted at the same time — brought me back. I wish I'd done this years ago."
"Gandhi was the first clinician who treated this as a complete medical concern — not just a shot and a goodbye. She looked at my testosterone, my stress levels, everything. The PT-141 and the hormonal work together changed things meaningfully."
Questions Patients Ask — Answered Honestly
Completely. Your records are held with the same legal protections as any medical record under HIPAA. The consultation, the treatment, and the follow-up are private. No employer, no family member, no insurer receives this information without your explicit written consent. Many of ARBOUR's sexual wellness patients are professionals, executives, and public figures who cannot have this information disclosed — and it never is.
PDE5 inhibitors like Viagra and Cialis temporarily increase blood flow to the penis by inhibiting the enzyme that degrades cGMP. They work acutely but do nothing to address the underlying endothelial dysfunction, neurological deficit, or vascular compromise that causes ED in the first place. The P-Shot delivers concentrated platelet-derived growth factors — VEGF, PDGF, TGF-β — directly into erectile tissue, stimulating new blood vessel formation, nerve regeneration, and tissue remodeling. The goal is restoration of physiological function, not temporary pharmacological augmentation. LiSWT amplifies this by mechanically stimulating neovascularization. The combination produces durable improvement — not a pill you need to take before every encounter.
The honest answer: the evidence for the O-Shot is promising but still emerging. A 2023 systematic review concluded the evidence base needs more randomized controlled trials. Existing studies — including a Brazil pilot study of 68 women with 94% reporting satisfaction — and published case series show meaningful improvements in lubrication, arousal, orgasmic function, and stress urinary incontinence. A 2021 study reported orgasm scores more than doubled after treatment. At ARBOUR, the O-Shot is offered with clinical honesty about what the evidence shows — it is not presented as a guarantee, but as a well-tolerated regenerative intervention with meaningful patient-reported outcomes in the existing literature. The key variable that most O-Shot providers miss: hormonal optimization. Estrogen-replete tissue responds dramatically differently to PRP than atrophied, estrogen-deficient tissue. ARBOUR assesses this before every O-Shot.
PT-141 (bremelanotide) is the same compound as Vyleesi, which is FDA-approved for hypoactive sexual desire disorder (HSDD) in premenopausal women. At ARBOUR, PT-141 is dispensed as a compounded peptide — which is significantly more cost-effective than the brand-name Vyleesi — pricing discussed at consultation. Its use in men for low libido and ED is off-label — this is disclosed and discussed at consultation. PT-141 works differently from any other sexual wellness treatment: it acts on melanocortin receptors in the brain, stimulating desire neurologically rather than through blood flow. It can be used by both men and women, takes effect in 30–45 minutes, and effects last up to 72 hours.
Both procedures use topical numbing cream applied 30–45 minutes before treatment, and a local anesthetic block for the P-Shot specifically. Most patients describe the sensation as significantly less than they expected. The blood draw is the same as any lab draw. The injection itself is brief. Post-procedure, mild soreness lasting 1–3 days is common for the P-Shot. The O-Shot typically involves minimal post-procedure discomfort. ProNox (nitrous oxide) is available for patients with significant procedural anxiety.
Because the outcome of your PRP treatment depends substantially on the hormonal environment of the tissue being treated. Testosterone directly influences the density and responsiveness of erectile tissue. Estrogen governs vaginal tissue thickness, receptor sensitivity, and lubrication capacity. A P-Shot delivered into testosterone-deficient tissue generates a fraction of the growth factor response of the same treatment in hormonally optimized tissue. The same is true for the O-Shot. At ARBOUR, this is not an upsell — it's a clinical imperative. Most sexual wellness patients benefit meaningfully from addressing the hormonal foundation before or alongside their regenerative treatments.
Thu 2–7pm · Fri–Sun 10am–7pm · By Appointment Only · 2217 Packard St #15, Ann Arbor MI 48104 48104
The ARBOUR Male Enhancement Sequence — Four Steps, One Program
Each step is clinically independent — you can begin at any point. The full sequence produces outcomes that no single treatment achieves alone.
Foundation
Testosterone, estradiol, thyroid, metabolic panel. Hormonal optimization before PRP creates a tissue environment that responds maximally to growth factors. The most important step most patients skip.
Core Program
PRP regenerates erectile tissue from within. LiSWT restores vascular function by stimulating neovascularization. Published combination IIEF improvement: 8.2 — the highest reported for any non-surgical intervention.
Enhancement
Off-label penile Botox relaxes smooth muscle to improve arterial inflow and reduce venous leakage — addressing the haemodynamic component of ED that PRP and LiSWT don't target directly. Disclosed at consultation.
Augmentation
Dermal filler for penile girth enhancement — a distinct aesthetic goal from ED treatment. Assessed separately. Requires specific anatomy, realistic expectations, and thorough consent. Not appropriate for all patients.
P-Shot® · CMA Licensed Provider
"You've tried the medication. It works, technically. But you want something that addresses why this started in the first place — not something you need to plan around."
The P-Shot® delivers concentrated platelet-rich plasma — drawn from your own blood, processed to 5–8× normal platelet concentration — directly into the corpus cavernosum and the head of the penis. The growth factors released (VEGF, PDGF, TGF-β, EGF) initiate a cascade: new capillary formation, nerve fiber regeneration, smooth muscle remodeling, and collagen production within the tissue that drives erectile function.
The mechanism is regenerative, not symptomatic. A PDE5 inhibitor asks dysfunctional tissue to perform better temporarily. The P-Shot asks that tissue to rebuild. Results develop progressively over 8–12 weeks as the biological response completes. For optimal outcomes, ARBOUR uses a series of up to 3 treatments — spaced 4–6 weeks apart — as taught in CMA training. Annual or biannual maintenance treatments sustain and build on the initial series result.
Indicated for: ED (vasculogenic, diabetic-related, post-prostatectomy), Peyronie's disease, penile sensitivity loss, performance optimization in hormonally healthy men.
Published Clinical Evidence — P-Shot® / PRP for ED
1
Preparation
Topical numbing cream applied. Local penile nerve block administered. Blood drawn from arm.
2
Processing
Blood centrifuged to 5–8× platelet concentration. FDA-approved separation system. 30 minutes.
3
Injection
PRP injected into corpus cavernosum and glans. Comfortable with nerve block. 5–10 minutes.
4
Recovery
Resume normal activity same day. Sexual activity after 4–7 days. Full response at 8–12 weeks.
LiSWT · Low-Intensity Shockwave Therapy · Vasculogenic ED
"If ED has a vascular component — and it does in most men over 40 — LiSWT is the only non-surgical treatment that addresses the underlying mechanism rather than compensating for it."
LiSWT delivers focused low-energy acoustic waves to the penile tissue — mechanically stimulating angiogenic growth factors and initiating neovascularization within the corpus cavernosum. The result: new capillary formation, improved arterial inflow, and restored endothelial function. The mechanism is identical to how LiSWT is used to stimulate bone and tendon healing — applied to vascular tissue.
A 2024 long-term randomized sham-controlled trial demonstrated statistically significant IIEF improvement at both 1 and 2 years post-treatment — the most durable non-surgical ED data published to date. The combination with P-Shot® produces the highest published improvement in erectile function of any non-surgical protocol: IIEF mean difference of 8.2 vs. 3.4 for LiSWT alone and 3.2 for PRP alone.
LiSWT + PRP Combination — The Highest-Evidence Protocol
Peyronie's Disease — A Specific P-Shot® Indication
Peyronie's disease — fibrotic scar tissue (plaque) in the tunica albuginea causing painful curvature and erectile impairment — has historically required surgical intervention or repeated collagenase injections for meaningful correction.
PRP offers a non-surgical alternative with meaningful published evidence. A 2023 prospective cohort study reported mean curvature reduction of 16–17 degrees, pain during intercourse decreased by 34–39% (VAS), and IIEF improvement of 50–61% following a PRP series. A 2025 large-cohort study (Dachille et al.) confirmed that PRP intra-plaque injections rapidly reduce penile curvature and improve sexual function.
ARBOUR's approach: PRP series (2–3 treatments spaced 4–6 weeks) combined with hormonal optimization and, where appropriate, LiSWT to support the tissue remodeling response. Most appropriate for stable Peyronie's — active-phase disease requires assessment before treatment.
Peyronie's Disease Evidence
Thu 2–7pm · Fri–Sun 10am–7pm · By Appointment Only
O-Shot® · CMA Licensed Provider
"After my second child — after menopause — intimacy just felt different. Less. I'd accepted it. I didn't know there was a clinical option until I came here."
The O-Shot® delivers PRP to two specific anatomical locations: the clitoris and the anterior vaginal wall (near the Skene's gland and urethral opening). The growth factors — VEGF, PDGF, TGF-β — stimulate angiogenesis (new capillary formation), collagen production, and nerve regeneration in the tissue responsible for arousal, lubrication, and orgasm.
The clinical mechanisms: increased clitoral blood flow → improved engorgement and sensitivity. Anterior vaginal wall regeneration → improved lubrication, reduced dyspareunia, and structural support for stress urinary incontinence. The results develop over 6–12 weeks. Series of up to 3 sessions recommended, spaced 4–8 weeks apart — consistent with CMA protocol. Annual or biannual maintenance based on individual response and hormonal status.
The ARBOUR difference: estrogen directly governs the tissue receptor sensitivity that determines how dramatically PRP can stimulate regeneration. Low-estrogen tissue responds modestly. Hormonally optimized tissue responds profoundly. Every O-Shot patient at ARBOUR has their hormonal status assessed before treatment — not as an upsell, but as a clinical determinant of outcome.
Published Evidence — O-Shot® / PRP Female Sexual Wellness
1
Preparation
Topical numbing cream. Blood drawn from arm. 30–45 minutes numbing. Completely comfortable.
2
Processing
Blood centrifuged. PRP separated and activated. FDA-approved system. Ready in 20 minutes.
3
Injection
PRP injected into clitoris and anterior vaginal wall. Minimal discomfort with numbing. 10 minutes.
4
Recovery
Return to normal activity immediately. Results develop over 6–12 weeks. Series of up to 3 sessions, spaced 4–8 weeks apart, for full program benefit. Annual or biannual maintenance based on response.
Stress Urinary Incontinence · O-Shot® Application
"The leaking when you laugh, sneeze, or exercise. It's not something you talk about. It's also not something you should simply accept."
Stress urinary incontinence — involuntary urine leakage during physical activity, sneezing, coughing, or exercise — affects approximately 35% of women and is dramatically underreported. The O-Shot® addresses this through PRP-stimulated collagen production and structural tissue support at the urethral sphincter and anterior vaginal wall.
Published evidence: a 2021 prospective study (Athanasiou et al., Female Pelvic Med Reconstr Surg) showed significant SUI improvement. Multiple cohort studies report 90%+ patient satisfaction for SUI improvement at 1–6 months post-treatment. ARBOUR assesses SUI as part of the complete women's sexual wellness consultation — not as a separate billing category.
Why Hormonal Optimization Changes Everything for the O-Shot®
Estrogen governs the density of estrogen receptors in vaginal and clitoral tissue — which directly determines how powerfully growth factors can stimulate regeneration when PRP is applied. In an estrogen-deficient state (perimenopause, menopause, postpartum, or OCP-induced), tissue is atrophied, receptor density is reduced, and PRP produces a muted response.
In an estrogen-optimized state, tissue is well-vascularized, receptor-dense, and primed for the regenerative stimulus that PRP provides. The outcome differential is not marginal — it is the difference between modest improvement and meaningful transformation.
At ARBOUR, every O-Shot patient receives a hormonal assessment before treatment. If estrogen optimization is indicated, ARBOUR can provide that through its hormone program simultaneously with the O-Shot preparation — producing a coordinated approach that no medspa offering O-Shot as a standalone procedure can match.
What changes with hormonal optimization
Thu 2–7pm · Fri–Sun 10am–7pm · By Appointment Only
Bremelanotide · Brand Name: Vyleesi®
Mechanism: Melanocortin receptor agonist (MC3R, MC4R). Acts centrally on the CNS — not on blood flow. FDA-approved for HSDD in premenopausal women. Off-label use in men for low libido and ED.
Unlike Viagra or Cialis — which work on blood vessels — PT-141 works on your brain. It activates melanocortin receptors in the hypothalamus that govern the neurological pathway for sexual arousal and desire. It doesn't require physical stimulation to initiate its effect. It initiates the desire response itself.
Effects: onset 30–45 minutes post-subcutaneous injection. Duration: up to 72 hours. Effective for both men and women. Particularly valuable for patients with primarily psychological or neurological libido dysfunction — where vascular treatments produce limited results.
ARBOUR offers PT-141 as compounded bremelanotide — significantly more cost-effective than brand-name Vyleesi — pricing discussed at consultation. No telehealth markup. No subscription required.
Off-label disclosure: PT-141 is FDA-approved for HSDD in premenopausal women. Its use in men and postmenopausal women is off-label. This use is clinically assessed and fully disclosed at consultation.
Kisspeptin-10 · HPG Axis Activator
Mechanism: Neuropeptide activating kisspeptin receptors in the hypothalamus → stimulates GnRH pulse release → drives LH/FSH → amplifies endogenous testosterone production.
Kisspeptin addresses sexual function at the most upstream point possible: the hypothalamic-pituitary-gonadal axis. By stimulating pulsatile GnRH release, Kisspeptin amplifies the body's own testosterone production — without the HPG-axis suppression that exogenous testosterone causes. This makes it particularly valuable for younger patients, patients who want to preserve fertility, or those who want to improve endogenous function before committing to TRT.
For women, Kisspeptin modulates the hormonal axis that governs libido and arousal — independent of estrogen. It also supports the restoration of HPG function in women with hypothalamic amenorrhea or post-OCP hormonal disruption. The Kisspeptin + PT-141 stack addresses both the upstream hormonal dimension (Kisspeptin) and the central neurological desire pathway (PT-141) — the most comprehensive non-pharmaceutical approach to libido support available.
Amplifies endogenous testosterone. Addresses the hormonal axis. Produces gradual, sustained improvement in libido and energy over weeks. No acute effect.
Activates neurological desire pathway acutely. Rapid onset (30–45 min). Effects last up to 72 hours. No chronic hormonal foundation effect.
Kisspeptin builds the hormonal foundation. PT-141 activates desire acutely when needed. Chronic improvement + on-demand activation. The most complete libido program available without pharmaceutical intervention.
PT-141 · Pricing at consultation
Meta-analysis
Double-blind RCT
16 studies · 907 patients
Long-term RCT
Candidacy — Who These Treatments Are and Are Not Appropriate For
Appropriate candidates — P-Shot® / LiSWT
Appropriate candidates — O-Shot®
Contraindications and clinical cautions
Thu 2–7pm · Fri–Sun 10am–7pm · By Appointment Only · 2217 Packard St #15, Ann Arbor MI 48104
Regenerative medicine and aesthetic arts — where science meets the artistry of transformation. Beverly Hills, CA.
