Some urologists do consider Trimix, and other injectables, as first line treatment (penile rehab).

Insurance companies, however, seem less inclined to cover the compounded injectables (trimix, bimix, quad mix) for ED (not rehab); although some (like tricare) do cover the injectables Caverject and Edex.

The pills and trimix are two different things. They can both be considered first line. The pills work on blood flow in the area, to help you heal. I've been told often that the pills are useful to recover the nerves, and in some cases actually help them reconnect. Trimix clamps off the return of the blood and causes an erection.

Two different potential objectives.

My doc prescribed both. Pills to hopefully help in some nerve recovery (both sides were taken) and blood flow, Trimix to do the deed.

Trimix is also helpful to blast out any internal buildup (like plaque in arteries), which can make even a natural erection more difficult.