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Hello,

I have ED of unknown nature but assuming its psychogenic mostly but I believe I might have a chemical imbalance centrally! I might have some blood flow issues possibly because I have a very large penis but when flaccid it shrivels up substantially?

I do not respond to just PDE5i medications although they do increase hardness but thats my form of ED, I can get super hard and finish by manual or oral stimulation just I lose my erection with vaginal/anal intercourse? Its horrible actually but im currently trying to systematically fix this issue because im very good looking and get girls so easy but then I fail a lot which thankfully they are usually really cool about it.

Current regimen is 60mg tadalafil, 200mg sildenafil and 1.5mg pt 141 subq. It works almost perfect sometimes and if the sides didn't get too horrible I would increase the pt 141 but as is I want to replace it!

Im currently waiting for apomorphine and phentolamine to arrive which I plan to use and I also ordered pure vardenafil because I have read reports that some respond to it better? I also am going to try yohimbine as my alpha2 blocker first before the phentolamine just to see if it works the same? I plan to stack some of these things together.

My approach is to try a dopamine agonist like apomorphine with a pde5i and an alpha2 blocker in a stack and see how that works!!

Im hoping somehow the vardenafil in salvage doses like say 80mg will work on its own. That would make me so happy instead of these crazy stacks I have to take. I hate how high salvage doses of pde5i make me feel except tadalafil which for me has zero sides but also seems to almost have zero effect unless I stack it with sildenafil?

Anyways just wanted to say hi and hopefully contribute to this board with some scientific information that in my quest to end my ED I have obtained!!!

Welcome to the forum, Lorentzianmanifold.

That is quite a lot of pharmacology to balance. My mind is reeling. I am happy you have the wherewithal to keep it all straight. Your screen name suggests you do and can sort out any cross-effects and do the variable analysis. Well chosen.

You suggest that you may have psychogenic or brain chemistry issues as well. I know little of how to treat those issues, but if those may be the source, I would venture the guess that addressing them might be physically healthier?

I look forward to your contributions and news of your eventual success.

Have you tried adding cock rings to your mix? It might help you reduce the need for some of the other stuff.

bldoink wrote:Have you tried adding cock rings to your mix? It might help you reduce the need for some of the other stuff.

I have with limited success? I still within a few minutes of thrusting get softer and softer and its so irritating? I can be rock hard and be good for the first 30s but then I can feel it get softer and softer over the next few minutes until its no longer good enough for sex. I can pull out and get hard again and continue that way but its disappointing for both of us?
.
I was having near complete success with PT141, in fact if I bear the side effects of say 3mg of it I am rock hard for hours and love i. Problem is I went from having zero sides to having debilitating sides over 1.5mg??

Sucks thought I found my solution and ordered 15 bottles of it lol. I am hoping that if vardenafil doesn't work maybe apomorphine which works on the dopamine pathways similar to PT141 though without MC4 activation but??

Lost Sheep wrote:Welcome to the forum, Lorentzianmanifold.

That is quite a lot of pharmacology to balance. My mind is reeling. I am happy you have the wherewithal to keep it all straight. Your screen name suggests you do and can sort out any cross-effects and do the variable analysis. Well chosen.

You suggest that you may have psychogenic or brain chemistry issues as well. I know little of how to treat those issues, but if those may be the source, I would venture the guess that addressing them might be physically healthier?

I look forward to your contributions and news of your eventual success.

I have addressed what I can but maybe some of my ED is performance anxiety fears maybe but I do believe I have an organic cause too. I have hypertension and I am currently taking an ARB lorsatan which actually has indications it helps with ED as well be blocking angiotensin!!

I have one other pharmacological avenue to explore which is the serotonin system, it seems HT2 C receptor antagonists might be a possible route for erectile response?

You are a LOT better educated in chemistry than I am.

Lorentzianmanifold wrote:
I have ED of unknown nature but assuming its psychogenic mostly but I believe I might have a chemical imbalance centrally! I might have some blood flow issues possibly because I have a very large penis but when flaccid it shrivels up substantially?

When did your erection issues start?

Has your penis always reduced in size to that degree when flaccid as your describe “ when flaccid it shrivels up substantially?” Or is this a new thing? Some penis’s do reduce in size dramatically when flaccid and others stay quite large. It’s quite normal.

If you are trying to reduce adrenergic sensitivity in the penis an A1 blocker may be more effective than an A2. For some males a combination of both works even better such as Phentolamine.
Trimix works so well because it has phentolamine in its mixture as well as vasodilators. It is targeting both adrenergic receptors(blocking them) and also directly targeting smooth muscle in the erectile tissues and cavernosal arteries causing them to relax and dilate respectively. The fact that it is administered locally means it has an even greater effect and is not felt as systemically as if it were an oral preparation.
Trying to find a medication that can alleviate excessive sympathetic function in the penis is not easy. We are almost limited to an A1 blocker such as Alfuzosin or Terazosin. Or there as an oral form of Phentolamine; Phentolamine mesylate, however the side effects of this can be quite uncomfortable due to it being in an oral form (its effects can be felt through the whole body rather than when injected directly into the penis). Or we have phentolamine as mentioned above which is part of the Trimix injection.

I am interested in your problem as I have a similar one. I also can maintain an erection more easily during foreplay sex (with the help of Tadalafil), However if I am having penetrative sex, if I approach ejaculation a couple of times and then hold off I can lose my erection and it is sometimes almost impossible for me to get it back. I have found I need to relax, take a shower and perhaps wait half an hour.
I have been trying to understand what processes may be at work here. There is no doubt a psychogenic element to this, however, I also feel there is a considerable physiological element to it as well.
I have discovered that just before the point of ejaculation the male body has a rise in norepinephrine, before orgasm. This rise is norepinephrine could also be occurring within the erectile tissues or it could be circulating to these tissues. In a male with normal adrenergic sensitivity in the penis this may not have much of a negative effect on erectile performance. However, if a male has increased adrenergic expression or sensitivity in the penis, I have hypothesised that this increase may cause problems. It could also be the case that during coital activity, anxiety’s about being able to remain hard may also be at a heightened level which further inhibits erectile ability through increases in sympathetic activity, not only in the penis but also in the rest of the body. Once this process is activated, it may take time to clear these chemicals from the body.

It has been suggested by recent research that sensitivity in the penis to the forces that keep the penis in a flaccid state during the day become exaggerated as we age. That is; sympathetic function in the penis increases in middle age. I also believe that some men are born with a susceptibility to be affected by this at an earlier age. This cohort of men, would IMO be far more likely to suffer with performance anxiety issues. They would also be more likely to be affected by various drugs or medications which can increase sympathetic activity in the body or penis such as party drugs and even coffee.
A simple test for this could be too see how one or two cups of coffee can affect erectile performance. For myself, coffee significantly lowers my ability to get a firm erection, even when Tadalafil is in my system. When I was in my twenties, coffee did not affect my erections at all.
I have also found a very low dose of Valium if taken nightly also significantly improves my erectile function for 24 hours. The combination of Tadalafil and Valium is working on the two basic elements or forces in the penis. Tadalafil enhancing the NO pathway and Valium is inhibiting the adrenergic pathway. Unfortunately Valium is not a good long term solution due to its addictive potential and its propensity to lose effectiveness over time owing to it being a benzo.
There are basically two biological forces working in the erectile tissues. Pro erectile forces and Pro flaccidity forces. We are designed in such a way that the pro flaccidity forces have the edge over the other. Otherwise we would be walking around with an erection most of the time! As we age the forces which maintain flaccidity appear to become more dominant. When we are a teenager they are IMO almost equal. The slightest brush against the penis will initiate a strong erection that will not want to go away and often causes embarrassment for the young male experiencing it. This is the perfect example of sympathetic function in the penis working in the correct balance with the NO pathway. This delicate balance could become disrupted by many health conditions in the body such as an autonomic nervous system dysfunction, anxiety disorders and aging as we discussed.

Lorentzianmanifold wrote:Hello,

I have ED of unknown nature but assuming its psychogenic mostly but I believe I might have a chemical imbalance centrally! I might have some blood flow issues possibly because I have a very large penis but when flaccid it shrivels up substantially?

I do not respond to just PDE5i medications although they do increase hardness but thats my form of ED, I can get super hard and finish by manual or oral stimulation just I lose my erection with vaginal/anal intercourse? Its horrible actually but im currently trying to systematically fix this issue because im very good looking and get girls so easy but then I fail a lot which thankfully they are usually really cool about it.

Current regimen is 60mg tadalafil, 200mg sildenafil and 1.5mg pt 141 subq. It works almost perfect sometimes and if the sides didn't get too horrible I would increase the pt 141 but as is I want to replace it!

Im currently waiting for apomorphine and phentolamine to arrive which I plan to use and I also ordered pure vardenafil because I have read reports that some respond to it better? I also am going to try yohimbine as my alpha2 blocker first before the phentolamine just to see if it works the same? I plan to stack some of these things together.

My approach is to try a dopamine agonist like apomorphine with a pde5i and an alpha2 blocker in a stack and see how that works!!

Im hoping somehow the vardenafil in salvage doses like say 80mg will work on its own. That would make me so happy instead of these crazy stacks I have to take. I hate how high salvage doses of pde5i make me feel except tadalafil which for me has zero sides but also seems to almost have zero effect unless I stack it with sildenafil?

Anyways just wanted to say hi and hopefully contribute to this board with some scientific information that in my quest to end my ED I have obtained!!!

I have a similar situation like you Mathematician. However, I am not good at pharmaceutical stuff you mentioned on your post as you. I have used 25mg Sildenafil with rock hard boners even the next day, but after several years all of a sudden I went from 10 to 2. Then I got Cialis 20 mg/every 2-3 days, and got mixed results. Sometimes, I get perfect erections for sex, but sometimes I just got erection and right before/during the intercourse I start loosing it. I used vardenafil a few times, but it had 0 effect with severe sides. My next hope is Avanafil... It is the last PDE5i medication in the field. It is a little expensive, but I heard better things about it.

Let's keep in touch and try to figure this out!

Yikes, my head is spinning. I gather this is a pharmacological puzzle and challenge, but I recall my SE of 100 mg Viagra were horrible and then it finally gave out. Even 5 mg of Cialis for PT now makes me pretty stuffy and my eyes scratchy now. Is it perhaps time for injections?? They really aren't that bad.

On a side note, I did some research on PT141 after the mention above, several YT's and articles. https://www.youtube.com/watch?v=rNWUsEV9-Uk

I noted a connection between melatonin-melanotan-PT141 peptides-tanning-desire. And so I have a question for your experts here. We take a 2 month beach trip every year. I get very tan after 2-3 weeks even with SPF.Outside 8 hours a day doing various beach things. Time in the water surfing and on the beach. AND, I get impossibly horny. I've always attributed it to the abundance of nubile bodies in skimpy thongs and to some degree of boredom not being home with the usual distractions. But could it be that the very process of tanning releases "the stuff" that makes me horny? Just asking. Thanks.

BTW< I've been working on some size, girth especially (shaft now 5.5" circum head 6.2" circum). See my post on that if interested but it sounds like you are fine. I've been working on the penises cardiovascular development tyrying to reduce the injection amount of PGE and reduce DE. A bigger unit takes more blood for sure and better blood flow especially with leakage. Have you considered some PT to augment more naturally the bigger units demand?