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I have been suffering from ED since 25 years . I am in India and now 51 years old . I have been doing the rounds of urologists and doctors and am fed up as urology so far has offered me very little. No doubt the Tadalafil and Sildenafil have helped over the years . But I have to take higher and higher doses  and the desired outcomes are becoming lesser.
Recently I got a penile doppler done and Angio CT pelvic . The cause is clearly vascular--arterial insufficiency. The angio reveals that some of the arteries are 'diseased'.

All blood tests were also done.
Glycosylated Haemoglobin(Glyco Hb/HbA1c)---5.70
Fasting Blood Sugar(FBS) --97
Sex hormone binding globulin(SHBG)-- 43.64
Liver Profile -normal
Lipid Profile(mini) -normal HDL/cholo ratio 4.05
Prostate specific Antigen(PSA) Total plu --all normal but FPSA/TPSA ratio 0.18
Thyroid Profile Total T3 T4 TSH -normal
Testosterone Total -- 606
Free Testosterone ---9.50 (is this on low side)
Estradiol --48.21
Prolactin.--47.81
Vitamin D --8.00
IGF-1 -- 123

Urologists are divided on the cure. Some say penile implant is the only way out. Other one says ESWT + daily tadalafil 5 + vaccum pump + cernos gel +kegel.
My prolactin has been increasing from 29 ng/ml on 9th March to 47 on 30th March . I have started Cabergoline 0.25 twice a week. Some drs in fact say prolctin has nothing to do with my ED and no need to treat. other drs say treat .
.I don’t want to try ESWT conclude it does not work or has to be done every year and then go for implant finally.

After intensive research, I feel the implant is the best option. in India, there are v few implant surgeons. Would it lead to loss of sensation?

Any guidance from anyone about the road ahead would be appreciated.

Love my implant, at least since I've healed.
My thought is all those drugs they want you to take isn't good. As much as drugs worked for me for a while, I still ended up having to get the implant. If you have leakage it will only get worse. 25 years dealing with ED is not good for a man's ego. If I were in your shoes I'd tell the docs you don't want to take a bunch of drugs, and an implant is inevitable.

Go for implant! You could have loss of sensation, though it will usually return after the nerves recover.

Thanks to the two of you for your inputs. Yes, im def going in for it.In India, I dont have too many surgeons to choose from .

Good luck.

Be VERY careful about your choice of surgeons. Interview the surgeon thoroughly and get him/her to accept you as part of the medical care team and respect your concerns. Also try to interview former and current patients.

thanks--this is exactly what worries me. In India, choice is v ltd and all of them do the malleable most of the time. that culture of asking, interviewing does not exist--i dont know any of his patients

There is another user on this forum from India who got the 3 piece implant done, but I believe he traveled to the US for it and paid out of pocket

I think Wolfpacker is correct. You can do a search on him. I love my implant my sex life was given back to me. Very happy with the results.

subhash wrote:thanks--this is exactly what worries me. In India, choice is v ltd and all of them do the malleable most of the time. that culture of asking, interviewing does not exist--i dont know any of his patients

If the choices in India dissuade you from staying local and the U.S. is too expensive, there are options in other countries. Dr Kramer travelled to Turkey to teach the surgery, so there might be options there. You could write to Dr Kramer to ask advice about who to contact there. He is very helpful if you keep the communications short and to the point.

Britain is another option. The currency exchange rate may be helpful to make the cost affordable.

Thanks, all.
in times of the pandemic, travel does become awkward. I do travel to Thailand and malaysia often, so could look out there too.
Choice of surgeon v v v v imp