Quite a Journey

[hopeful_future]

I just made an appointment with one of the leading doctors for implants, so I was writing up a reference sheet for myself (and for him if he wants it). While going through it, I was kind of floored by the number of things I've tried over the years, never managing to figure out the right solution. I'm still not 100% sure I want to go the implant route, but I'm finally at the point of considering it.

Here's the sheet:

Scale for Reference: 0-10 scale, where 0 is completely flaccid and deflated (cold shower), and 10 is extremely rigid. Around a 7 would be capable of penetration.

Describe the issue: Lifelong moderate to severe erectile dysfunction. Very low percentage of successful penetration in attempted sexual situations (around 10%). PDE5 inhibitors bring that up to about 30%. Erection can be maintained at a 5-8 with direct mental and physical stimulation, but deflates (to 1-3) within 10-20 seconds. PDE5 inhibitors bring the deflated hardness to 3-5 but do not allow for consistent penetration or make erections last longer. Orgasm can be reached through oral or manual stimulation, but erection fluctuates through the entire experience (usually between 4-7). Erection at an 8 or 9 for about 10-20 seconds before orgasm. Orgasms are good quality, if somewhat delayed.

Despite desire for penetrative sex, only have managed a handful of times in a few decades, despite numerous sexual encounters.

Goal: Determine whether there is a structural issue causing this erectile dysfunction. Discuss treatment options. Get a diagnosis that may at least allow insurance to cover medication.

When did erectile dysfunction start: There has never been a period of my life that erectile dysfunction was not present. My first sexual experiences, I was unable to get an erection or reach orgasm.

Treatments attempted:

Viagra - Got a prescription for viagra at 18. Produced an erection that allowed penetration a few times over several years. Improved erections, but not enough for penetrative sex. Have used up to 200mg in a single dose, as well as mixing with Cialis. Vision changes and headache as side effects.

Cialis - Got a prescription for Cialis in my 20s. Have tried both 5mg every day and 20mg as needed. Similar results to viagra in terms of results. Stuffy nose and headache as side effects. A bit more annoying since it lasts for days. Have used up to 40mg in a single dose, as well as mixed with Viagra.

Levitra - Tried a few times from samples. Severe headache and some body ache. Side effects were bad enough that I wasn’t able to have sex.

Bromocriptine - After going through an endocrinologist, mild elevation of prolactin was found, along with low-normal testosterone. Testosterone was not out of range, and checks for prolactinoma were negative. A short course of bromocriptine produced no results on erectile quality despite lowering prolactin into normal range.

Varicocele Embolization - Significant varicocele was present on the left side of the scrotum. Embolization surgery was used to correct it. Varicocele was successfully reduced, but no affect on hormone levels or erectile function.

Abstinence from Orgasm/Masturbation/Porn - Went through 90 days avoiding orgasm, stimulation via porn, and masturbation. Improvement in sex drive, but no affect on erectile function. Was able to reach orgasm quickly.

Psychological Therapy - Spent a year in therapy with an AASECT certified sex therapist. No improvement in erectile function, but some reduced frustration, anxiety, and depression associated with sex and my ED.

Muse - Urologist offered a sample of Muse. This was extremely painful to administer (due to smallish penile opening). Mild engorgement of the penis occurred with no rigidity. A severe ache spread through the entire groin area and persisted for about 20-30 minutes.

Trimix (papaverine, phentolamine, and prostaglandin) - Men’s clinic offered trimix. Shot was painless. Produced mild engorgement along with the previous severe ache. The clinician seemed confused, and gave another dose of just prostaglandin. The ache increased, but the erection did not improve.

Testosterone Replacement Therapy - My testosterone has been on the low side of normal (but not out of range) for several years. A men’s clinic has put me on a TRT regimen to bring me to high-normal (their original protocol put me above the normal range, so I had it reduced). I am approximately a year into TRT treatment (with aromatase inhibitors for estrogen and HCG to prevent testicular atrophy). Sex drive improved, morning erections are more frequent and slightly improved, but still not strong enough for penetration, and they do not last for very long. No improvement in erectile function in sexual encounters.

[hopeful_future]

I guess there are a few other things that aren't directly related, but are probably at least partially due to my frustration with my erectile function.

Fitness Training - I have done crossfit, powerlifting, running, cycling, and all manner of physical activity in part to attempt to improve my erectile function. It has been great for my self confidence and self image. Honestly, I think I would have been crushed under the frustration and shame over my ED if I hadn't built myself into a hottie.

Diet - I have done keto, low fat diets, slow carb, vegetarian (that didn't last long), and total replacement diets (Huel). I've tried cutting caffeine (the horror) for months, quitting sugar, cutting wheat/gluten, low-FODMAP, no dairy, etc, etc...Nothing helped with erectile function, but some things helped with my IBS (which is a quite literal pain in the ass). Also helped me get really good at staying in shape.

Not sure if I would have gone as far down the rabbit hole in either of these things if not for my compulsion to improve my ED, so I guess maybe it's a bit of a silver lining?

[Hunchback]

The things we do to get a hard dick... Sad :/

How many times have you tried the injections? My experience is very varied with injections, sometimes they work, sometimes they don't... Mostly the later.
If you haven't had at least 10 shots, i'd suggest giving it some more tries, it might work well for you in the end.

[silver daddy 1960]

Also with injections I found that I was allergic to Bi-Mix(per the Doctor), thus the pain in dick and groin. I went to Bi-Mix with great results, little to no pain and great orgasms with penetrative sex. Your list looks just like mine, except I don't see the vacuum pump (VED). Good luck with the doctor.

[silver daddy 1960]

Sorry I started with Tri-mix which hurt and went to Bi-mix - sorry for the typo

[vajim1]

I had to slowly inject trimix and that reduced or stopped the pian. Do you find sex with women or men give you better erections?

[Azib92]

My advice to you.
Stop torturing urself. Decades of missed opportunities in life.
Do you want your life back? Get an implant. No more questions. No more wondering. On demand erections. Please your partners whenever you want for as long as you want (better than any natural guy)
And also. Please get a good surgeon and do it right! No matter the cost.
Dr. Kramer is the best and you should really opt for him.