Need Advice

[Flame885]

Hi all, I am new to this website but been reading through different topics and seems to be a good place to ask for advice. I am 36 yrs old (6'2'') living in orange county, married and have 2 kids. I have suffered from ed since mid 20's and never thought that I would have an actual physical problem . I got married 6 yrs ago and since day one , I have experienced ed . I went to different urolgists and they said nothing wrong physically . It is all in your head. My testosterone level will alway be around 300 , which they told me is normal. I never enjoyed sex as I was worried about my performance during intercouse. I was give cialis 5mg daily to help. It worked for a while. Now I cannot get an erection without using cialis and sometimes I dont get erection at all with it . I also tried viagra, same as cialis . Also, when it worked, i will lose it within few minutes. This has damaged my relationship with my wife. So I finally decided to see a urologist that specialized in implants. He ran full horome tests and found the total testosterone to be 311, all other hormones where within normal range. He told me that this is within normal range but based on my age and size , this is considered low. He prescribed clomid 25 mg daily for 3 months. He also did a doppler ultrasound for my penis and found that blood flow to the penis on one side is low causing soft erections. I was happy because I was able to understand my problems. I started hitting the gym to lift weights and lose weight. I also have anxiety performance due to facing this issue for many years. I have asked my doctor about implants and been educating myself . The thing with implants is once you go with it , you cannot go back. I dont like the idea of injections or shockwave therapy. I feel that implants is the best way to fix this issue but wanted to see what you guys think since lots of people here have been down the same road .
Thanks ,

[abhishek26]

Hi all, I am new to this website but been reading through different topics and seems to be a good place to ask for advice. I am 36 yrs old (6'2'') living in orange county, married and have 2 kids. I have suffered from ed since mid 20's and never thought that I would have an actual physical problem . I got married 6 yrs ago and since day one , I have experienced ed . I went to different urolgists and they said nothing wrong physically . It is all in your head. My testosterone level will alway be around 300 , which they told me is normal. I never enjoyed sex as I was worried about my performance during intercouse. I was give cialis 5mg daily to help. It worked for a while. Now I cannot get an erection without using cialis and sometimes I dont get erection at all with it . I also tried viagra, same as cialis . Also, when it worked, i will lose it within few minutes. This has damaged my relationship with my wife. So I finally decided to see a urologist that specialized in implants. He ran full horome tests and found the total testosterone to be 311, all other hormones where within normal range. He told me that this is within normal range but based on my age and size , this is considered low. He prescribed clomid 25 mg daily for 3 months. He also did a doppler ultrasound for my penis and found that blood flow to the penis on one side is low causing soft erections. I was happy because I was able to understand my problems. I started hitting the gym to lift weights and lose weight. I also have anxiety performance due to facing this issue for many years. I have asked my doctor about implants and been educating myself . The thing with implants is once you go with it , you cannot go back. I dont like the idea of injections or shockwave therapy. I feel that implants is the best way to fix this issue but wanted to see what you guys think since lots of people here have been down the same road .
Thanks ,

welcome to the forum, brother! can you please share your doppler ultrasound test results if you don't mind? I can understand your inclination towards getting an implant. for many folks, it is the right and quite amazing, life-changing decision. let's make sure it's the right decision for you as well.

[Flavio]

[...] I was give cialis 5mg daily to help. It worked for a while. Now I cannot get an erection without using cialis and sometimes I dont get erection at all with it . [...]

I'm not a huge fan of daily Cialis. I tried it for a while but there were side effects and no visible improvements, zero efficacy.

I also tried a lower dose (100 mg) of Cialis as needed and it didn't work either, I had to take the max dose (200 mg).

Now that Cialis has stopped working for me, I have changed to udenafil and I am very happy with the results.

I suggest you do the same and try all available solutions before having an implant.

Yes, implants are excellent but irreversible.

[Txagq8]

I would not be so quick to dismiss the idea of injections and jump on the implant train. They sound a lot worse than they are. Nobody likes the idea of sticking a needle in his dick. Until you do it, discover it’s actually pretty easy, and get a raging hard on that lasts.

I injected more or less successfully for 34 years. They didn’t have pills (viagra, cialis) when I started. When the pills came out, I found out that giving myself a shot worked better and the pills gave me reflux and a splitting headache. When the shots started to lose effectiveness, I was able to go a bit longer before implanting by using pills plus shots.

For the type of ED you describe in your post the medication in a shot sounds ideal. Your doc can monitor you to make sure you aren’t scarring or developing fibrosis. Trust me when I say it sounds a lot worse than actually doing it.

And, if later on you end up like me and the shots aren’t helping, you still have the option to implant. Or if you try it for a year or two and feel like it’s not providing you a satisfactory sex life, you still have the option to implant.

I don’t know enough about shock wave to say yea or nay, I never tried it, with me it was never a viable option. Don’t get me wrong, I love the implant and it works better for me than anything else ever has. But I do not regret having tried other remedies before getting one.

[Leebert]

I agree ! I exhausted all the options before I decided it was enough. I cringed at thought of injecting my dick. I read alot in here and new what i had to do, so got a script, went to uro and he gave me the syringe and i did it ! Hardly even felt it. Implant is the end of the journey with ED.

[68CatFan]

I didn't like the idea of injections either but all it took was one injection and after two hours of acrobatic sex I changed my mind.

[Martin6469]

Flame: If libido is low I would see an endocrinologist for another opinion about possible low testosterone. The normal range is about 260-1100 depending on the doc you talk to. If I get down to 300 I'm starting to have problems; 450-500 is right for me.

You can see other FT guys' levels in several testosterone topics in the forum.

[tomas1]

I agree with many of the respondents that suggest injections.
It's the next step and may postpone going to the final frontier.
I'd also recommend testosterone therapy.

[Flame885]

Thank you all for the replies. As for the testosterone, if clomid doesnt bring it up, then will go with trt. As for injections, I will ask my doctor for some to try it. Thanks again.

[Simbarn]

He ran full horome tests and found the total testosterone to be 311, all other hormones where within normal range. He told me that this is within normal range but based on my age and size , this is considered low. He prescribed clomid 25 mg daily for 3 months.

You have had some great replies.
Your T level seems to be an issue here and may or may not be the direct or indirect cause of your ED.

I have only one thing to add seeing as you may be about to embark on the long journey of HRT: Do some research yourself on Enclomiphene citrate. It is the better, safer form of Clomiphene citrate (Clomid) for use in males. Your doctor has put you on Clomid to try and improve and maintain natural testosterone production and also keep all the “upstream” hormones (LH, FSH and GNRH) in place as well. This is always preferable to a life on TRT. I suspect he is considering doing this for the short term and then slowly stopping the therapy, hoping the higher T level will stick. Sometimes this does not work.
Clomiphene citrate (Clomid) is made up of two parts: Enclomiphene and Zuclomiphene.
Sexual function can be all over the place when on testosterone replacement in young men. It may do nothing to help your erectile function as it causes the shutdown of other hormones that contribute to the whole process of sexual function. This in itself can cause issues with erectile function.

Enclomiphene citrate is the single isomer version of Clomid. Clomid can cause many side effects in men, hence why it is not good to use for long periods and it can also make erectile function worse due to the estrogenic like effects it can also cause. This can inhibit erectile function in some men, not all. Which is predominately caused by the “Zuclomiphene” part in Clomid. Excessive estrogen receptor agonism (stimulation) is not desirable for good sexual function in the male.

There are compounding pharmacy’s in the US that are now making Enclomiphene citrate, so it is possible to get the drug. It has a long history with a company called Repros Therapeutics of whom tried to get it passed as Androxal.
It will only work if you have secondary hypogonadism, in cases where the pituitary needs a little nudge to produce higher levels or LH and FSH, typically in cases where T levels are borderline low like yours. In some men this may need to be long-term therapy as their pituitary will simply revert back to the lower level when the drug is stopped. When this happens with Clomid, the doctor usually puts you on T replacement. Enclomiphene (Androxal) could have been the solution for this, as it is better to use on a permanent basis for the reasons of fewer side effects and that sexual function actually works much better for a higher percentile of men whilst they are actually taking the drug.
Here is one pharmacy I found that is compounding it in the US:
https://tailormadecompounding.com/
https://imcwc.com/wp-content/uploads/20 ... atalog.pdf

Defy medical also appear to have access to it:
https://www.defymedical.com/

If I was able to get Enclomiphene in my country being Australia, I would certainly give this a try so that I did not have to be on Testosterone replacement. Unfortunately no one is compounding it here.
The other possible alternative use for this is alongside TRT, to keep the testes functioning and some LH and FSH in the system. Some doctors don’t think you need this to function well sexually. But let me tell you as someone who has experienced this in my own body for many years, T replacement does not work as well as our natural system. This is why experienced doctors will put you on HCG (Pregnyl or Ovidrel) with exogenous testosterone, so as to try and compensate for the loss of upstream hormones (These are the doctors who understand hormone replacement better than the rest.)
LH is an important hormone in the body, shutting it down does have consequences. T replacement for the most part shuts it down.

For older males in their 60’s and 70’s reading this, Enclomiphene citrate used as a solitary form of HRT, may not work, for the simple reason of aging. The testicles have aged and may not be capable of producing a higher amount of T and the pituitary may also not be very responsive. T replacement is the only option for this age group and often yields a satisfactory result especially when combined with the IC injections such as Trimix (testosterone rarely does anything to improve erectile function in older men, mainly libido).

If it were me, I would try the above and if need be IC penis injections (for persistent ED) before considering an implant. Nothing beats what we were born with, even if an injection is needed to give a helping hand. As you are in a relationship with someone this can worked out so as to not be an issue with your sex life and the result may actually surprise you as has been mentioned by many others.

If you need more information about HRT and my experience with it (over 20 years) don’t hesitate to ask.