FrankTalk.org

47 years old, married. ED has been checked out to make sure it's not diabetes/heart disease related. Lost 30 lbs and started running to get in even better cardiovascular shape (10% body fat....6' tall around 206 lbs, 31" waist). Lift moderately heavy for my age about 4 days a week....try to run at least that many days, sort of a HIIT type run....3/4 of a mile in 4.5 minutes (10 mph pace). Changed my diet to eat a lot healthier, upped my testosterone levels (on clomiphene citrate 25 mg per day now) to 1113 total test (free test and other hormones are at the top of their ranges in the 'good' categories) at my last check up. Drinking well over a gallon of just water each day as well. I do have sleep issues....did a sleep study this month....won't have results until next month.

Had a lower trimix injection (0.1 cc ) and doppler ultrasound performed and while I didn't get fully erect at the doc's office....when I left the office....then the trimix really kicked in and I got a priapism that had to be drained at the local ER (horrific experience). If not for the priapism, the technician's (that performed the flow test) notes said I had arterial insufficiency. But due to the priapism, the urologist ruled out venous leak completely and he, as well as another urologist (2nd opinion) said flow of between 25-35 cc/sec for PSV (Peak Systolic Velocity) was a gray area of acceptable and I was just barely in that range during the ultrasound. The first urologist, whose wife is an ED counselor, thought it was psychologically caused. Haven't had ANY luck finding a good ED therapist to work through this with...she's not currently taking new patients with COVID and all.

I undoubtedly have developed anxiety about being able to become erect, so there's a definite mental component. Often can't get anywhere near fully erect for masturbation, let alone with my partner. I rarely have night time erections and lately none at all. Past ones were often extremely weak. Quit porn over 7 months ago, don't miss it....used it with no issues for probably 20+ years daily, so I don't think that is part of it.

Feel like I've tried many of the crazy ideas out there....bought the Phoenix Acoustic Wave device (seemed to help the first month....on the 'off month' seemed to have regressed; just starting month 2 now). Have tried the Angion Method but with limited success since you're supposed to be erect to do the exercises.....not much of an ED fix if you have severe ED. Been looking into the theories about tight pelvic floor muscles and "hard flaccid" but I have no real symptoms short of having very little sensation in my penis (but no pain in my pelvic region). Looking at Dynamic Contraction Technique https://dynamiccontractiontechnique.com/ as a potential way to try and solve the problem as well as considering contacting Dr. Susie Gronski who've I've seen mentioned here. https://drsusieg.com/ https://www.amazon.com/dp/099869570X/ I'm basically desperate for a solution (as I'm sure anyone here dealing with similar can attest).

I recently discovered that when slightly aroused (but not even 50% erect) I can feel about 1-1.5" of the base of my shaft is hard....not really engorged much beyond my flaccid state, but definitely hard under the skin (if that makes any sense)....but the rest of my penis is flaccid (for me). Is this "hard flaccid"?

I say "for me" b/c I engaged in Penis Enlargement (PE) pretty heavily back in 2013 for several years on and off....using primarily a vacuum pump which greatly increased my flaccid size from like 3.5" to 5-5.5" and my erect bone pressed length from 7.25" to 8" in the first 3 months....no real gains after that even though I continued with pretty 'extreme' pumping on and off for several years. I personally believe the pumping may have contributed or downright caused my ED, but both urologists scoffed and seemed to think it absolutely could not have contributed or caused it. In any case, after engaging in this PE method, my flaccid state has been noticeably more firm...not hard. More like 'tough' or even 'rubbery' compared to my very soft flaccid state prior to vacuum pumping (as high as 10" of Hg for 12 minutes at a time; sometimes 3 times in a row after a 10 minute or so jelqing/massaging routine in between vacuum 'sets').

I also have looked into TMS (Traumatic Masturbation Syndrome) thinking my motions while masturbating may have damaged some nerves or the suspensory ligament by being seated in a chair and stretching my erect penis down between my legs which induced rock hard, long lasting erections for well over 20 years without any issues that I'm aware of. The doctors didn't think this was the cause either in spite of my getting a audible 'pop' from the ligament upon that first good stretch with close to a full erection during masturbation or upon entering my wife during penetrative sex (there was no pain associate with the pop either).

I'm struggling to find an answer to this problem frankly. I'm doing everything I physically can, and it seems like things are getting worse with time.

Sorry this is so long...I'm not even sure there's a question in here beyond do I possibly have a pelvic floor/hard flaccid issue? But, this is my story...I'm sure many others here can relate. I wish you all a speedy recovery; I wouldn't wish this on my worst enemy.

Sean

Forgot to mention I've tried (and have a boatload of) prescription ED drugs (generics mostly of Viagra and Cialis)....they seem to have grown less effective over time and only worked sporadically before. Talked to the 2nd urologist about injections of Trimix....and that's still on the table. Haven't taken the plunge mainly b/c of the debacle of the first priapism. Doc said he'd start me on the lowest dose (0.03cc) and monitor me closely while teaching me how to inject (he's not a fan of auto-injectors) with a syringe.

Welcome to the forum.

bldoink wrote:Welcome to the forum.

Thanks!

Hi Sean,
Well, you have been industrious with all your research and various attempts to fix your issue. As there is often no clear cut way to fix ED and or sexual dysfunctions, it can become a journey of much searching and trial and error.
We all understand your issue here and you are not alone.
Firstly I would like to comment on your use of Clomid or clomiphene citrate. Why did you start using this, did you have a very low T problem? For a start, while you are taking this drug, erectile function and possibly even sexual function as whole will most likely be negatively affected.
This happens in many men due to the Zuclomiphene isomer part of clomiphene. It exerts unwanted estrogenic like effects in the male body, most probably exacerbating any form of ED you may have or even causing ED in someone who did not have it in the first place.
IMO it should not be used as a means to elevate T levels on a permanent basis. You may be using it correctly to help boost a low T issue for a period of time and then slowly stopping the drug? But be mindful that sexual function could be all over the place while you are taking it, moods included. If you could get your hands on the superior form of this: Enclomiphene citrate, many of these side effects may be eliminated, this could be used in theory long term.
Your T level is quite high. Having a high T level is not always necessary or desired for good sexual function. Having a T level that your body was designed to have; is. Homeostasis is the key here.

Secondly, I would seriously consider contacting Dr Susie Gronski (I was the person who mentioned her in another post), as It could be quite possible IMO that you may have some form of a pelvic floor issue. I say this because of the loss of sensitivity and the relatively significant use of penis pumps for penis enlargement and jelqing that you mention, which can cause problems in the pelvic floor. As can periods of heavy leg training in the gym doing a lot of heavy squats and deadlifts. The loss of nocturnal erections could also suggest that a form of constant muscle spasm in the area may be affecting blood flow and neurological function. From what I understand, pain is not always present. How long has this lack of sensation in your penis been noticeable? Before the use of Clomid? low T can also cause this as can Clomid itself.
The description you give of how your penis is now when flaccid does have some similarity to the hard flaccid condition, so possibly more indication that this may be a pelvic floor problem.
I am also very interested in the guys at DCT. Could also be worth talking to them.
I wouldn’t be too perturbed by the urologists who apparently “scoffed” at your suggestion with regard to the above. In reality the only thing they can offer you once they perform all their elaborate tests is the following: PDE5 inhibitors, followed by a varied range of injections, Trimix being the strongest and then an implant. That’s it. I have not bothered to go and see one and most likely will not unless surgery is required for some reason. Quite often they have no answers as to why you have ED, they just use the term “venous leak” which covers so many different reasons why your penis cannot perform venous occlusion properly, they may as well just say you have ED. I think urologists that are more focused on male sexual function are more help than those that are not.

I am quite against the practices of penis enlargement as I feel they are damaging to the erectile tissues in the penis. Changing the shape and dimensions of theses tissues in relation to the tunica is just asking for trouble IMO. Using a penis pump gently to help blood flow and restore lost size due to atrophy of the penis is another matter. If done correctly as many of the experienced guys on this forum can attest is actually quite beneficial. The penis is NOT a muscle and not designed to grow in capacity with repeated stressors placed on it. Its size and function is encoded in your DNA and it grows at the required time when you go through puberty. Collagen deposition in the penis is something you want to avoid, It can happen when levels of oxidative stress are excessive (over production of reactive oxygen species ROS) and this may occur when micro injury (inflammation) to the penile tissues occurs. Smooth muscle health and quantity in all the erectile tissues and cavernosal arteries is vital. If the process of collagen deposition occurs, it replaces smooth muscle with non-compliant tissue. As you get older this is more likely to happen. Atherosclerosis is another way this process starts. Resveratrol and chronic low dose Tadalafil combined is showing promise in research with halting this process and even reversing it.
I have also seen the “angion method”. Not sure what to think about the guy who has developed this. Pseudo-science alarm bells go off for me here.

Enough of my rant about penis enlargement.

I do not know why you needed to raise your T levels, as you did not mention if you had very low testosterone at one point? So I am not sure if this could be the initial issue, setting of physiological changes in the penis, unrelated to a pelvic floor problem or part of that problem.
ED is often a combination of causal dysfunctions, which is why it is often so difficult to cure.

Not so good to hear about the Urologist who sent you off after the Doppler test and you subsequently experienced a serious case of priapism! I often wonder about these Doppler tests. The lack of inflow that the specialists suggested you had during the actual test, could be caused by your being quite stressed in the doctors clinic IMO. The process of having a needle stuck in your penis for the first time in a clinical setting and the apprehension of being there in the first place, stressed about your erectile function would IMO turn the adrenergic function in the penis on to full throttle! This could cause smooth muscle in your cavernosal arteries to remain relatively constricted even with the blocking action of phentolamine in the injection. It was quite telling after you left the practice this inhibiting influence may have dissipated (owing to you being more relaxed) and you then had a full blown erection that would not go down. If you had a pelvic floor issue as well (which most urologists don’t recognise) this may also contribute to the tension in the area further restricting blood flow during the test. Men that have this problem tend to unconsciously cause these muscles to constrict even further in stressful situations. Having penetrative sex with a partner can also be one of those stressful situations, due to anxiety’s about performance.
IMO adrenergic function in the penis can be all powerful and even the ingredients in Trimix will have trouble overcoming it if your body is pumping out adrenalin.
It does imply, from your experience with the priapism event, that your penis can function properly, so there doesn’t seem to be any significant structural problems.
As you also mention: there will be a psychogenic component to your ED. Once a guy experiences ED for a period of time irrelevant of the cause, this will develop also. So in effect the adrenergic inhibitory influence in the penis becomes stronger. How this occurs we are yet to discover, but I think it’s a combination of particular neural pathways in the brain becoming more dominant and possibly even an increase in the expression or the sensitivity of the adrenergic receptors in the penis itself. We do know this does happen with age, but I think it is plausible that it may happen due to certain periods of psychological stress, especially in men that may have a congenital susceptibility to the issue. Some men are far more susceptible to losing their erections in stressful situations than others.

It is very good that you are doing a considerable amount of cardiovascular exercise and concentrating on improving your diet. If this was neglected in the past, it will take time for improvements to happen, but they will. The tissues and small blood vessels in the penis are more sensitive to the ill-effects of no exercise and a bad western diet than the rest of the peripheral vascular system, the penis being just an extension of the peripheral vascular system. In fact the penis is often considered a barometer of the health of our vascular system, as it usually shows signs (not always) of failure before the more serious life threatening parts of our vascular system do. I think sometimes the Doppler tests show some form of CVOD when this is occurring, as the endothelium in these tiny vessels in the penis is deteriorating and this possibly shows as CVOD due to the NO pathway in these tissues becoming dysfunctional and smooth muscle has also deteriorated due to hypoxic conditions in the erectile tissues. The specialist may only determine that you could have a venous leak in this instance as these micro changes in the function of the blood vessels is not detectable, it causes them to be less able to relax and expand as they once did.
I lost one of my brothers to a heart attack at just 45. He wasn’t overweight nor did look unhealthy, but his complete lack of exercise and typical western diet with too much fat, sugar and carbs obviously caused many issues in his vascular system. You do not need to be past middle age for the above to start causing significant damage to the endothelium in small blood vessels. Looks like you have been checked for signs of heart disease, which is also good. Anyone with ED at middle age or even younger should do this.
I suppose this would only be relevant for you if had many years of not looking after yourself before you started the changes in lifestyle that you describe.
Hope the above helps.

Bump.

Hi Sean, seems like we have a very, very similar issue. Pelvic floor dysfunction (with all other physical factors, blood/hormone levels, blood flow, tissue health being good). Here's my story/diagnosis thread (viewtopic.php?f=3&t=17494)

abhishek26 wrote:Hi Sean, seems like we have a very, very similar issue. Pelvic floor dysfunction (with all other physical factors, blood/hormone levels, blood flow, tissue health being good). Here's my story/diagnosis thread (viewtopic.php?f=3&t=17494)

That's the problem, I'm not sure I have pelvic floor dysfunction....no real symptoms other than ED and a flaccid penis that is on the firmer side...but was for years without issue since using a VED for Penis Enlargement.

Thanks for posting...I'll read over your thread and get back....

Simbarn wrote:Hi Sean,
Well, you have been industrious with all your research and various attempts to fix your issue. As there is often no clear cut way to fix ED and or sexual dysfunctions, it can become a journey of much searching and trial and error.
We all understand your issue here and you are not alone.
Firstly I would like to comment on your use of Clomid or clomiphene citrate. Why did you start using this, did you have a very low T problem? For a start, while you are taking this drug, erectile function and possibly even sexual function as whole will most likely be negatively affected.
This happens in many men due to the Zuclomiphene isomer part of clomiphene. It exerts unwanted estrogenic like effects in the male body, most probably exacerbating any form of ED you may have or even causing ED in someone who did not have it in the first place.
IMO it should not be used as a means to elevate T levels on a permanent basis. You may be using it correctly to help boost a low T issue for a period of time and then slowly stopping the drug? But be mindful that sexual function could be all over the place while you are taking it, moods included. If you could get your hands on the superior form of this: Enclomiphene citrate, many of these side effects may be eliminated, this could be used in theory long term.
Your T level is quite high. Having a high T level is not always necessary or desired for good sexual function. Having a T level that your body was designed to have; is. Homeostasis is the key here.

Secondly, I would seriously consider contacting Dr Susie Gronski (I was the person who mentioned her in another post), as It could be quite possible IMO that you may have some form of a pelvic floor issue. I say this because of the loss of sensitivity and the relatively significant use of penis pumps for penis enlargement and jelqing that you mention, which can cause problems in the pelvic floor. As can periods of heavy leg training in the gym doing a lot of heavy squats and deadlifts. The loss of nocturnal erections could also suggest that a form of constant muscle spasm in the area may be affecting blood flow and neurological function. From what I understand, pain is not always present. How long has this lack of sensation in your penis been noticeable? Before the use of Clomid? low T can also cause this as can Clomid itself.
The description you give of how your penis is now when flaccid does have some similarity to the hard flaccid condition, so possibly more indication that this may be a pelvic floor problem.
I am also very interested in the guys at DCT. Could also be worth talking to them.
I wouldn’t be too perturbed by the urologists who apparently “scoffed” at your suggestion with regard to the above. In reality the only thing they can offer you once they perform all their elaborate tests is the following: PDE5 inhibitors, followed by a varied range of injections, Trimix being the strongest and then an implant. That’s it. I have not bothered to go and see one and most likely will not unless surgery is required for some reason. Quite often they have no answers as to why you have ED, they just use the term “venous leak” which covers so many different reasons why your penis cannot perform venous occlusion properly, they may as well just say you have ED. I think urologists that are more focused on male sexual function are more help than those that are not.

I am quite against the practices of penis enlargement as I feel they are damaging to the erectile tissues in the penis. Changing the shape and dimensions of theses tissues in relation to the tunica is just asking for trouble IMO. Using a penis pump gently to help blood flow and restore lost size due to atrophy of the penis is another matter. If done correctly as many of the experienced guys on this forum can attest is actually quite beneficial. The penis is NOT a muscle and not designed to grow in capacity with repeated stressors placed on it. Its size and function is encoded in your DNA and it grows at the required time when you go through puberty. Collagen deposition in the penis is something you want to avoid, It can happen when levels of oxidative stress are excessive (over production of reactive oxygen species ROS) and this may occur when micro injury (inflammation) to the penile tissues occurs. Smooth muscle health and quantity in all the erectile tissues and cavernosal arteries is vital. If the process of collagen deposition occurs, it replaces smooth muscle with non-compliant tissue. As you get older this is more likely to happen. Atherosclerosis is another way this process starts. Resveratrol and chronic low dose Tadalafil combined is showing promise in research with halting this process and even reversing it.
I have also seen the “angion method”. Not sure what to think about the guy who has developed this. Pseudo-science alarm bells go off for me here.

Enough of my rant about penis enlargement.

I do not know why you needed to raise your T levels, as you did not mention if you had very low testosterone at one point? So I am not sure if this could be the initial issue, setting of physiological changes in the penis, unrelated to a pelvic floor problem or part of that problem.
ED is often a combination of causal dysfunctions, which is why it is often so difficult to cure.

Not so good to hear about the Urologist who sent you off after the Doppler test and you subsequently experienced a serious case of priapism! I often wonder about these Doppler tests. The lack of inflow that the specialists suggested you had during the actual test, could be caused by your being quite stressed in the doctors clinic IMO. The process of having a needle stuck in your penis for the first time in a clinical setting and the apprehension of being there in the first place, stressed about your erectile function would IMO turn the adrenergic function in the penis on to full throttle! This could cause smooth muscle in your cavernosal arteries to remain relatively constricted even with the blocking action of phentolamine in the injection. It was quite telling after you left the practice this inhibiting influence may have dissipated (owing to you being more relaxed) and you then had a full blown erection that would not go down. If you had a pelvic floor issue as well (which most urologists don’t recognise) this may also contribute to the tension in the area further restricting blood flow during the test. Men that have this problem tend to unconsciously cause these muscles to constrict even further in stressful situations. Having penetrative sex with a partner can also be one of those stressful situations, due to anxiety’s about performance.
IMO adrenergic function in the penis can be all powerful and even the ingredients in Trimix will have trouble overcoming it if your body is pumping out adrenalin.
It does imply, from your experience with the priapism event, that your penis can function properly, so there doesn’t seem to be any significant structural problems.
As you also mention: there will be a psychogenic component to your ED. Once a guy experiences ED for a period of time irrelevant of the cause, this will develop also. So in effect the adrenergic inhibitory influence in the penis becomes stronger. How this occurs we are yet to discover, but I think it’s a combination of particular neural pathways in the brain becoming more dominant and possibly even an increase in the expression or the sensitivity of the adrenergic receptors in the penis itself. We do know this does happen with age, but I think it is plausible that it may happen due to certain periods of psychological stress, especially in men that may have a congenital susceptibility to the issue. Some men are far more susceptible to losing their erections in stressful situations than others.

It is very good that you are doing a considerable amount of cardiovascular exercise and concentrating on improving your diet. If this was neglected in the past, it will take time for improvements to happen, but they will. The tissues and small blood vessels in the penis are more sensitive to the ill-effects of no exercise and a bad western diet than the rest of the peripheral vascular system, the penis being just an extension of the peripheral vascular system. In fact the penis is often considered a barometer of the health of our vascular system, as it usually shows signs (not always) of failure before the more serious life threatening parts of our vascular system do. I think sometimes the Doppler tests show some form of CVOD when this is occurring, as the endothelium in these tiny vessels in the penis is deteriorating and this possibly shows as CVOD due to the NO pathway in these tissues becoming dysfunctional and smooth muscle has also deteriorated due to hypoxic conditions in the erectile tissues. The specialist may only determine that you could have a venous leak in this instance as these micro changes in the function of the blood vessels is not detectable, it causes them to be less able to relax and expand as they once did.
I lost one of my brothers to a heart attack at just 45. He wasn’t overweight nor did look unhealthy, but his complete lack of exercise and typical western diet with too much fat, sugar and carbs obviously caused many issues in his vascular system. You do not need to be past middle age for the above to start causing significant damage to the endothelium in small blood vessels. Looks like you have been checked for signs of heart disease, which is also good. Anyone with ED at middle age or even younger should do this.
I suppose this would only be relevant for you if had many years of not looking after yourself before you started the changes in lifestyle that you describe.
Hope the above helps.

First, Simbarn...thank you very much for taking the time to thoughtfully write all that out.

Second, thanks for PMing me...I had no idea this thread had gotten any replies recently.

To address some of your questions:

Yes, I had a blood test revealing Low T....as well as low free T. I don't have my numbers in front of me right now, but all my hormone numbers are now good (or in the case of Testosterone...on the high side).

Long story behind all that. Back in 2017 (Jan.) I went to my endocrinologist to get tested since I just didn't feel like myself...and hadn't for a couple years at that point. Couldn't lose weight very easily....couldn't get any stronger, felt tired all the time. I"ve been very actively weight lifting since I was about 14....47 now. Tested low...and b/c my wife and I were still trying to have kids, he put me on Clomid over Test Cyp (for example) b/c of the fertility impacts.

I was on it for a year....no side effects. Total test level went from the low 300s to 700ish IIRC.

Got off it for roughly 3.5 years. Got back on it last fall. I tested at around 230 Total T. Went up to about 540 with just Clomid for a few months. I added in DHEA...it went up to about 750 (again, a few months worth of using it). Added a supplement test booster and went over 900. Only then did I really start to feel 'normal' in terms of my strength and energy levels. Added one more supplement and ended up at 1113 on the last test in April. Now I actually feel like I'm supposed to.

Before you ask, no, I haven't ever used steroids/HGH or IGF-1. In reasonably good shape for my age and have never really neglected my fitness...though I'm certainly in better shape now than I was last year...being a good 17% or so body fat and 230 lbs. last year...and in worse cardiovascular shape.

I had ED before and without the Clomid...so I doubt that's it...though it's done nothing to help the ED situation other than restore my libido....That said, your recommendation to try Enclomiphene Citrate is something I'll discuss with my endocrinologist. What are your qualifications for making that recommendation? He's a surly fuck, so if I just say , "Some guy on the internet told me to use it instead of Clomid"...he's going to blow me off.

As for my pelvic floor...I may have overstated the jelqing portion...it was more just getting fresh blood into my penis after a pumping set. Truth is, I have no idea if I have a pelvic floor issue. I've been watching and doing pelvic floor exercises and the stretches/strengthening techniques used are easy for me to complete as I am very flexible to begin with. Not sure someone with pelvic floor issues would be capable of that type of flexibility. In my younger years, I squatted 605 for reps (2-3 usually) and deadlifted 455 for 12 going up to 545 for reps as well at a body weight of 225 and around 6-8% body fat. I haven't gotten much above 455 on squat in years....but I still load up a hip sled/leg press with 8-10 plates on each side and my deadlifts are pretty much just stiff legged with 405 for a few reps now.

To clarify...it's not that pelvic pain isn't always present...it's NEVER present. I have no pelvic pain or discomfort; just ED and a somewhat firmer than normal (for me) flaccid state that started for several years before ED when I started penis enlargement via pumping.

The lack of sensation in my penis preceded Clomid. It's been that way since my ED started.

The urologist that did my doppler U/S is the premier implant doc in Phoenix. So he mainly focuses on male sexual health....that said, if you're not an implant candidate...yeah...I don't think he does much beyond throwing pills at it. He said I definitely did not have venous leak as attested by the priapism.

We agree on Penis Enlargement....but the damage in my case is already done...*IF* it's even a contributor. I'm only interested in Angion for the supposed increase in blood flow for helping with ED....not size increases. At this point, I just want a working dick, though I admittedly dont' want to give up the size I gained. So far, when I can get an erection....that's stayed with me.

I think you're spot on about my nerves being the cause of not getting a full erection during the doppler U/S.

Your comment:

Simbarn wrote: If you had a pelvic floor issue as well (which most urologists don’t recognise) this may also contribute to the tension in the area further restricting blood flow during the test.

Makes me wonder more about pelvic floor issues....as I've always experienced erections that were the strength of the one I got from injection for the test. Most accounts I've read said that injections result in the "hardest erection" you've ever had. For me, it just felt normal....and I don't know what normal is for everyone else...just that my partners have commented about how "hard" it gets. Maybe that's a sign of an underlying pelvic floor issue? I have had a few bouts a year of anorgasmia with partners as well.

Thanks again for the thoughtful response.

Sean762 wrote:I had ED before and without the Clomid...so I doubt that's it...though it's done nothing to help the ED situation other than restore my libido....That said, your recommendation to try Enclomiphene Citrate is something I'll discuss with my endocrinologist. What are your qualifications for making that recommendation? He's a surly fuck, so if I just say , "Some guy on the internet told me to use it instead of Clomid"...he's going to blow me off.

As for my pelvic floor...I may have overstated the jelqing portion...it was more just getting fresh blood into my penis after a pumping set. Truth is, I have no idea if I have a pelvic floor issue. I've been watching and doing pelvic floor exercises and the stretches/strengthening techniques used are easy for me to complete as I am very flexible to begin with. Not sure someone with pelvic floor issues would be capable of that type of flexibility. In my younger years, I squatted 605 for reps (2-3 usually) and deadlifted 455 for 12 going up to 545 for reps as well at a body weight of 225 and around 6-8% body fat. I haven't gotten much above 455 on squat in years....but I still load up a hip sled/leg press with 8-10 plates on each side and my deadlifts are pretty much just stiff legged with 405 for a few reps now.

To clarify...it's not that pelvic pain isn't always present...it's NEVER present. I have no pelvic pain or discomfort; just ED and a somewhat firmer than normal (for me) flaccid state that started for several years before ED when I started penis enlargement via pumping.

The lack of sensation in my penis preceded Clomid. It's been that way since my ED started.

Thanks again for the thoughtful response.

No problem. I'm happy that some of what I said might help.

Ok, I can understand a little more now.
It does appear that you may have a low T issue. Clomid was quite successful with stimulating a higher T level, nothing wrong with your testes, definitely sounds like a secondary hypo problem. Pituitary issue.
T levels do drop as we age as you know, it looks like yours has done this earlier.
Your ED may be a result of the low T. I am not convinced that the Clomid is not interfering with your sexual function though. It is notorious for doing this. Your “surly” endo should be aware of this.
If your ED was from low T and the increase of natural T which Clomid causes did not improve your erectile function, this could be from the estrogenic effects Clomid has while you take it. Clomid has this effect on many men.
I have no “qualifications” to offer you to present to your endo other than 20 years of experience of TRT and research into the many pitfalls of hormone replacement. I will say this, I have discovered after talking to many guys with low T in the past that frequently, endos did appear to be extremely behind the times when it comes to TRT for men. I saw one many years ago and vowed to never see another. He was also a surly character, brimming with arrogance and made me feel about 2 foot tall. I walked out and didn’t pay him a cent.
I have had much better experiences with doctors who have a keen interest in men’s sexual function and hormone issues. Perhaps some endo’s have become more progressive these days.

The information I gave you in the previous post regarding Clomiphene citrate versus Enclomiphene citrate (EC) is the main reason IMO that it would be preferable to use Enclomiphene.
A company called Repros Therapeutics tried over many years to get EC passed by the FDA for use in HRT for men with secondary hypogonadism. As it was the part of clomiphene citrate that did all the good work (Enclomiphene) without the part that causes all the issues (Zuclomiphene). A better drug for men to take on a long term basis. It would make good sense that the best form of HRT for men keeps the gonads and the HPTA functioning. All the hormones produced in this process are important, not only for sexual function but also for other processes in the body. LH has effects on the brain as well. Shutting down the “upstream hormones” of testosterone is not without its detrimental effects, not confined to loss of fertility. Some men just need a medication that will give the HPTA a push to produce higher levels of gonadotropins in order to increase T, this most likely will need to be used on a permanent basis. Clomid and Tamoxifen are not good to take permanently.

Unfortunately Repros was trying to get this approval at a bad time and for political reasons EC did not get approved. This was so unfortunate as many doctors still use the more harmful version of this drug frequently for HRT and restart protocols: Clomid, as you know well!
I have spoken with countless men over the years who have issues with T replacement, myself included. There are a number of main reasons for this: ignorant endos who put them on drugs like Nebido, or other forms of T replacement and don’t monitor other hormone conversions in the body, not adjusting the amount of T needed for that particular individual, the shutdown of upstream hormones as already mentioned and the fact that TRT just does not work as well as natural hormone function does for some men. From my experience it is the younger men that have most of the issues with TRT. By younger I mean men under 60. The issues are generally to do with sexual function and this is mostly caused from the loss of LH, FSH and GNRH. I eventually worked this out for myself as I could feel it in my own body. Something was missing, sexual function has never felt the same as it did when all my hormones were running and why should it?
Thus, if one could use a drug to keep it all running without too many side effects, this is the way to go IMO, far superior. Clomid is not a drug I would want in my body long-term. The work put in by Repros showed that EC was the better alternative, It raised T levels comparably to that of T gel administration and in reality a ENDOGENOUS testosterone level of the same amount as compared to a synthetic level, works far better for these reasons: the natural diurnal rhythm is maintained, this preserves receptor sensitivity for T on a daily basis (No form of TRT can match the finely tuned production of T the body does on a daily basis, it does this so you have two purposeful peaks in the day and more on demand if needed). Conversion to other hormones is maintained to the levels that maintain homeostasis and most importantly gonadotropins are all doing their bit too. The examiners judging the efficacy of EC were obviously completely ignorant of these important facts. I also heard that the FDA considered that another T producing medication was not needed in the market place if T gel was going to do the same thing. That’s just it, it didn’t!

Do some of your own research on EC. You do not have to mention that someone on the internet told you it was superior, find the information yourself and present the data. It will most likely be a waste of time with an endo IMO. Defy medical in the US I have been told do have access to EC. It is being compounded by a pharmacy related to them. So that could be an option if you decide you like the idea of trying it compared to Clomid. As I am in Australia, I cannot seem to find a reputable source to get the genuine product. I would try it in a heartbeat if I could.
Clomid made me feel awful, sexual function was a lot worse for me that on Testosterone. Nolvadex seemed a little better, but this is also not something one should take long term. These are restart drugs IMO.
So there you have my reasoning for EC.

How did you come off the Clomid last time when you stopped the therapy? Did you get some tests done at various intervals after cessation to see how the increased level held?

Low T may not be your only issue:

With regard to pelvic floor, I still think this should be investigated, even more so now that you have mentioned your years of doing very heavy squats and dead-lifts! I worked as a PT in a gym for a number of years as a young lad so I understand the sport of weight lifting well. It is not entirely healthy in IMO as the strain one puts on the body performing lifts like this can be counterproductive. The injuries I saw from guys doing these exercises over time made me question why do we do these things to ourselves? I also went through a period of training where I put a considerable amount of extra muscle on my body and pushed it to extremes as this was part of the gym culture. I knew deep down this didn’t feel right. It can become obsessive. I had a great bod, but at what cost? I train now with a very different attitude and motivation, you just have to as you get older.
I am impressed that you have been able to get your natural T up to a level over 1000 with the addition of “extra supplements”. What were these as they have been quite effective in combination with your SERM therapy?
Be mindful when trying to use a high testosterone level in order to feel like you felt when you were 20-25. Your body has aged since then and sometimes this can have side effects as in effect it can work like a drug, a band-aid so to speak, covering for the effects of aging. This happens more so with the use of exogenous T (as most people do find it difficult to do this naturally) where it is easy to administer more. Initially the person doing this can feel amazing for the first 3-6 months of having a very high T level until the body starts to desensitise to the T and side effects begin such as increase in aromatase enzyme and subsequent increase in E2 and other conversion hormones. Body builders are quite familiar with this phenomenon. It can happen at dosages far less that what they use.
You could of course be one of those not so common individuals who had a very high T level in your young years.

When I said pain does not always have to be present, I meant it doesn’t need to be present at all. Lack of sexual sensitivity and ED can be the only symptoms. The nerves that leave the sacrum travel a complex journey through ligaments and muscle in the gluteal region. They can become affected at various points and depending on where they are being compressed, the symptoms may vary. Pudendal nerve entrapment is a medically recognised condition and I did read a case of a young man presenting with just sexual numbness and he was subsequently diagnosed with this condition. The Pudendal nerve is responsible for sensory sensation in the penis as well as reflex erections; that is erections that are generated by touch to the penis itself. Psychogenic erections are generated by a different path of nerves a little higher up in the lower spine. These are the ones affected when the prostate is removed. Both pathways are needed for strong erectile function. Blood supply to the penis is also traveling in a similar area, so this as I have mentioned in my other post can be affected also.
Given the above it would be well worth your while to see someone experienced as I do not think you will be able to determine if you have or don’t have this problem by yourself.
Time to try something else…

Science is still trying to understand much about erectile function. There are so many processes (that we are currently aware of) that need to occur correctly for what looks to be a simple event to occur. When you start to dig deep into all these processes and the possible long list of dysfunctions that can interfere with erectile function, you begin to understand how difficult it is to know what is causing a problem. We do have one thing on our side and that is the body is continually striving to fix itself.

Sorry for the length again of this reply, I get carried away sometimes..