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I'm a young guy (36, without medical issues) and I've had varying results and needed to use increasing doses of Trimix (from Olympia) over the past few months. Was dxed with venous leak in the past several months. Getting frustrated to the point that I'm thinking about an implant. I take Trimix with sildenafil.

For instance;
PAP 30, Phen 1, PGE 10 (40 U) + sildanfil 200mg - got me a 2 hr "9/10" erection when testing at home a few months ago (looking at porn). Now, have trouble getting a 30 min erection when testing this dose at home.

PAP 30, Phen 3, PGE 40 (30 U) + sildenafil 200mg - got me a 1.5 hr "8/10" erection when testing at home a few weeks ago (basically just from looking at porn). But, when trying to have sex last week (was attracted to woman), I got probably a "5/10" erection that was variably hard enough for penetration. Took maybe 10 min to get it up the first time and was not super hard, but enough for penetration. However, after I orgasmed, and maybe 30 min later, (still within 1.5 hrs), could get hard but couldn't maintain erection (pulled out and couldn't get it hard enough for re-penetration).
I had an ache when doing this at home before...but not when I actually had sex.

Furthermore, don't understand why I'm struggling with misses occasionally in real life (25-50% of the time). I'm using a 1/2" needle , going between 2-3pm and 10-11am positions. Have probably tried 20-30 injections total. Unfortunatley I can't use penis pumps or cock rings (would be weird for dates). Have looked at a lot of the threads on positioning.
Don't know if any of the following could be affecting this, or if anyone has ideas as to why I'm needing escalating doses and how to figure out the right dose? Not sure if it's psychological, but I'm not more noticeably anxious from what I can tell.
Or if folks have personal insights on the following:
1) Trimix is sitting out at room temp sometimes for 4-8 hours. I try to keep it in a refridgerated pouch. Does this matter much?
2) Does time of day matter? E.g. earlier or later in night.
3) Is there a good way to "practice" injections so that I'm not missing so much?
4) Does masturbating/orgasming more (or in the days leading up to sex) affect the strength of your erection?
5) Does anyone use a VED and notice that this helps their erections?

Re. failed injections, you may be injecting into inflammation/clotted areas from prior injections. It is very important to compress the injection site after injection for long enough so that you minimize internal bleeding.

After compression, it helps me a lot to massage the trimix throughout the penis.

I just need to take a break after a handful of injections so all that can heal up and then it works better again.

Sometimes 1/2 inch needle may press through the corpus into the divider between the two sides, i.e. too deep. I have had some luck using a shorter 8mm needle, taking the head of the penis and stretching it and then injecting with the 8" as deep as it will go (indent the skin.

If there is resistance to the plunger going down, don't force it.

seinefight: When I was learning to inject, it took me a month of solo practice twice a week to get it reasonably right, and after seven years, I still miss every tenth time or so. The penis cross-sections you see show an erect penis - the flaccid penis has quite thin corpora; mine are as thin as thick spaghetti, so I have to feel for them carefully, not just aim at 9-11 or 1-3 o'clock. I know I have the needle placed well when the plunger goes down without effort, as if the needle were in air, and there's no pain from the fluid coming out of the needle.

When using a 1/2in needle, you might be going right through the corpus. If the two conditions above are not met, try pulling out a small amount.

Many guys "plump up" with VED or masturbation first. I don't think time of day has anything to do with injecting.

Look through the "Injections" topic as much as you have time for - there's a lot of good technique written there. PM me if I might help.

I've used Trimix on vacations which had warmed to room temperature for 3-4 days, without any drop-off in results.

For some reason that I haven't figured out yet (maybe old age), I stay nice and stiff in the missionary position if I get up on my knees, but I start to lose it if I lay down on her.

Try using an auto injector we found when we were doing the shots it helped a lot in hitting the right spot ..even though the shots never worked for me I would still get a chubby and sometimes extreme pain from the shots.

Use a ring, with that you can complete the act.
It is more humiliating to not be able to.
I am 32 years old and I use the ring, if you ask me I tell you it is so I don't ejaculate so quickly.

I'm on 30-3-40 as well. Injection site is important. I've missed a few times, usually when I was quite limp. The worst was coming in from skinny dipping and shooting into a very cold penis and I think I missed. It would be easy to do. I try to stroke it a little plump before I inject. I've used Trimix at room temp (having sex at night and leaving it out and then shooting in the morning to take care of her) and it seemed to be fine. The rest of the time, I keep mine in the freezer and the shelf life seems to be great. The massaging was key for me as I learned from my second urologist and now I take the time to inject and calmly massage before doing anything else, including just watching porn.