Variable Response

[rich2222]

I have been using roughly 3 Alprostadil injections per week for a couple of months. I use a very low dose of 3.5mcg and initially, once I had calibrated the best dose, the injections were very reliable.

For the last 2 weeks my early morning Erectile Quality (I.e. no meds or injections) has been quite low.
This is when I wake up with or can achieve the closest thing to a ‘natural’ erection (about 70%) and is how I assess my underlying EQ for the day.

Before I started injections, when I was using Cialis regularly, if my EQ was low beforehand, then I knew that the response to the Cialis on that day would be reduced.

During the last couple of weeks, my EQ has been quite low and I have noticed a drop in rigidity when using injections, and an associated loss in duration. I am not talking about a total ‘miss’, rather a 15% - 20% reduction.

I seem to be going through one of those periods when my underlying EQ is generally lower (maybe blood sugars are higher at the moment) and the previous dose isn’t enough. This is similar to how Cialis used to be less effective at these times.

I was on a course of Naproxen for a couple of weeks to treat Tendonitis.

I have tried increasing the Alprostadil dose by 25% (which is quite a lot proportionately on a low dose but not much in volume terms) and this did improve things a little, but not to the the previous levels.

I did discuss with my NHS Specialist Nurse how soon I could repeat a dose when I had a total failure in the early days (she said after a few hours as an exception), but I haven’t discussed the partial failure scenario yet.

Adjusting doses, however is tricky, because you never know beforehand how much is enough - I’m sure with a bit more experience I will get better at this.

It’s only a couple of months since I started Alprostadil, so I think it’s most likely to be a temporary glitch rather a step-change in dose requirement.

I don’t understand what the Alprostadil does in physiological terms, but I thought that somehow the usual ‘triggers’ were bypassed and not dependent on other physical factors like PDE5 Inhibitors

Some questions for anyone with relevant experience:

- What health issues can occasionally make injections less effective?
- Do some medications affect injection responses?
- Do you find that your injection results vary from one period to another?
- Are there times that you know beforehand are going to be less effective than usual?
- Do you ever ‘top up’ (i.e a second small dose after say 30 minutes when it is clear that the first dose is going to be only partially successful)?
- Do you adjust dosage (other than ‘step-changes’ as your ED has deteriorated) and why?