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I abused drugs, primarily opiates, and I also have a pineal cyst, both cause low testosterone. I was initially tested around 2019 and I found out I had a total testosterone of 167ng.

Shortly after that I started TRT at 200mg and started experimenting with cialis and viagra. For the last year I’ve been taking cialis daily. I used to get rock hard erections and the worst “ed” I faced came from performance anxiety a couple of times. Before all I needed was a 5mg cialis (on top of TRT) and I go back to back rounds all day and night.

Fast forward to about 4 months ago I started losing morning wood. I did run 2 testosterone + anavar cycles over the last 2 years. About a month ago I wenty urologist and was diagnosed with a VL. I have tried 3 different kinds of injections, bimix, trimix and one that’s about 4-5 drugs in one (my dad swears by it), none have worked. I have a 60 unit injection of bimix left, max I’ve done is 40. I’m healthy, active and eat properly.

The thought of never having morning wood again is really messing with my head. I attached my ultrasound, how bad is it? I think the implant may be my only chance at having a sex life again. I see a lot of posts about misdiagnosed venous leaks but I don’t think that’s my case

The file was too big to upload so here it is:

https://imgur.com/a/K3L6Tmj

First of all you should take care of your TRT dosage. if you use to have such hard erections it is not likely you could develop such organic VL in that very short time. Your problem seems to be hormonal and functional.
200 mg of testosterone per week is very likely to be overkill. Few men would need it. 100 mg is more standard. The more is not the better, and you could end up having symptoms similar of those of hypogonadism, like low libido, ED.
I don’t have the paper now, but it has been shown that excess of estradiol, which can be produced through aromatization of excessive testosterone, can produce functional VL, which is transitory and may improve after hormones get in balance.

The attached study argues that venous leak is due to hormone dysfunction and that HRT reverses venous leak even in those with severe ED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987956/

fucked0ne wrote:The attached study argues that venous leak is due to hormone dysfunction and that HRT reverses venous leak even in those with severe ED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987956/

Thats for a specific population that has small testicles (hypogonadal)

I think most of us have venous leak due to changes in our tunica or our carvernosal bodies

My testosterone has always been above average for my age, but I have venous leak. I'm pretty sure I screwed up my tunica from years of death-grip masturbation

Mark1974:

My bad. Thanks for the correction.

Mark1974 wrote:

fucked0ne wrote:The attached study argues that venous leak is due to hormone dysfunction and that HRT reverses venous leak even in those with severe ED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987956/

Thats for a specific population that has small testicles (hypogonadal)

I think most of us have venous leak due to changes in our tunica or our carvernosal bodies

My testosterone has always been above average for my age, but I have venous leak. I'm pretty sure I screwed up my tunica from years of death-grip masturbation

Yes, your VL must obviously be due to organic damage. But here we are saying that there is also functional VL in some people, due to hormonal imbalances, which might be Kuttley's case but not yours.

Jucaro wrote:First of all you should take care of your TRT dosage. if you use to have such hard erections it is not likely you could develop such organic VL in that very short time. Your problem seems to be hormonal and functional.
200 mg of testosterone per week is very likely to be overkill. Few men would need it. 100 mg is more standard. The more is not the better, and you could end up having symptoms similar of those of hypogonadism, like low libido, ED.
I don’t have the paper now, but it has been shown that excess of estradiol, which can be produced through aromatization of excessive testosterone, can produce functional VL, which is transitory and may improve after hormones get in balance.

Total t: 940
Free t: 240
E2: 30

Not sure what the units are but it’s us and everything is in range except free t is slightly above. I know it’s on the high side but it’s never given me a problem. I do not take an AI. I’ve been on this dose for years and it’s never been a problem unless I was on hcg, even then 20mg cialis and I had no problem whatsoever

Kuttley wrote:

Jucaro wrote:First of all you should take care of your TRT dosage. if you use to have such hard erections it is not likely you could develop such organic VL in that very short time. Your problem seems to be hormonal and functional.
200 mg of testosterone per week is very likely to be overkill. Few men would need it. 100 mg is more standard. The more is not the better, and you could end up having symptoms similar of those of hypogonadism, like low libido, ED.
I don’t have the paper now, but it has been shown that excess of estradiol, which can be produced through aromatization of excessive testosterone, can produce functional VL, which is transitory and may improve after hormones get in balance.

Total t: 940
Free t: 240
E2: 30

Not sure what the units are but it’s us and everything is in range except free t is slightly above. I know it’s on the high side but it’s never given me a problem. I do not take an AI. I’ve been on this dose for years and it’s never been a problem unless I was on hcg, even then 20mg cialis and I had no problem whatsoever

Your baseline numbers were very low and your current numbers are probably too high for you to manage successfully long term. TRT is a marathon, not a sprint.

When you have absurdly high levels of testosterone for a long time, you damage your body and blood vessels (i.e. many bodybuilders suddenly die of a heart attack after using steroids).

Free testosterone is bioavailable testosterone and that's the one that matters to your body, if yours is above the range it is probably because you have low levels of shbg, so much of your testosterone is left free and metabolized faster and that is why you take a high dose but your total T is still within range (upper range). To fix this, you can try lower doses every day or every other day, and reduce the total weekly dose.

And yes, sometimes HCG use can worsen ED and kill libido (not for everyone), and it's also hormonally and biochemically mediated (E2, 17-hydroxyprogesterone...and who knows what else).

I suggest you try this way and see what happens. If there is no improvement, then consider an implant.