Wrong Urologist?

[byestreet]

I'm new to this site, so I hope I'm doing this correctly. Simple question: Did you ever have the feeling that you were working with the wrong urologist? I have been using Trimix (40mcg, 30ml, 0.5ml, six units), with decreasing effectiveness, which I expected. When I asked my urologist about stronger doses of Trimix, as well as Quadmix, he suggested that I see one of his colleagues about an implant. I was shocked. I'm 72 and in excellent health, with the exception of mild hypertension which is controlled by Lisinopril. My regular PSA readings are below 2.0. I do use bio-identical hormone replacement, so I have no issue with Testosterone. I will definitely get a second opinion, but I would greatly appreciate any guidance from others on this site.

[Robert66]

Sounds like a sales pitch i use 45/1/27 and inject 38 units

[Txagq8]

One of my favorite lines from any work of literature comes from Harper Lee's To Kill A Mockingbird. On the witness stand, Tom is asked if he’s accusing Miss Mayella(the white girl) of lying. As it would be heretical for a black to accuse a white of lying at that time, Tom tells the court she ain’t lying, but she might be mistaken in her mind.

Rather than think your urologist is trying to railroad you into an implant, let’s give him the benefit and say he’s simply mistaken in his mind.

Anathema as it may be to their egos, doctors don’t always know everything. Some doctors aren’t aware that compounded anti ED drugs that you inject come in different formulations.

Then again, it may be that the doc has the opinion that chasing ED with ever increasing strengths of injectables might be doing more harm than good Vis a Vis possible scarring.

Another old cliche is that if you don’t like the goods at Macy’s, go to Gimbel’s. And that’s my advice. Find a urologist who specializes in ED and take your concerns to him for an additional opinion.

[Greg1956]

I went to quite a few urologists until I finally found one who wanted to figure out the problem instead of prescribing something to see if it would work. I had used every pill, injection, urethras suppository, and vacuum pump by that time, simply because no doctor cared to figure out why I had ED.

It should be customary for those of us who have tried everything to have a urologist suggest talking to an implant surgeon because that is pretty much what’s left. Until the other products have been tried, they usually have you keep trying others.

I finally found the “right” urologist who sent me for a Penile Doppler test which confirmed a severe Venous Leak. That explained why nothing worked. Too bad I wasted many years and a lot of money trying things they would have known were going to be ineffective due to the VL.

[notaes]

My outlook is a little different. I attempt to explain why. I have been suing Trimix for going on four years. I had my Urologist redo my script a few months ago. It is working the best it has worked in a long time. When I started using Trimix no one mention the potential for scarring to me period. All the sudden I started feeling hard places on the sides of my penis. I have it on both sides now and also notice a little left curvature. My penis has always been straight as a stick. I went to my Urologist and showed him the hard places as well as the curvature in my penis. He said both were as a result of using Trimix. The Urologist I see now is not the one that originally started me out using Trimix. I ask why no one had ever mention the scarring possibilities to me before starting Trimix and he told me they should have. I also told him that I had talked with guys that had used Trimix for ten years with no scarring. He told me he would take issue with guys that thought they had no scarring after ten years of use. He said maybe its not as pronounced as yours or maybe they don't know they have some scarring. He talked like this was common thing with Trimix users. Also, this Urologist has told me for eight months that I needed an implant accepted the fact that he is correct. I cant keep sticking needles in my penis without the side effect of scarring. lt will only get worse. Im scheduled for implant Jan 9th. I finally accepted my doctors opinion and sch the implant. He only has my best interest at heart. He is not going to gain a thing by recommending an implant to me. He knows is I keep sticking needles in my penis its only going to get worse. Long term an implant is the best thing for me. It took me a long time to accept that fact. I want to keep having sex as long as I am physically able and getting an implant will enable me to have sex as long as I am able. I wish you the best!

[byestreet]

I really appreciate all the responses - Thank You. I've decided to find a urologist who wants to find out why I have ED, rather than jump at one-way, no-return alternatives. I know it's cynical, but it's also true - someone is going to the worst doctor in the world; in this case, the worst urologist. I just don't want it to be me. More to follow, but for now, Thanks again.

[stephen54]

I'm new to this site, so I hope I'm doing this correctly. Simple question: Did you ever have the feeling that you were working with the wrong urologist? I have been using Trimix (40mcg, 30ml, 0.5ml, six units), with decreasing effectiveness, which I expected. When I asked my urologist about stronger doses of Trimix, as well as Quadmix, he suggested that I see one of his colleagues about an implant. I was shocked. I'm 72 and in excellent health, with the exception of mild hypertension which is controlled by Lisinopril. My regular PSA readings are below 2.0. I do use bio-identical hormone replacement, so I have no issue with Testosterone. I will definitely get a second opinion, but I would greatly appreciate any guidance from others on this site.

Hi, and welcome. Enjoy this site and this group of guys, they're the best.

These docs...they all have their biases and their sometimes (ok...often) linear ways of thinking, like us all, and they're no better nor immune to all that. The challenge for patients of course is to press and pointedly question and challenge a guy who is one of the most educated and skilled professionals anywhere (and, not accustomed to being really materially questioned). Precious few of them enjoy being challenged. It kinks their egos. So patients become mostly deferential, we don't want conflict, we assume the physician knows best, and we mostly ultimately follow. This is not the healthiest of patterns. This is how perfectly functioning airplanes inexplicably fly into the side of a mountain.

I was with my urologist/surgeon (Levine, Chicago) for about 5 years of starting Trimix, and seeing it escalate minimally. It was still very effective when I was with him. Then due to insurance plan changes I was forced to find a new guy. I did...in a major university medical center...a well known and well respected guy. This new urologist saw me, in the next 3 years, blow through every remaining mix/concentration of Trimix, with really alarming speed. It still worked well, mostly, but it took more and more drug to get the same hardons and their quality and duration was steadily slipping, all the while bruising and fibrosis and significant pain from the prostaglandin. I kept asking new urologist about implants. He did them but god only knows who he reserved them for, because he saw me at this frustrating intersection of 9 years of Trimix, and he was well aware (because I repeatedly told him) that I was in a very highly physical/sexual relationship and my goal...MY GOAL...and expectation...not HIS goal...but MINE...was to the extent medically possible to make that continue. But he just had a fundamental bias against implants. His comments were always, "Listen, you really don't wanna do that".

Well, the fuck I don't, doc. The fuck I don't.

Better path would have been for him to say to me, listen, I'm not comfortable here. I'll explain why. I do implants but I reserve them for ________ (whatever...traumatic reconstruction? whatever) and in my practice I'm just not comfortable otherwise. That would have been fine by me. Say THAT. Then I know who, down to the bones, you really are, and how you think, and what you will and won't do. Now we're having a productive conversation that is bi-directional, not just doctor monologue headed toward a pre-determined point.

Another interesting thing...this second urologist...he prescribed Trimix but he really knew very little about it overall. When I was pressing the hell out of him on escalating dosing it was not the urologist ultimately but the out of state compounding pharmacy I had been using, who ended up showing their deep expertise. The pharmacy I used was run by a PharmD who was involved with the creation of Trimix. I sought this guy out. He's sort of semi-retired. We talked by phone. At my request, he called my urologist and schooled him on the various blends of injection. My urologist, on next office visit, says to me (to his credit) "yeah I talked to Terry (the PharmD) and that guys knows EVERYTHING about Trimix, wow, what a resource!". I wasn't with uro #2 here for that much longer...my insurance changed again and I immediately went back to Levine, with whom my rapport and conversations were just better and more balanced and open. And in truth...I absolutely knew logically and also in my heart that I was at the end of my run of getting from injections what I wanted and expected. I knew I was entering the frontier of implantation and I was happy to get back to Levine because of his reputation and track record implanting.

Upshot of this all being - you need to advocate tirelessly for yourself and not feel corralled into one guy's straight-line way of thinking...whatever that may be. This is tiring on our part as patients because there's some fairly exhaustive research and effort required to validate the uro, the surgeon, and then to intently check all that against our own sensibilities and needs. But it needs to be done, and we need to eject from guys who aren't hearing us, who aren't seeing us holistically.

Side note to anyone interested - the pharmacy and PharmD I mentioned - I'm happy to share their info and anything about them which might be of help to guys using injections. These guys are a really outstanding pharmacy and a wealth of information and experience due to their founder I mentioned above. Private message me if that info is of interest. I used several pharmacies until I found these guys and Trimix pharmacies are definitely NOT all created equal !