Psychological Therapy doesn't work. What about NoFap?

[Turtle]

I'm 28 years old. I met the first girl of my life 3 years and a half ago, and from that time I always had trouble maintaining or having erections.
For the first two years, I sometimes had erection for some minutes, sometimes it went away quite fast, and sometimes it didn't even start. Always seemed pretty random, and couldn't even ejaculate, not even from the flaccid state.
1 year ago I started therapy with a sex professional. I can say it helped me because I was able to sometimes ejaculate with my girlfriend, but the way the erections occurred stayed the same. This means that pretty randomly one day the erection could last 20 minutes and another day could last 0 minutes, or 5 minutes. All pretty random. Of course I could ejaculate only when the erection stayed good for at least some minutes.

In the mean time, I never had problems with masturbation. Tried nofap on and off for a period of maybe 6 months, but nothing changed.

Today the therapist basically said that there is nothing more he can do. He teached me autogenic training with the purpose of decreasing anxiety levels and enabling erections and ejaculation.

The problem is that the way my penis behaves with erections stayed exactly the same in these 3 years. I don't know what to do apart from keep doing autogenic training.

What about resuming nofap? What can I do to save myself without taking pills? I would like to not depend on pills since the logistics of pills can be pretty annoying, and also side effects.

The therapist said that he doesn't approve nofap because the penis is something like "use it or lose it", and prolonged periods of time of neglect might be harmful. He says I should fap once per week max.

What can I do?

[Txagq8]

I won’t argue that what you describe sounds pretty psychogenic in origin.

But just out of curiosity have you seen a urologist/endocrinologist for a full and complete workup?

Yes, the mind is powerful and can do a lot of things to kill the ability to interact sexually.

But the body, it’s hormones and chemicals, can do as much if not more damage.

Excessive prolactin levels. Too much adrenaline. Not enough testosterone. Enough testosterone but too much estradiol. A benign tumor in the hypothalamus. All sorts of weird shit.

I doubt that giving up masturbating is an answer. Normal, for most men, is as much sex as possible with a fair amount of self abuse too.

If you haven’t been gone over with a fine toothed comb by the medical doctors, it’s overdue. If that checks out clean, and the therapist you have is at a loss to make any progress, find a different therapist.

Not a doctor, so what I’m telling you isn’t medical advice. I’m encouraging you to seek out medical advice. The function you describe isn’t exactly normal. Neither was mine, for that matter. The goal ought to be to restore you to as close to a more or less normal average male in terms of sexual function as is possible. To find out why, doctors and therapists are going to have to look well beyond the obvious. If the problem were obvious and easy to discern, you could have it done at a drive thru window. Matters of sexual function are a lot tougher to diagnose than a hangnail or a case of hemorrhoids.

[Turtle]

I won’t argue that what you describe sounds pretty psychogenic in origin.

But just out of curiosity have you seen a urologist/endocrinologist for a full and complete workup?

Yes, the mind is powerful and can do a lot of things to kill the ability to interact sexually.

But the body, it’s hormones and chemicals, can do as much if not more damage.

Excessive prolactin levels. Too much adrenaline. Not enough testosterone. Enough testosterone but too much estradiol. A benign tumor in the hypothalamus. All sorts of weird shit.

I doubt that giving up masturbating is an answer. Normal, for most men, is as much sex as possible with a fair amount of self abuse too.

If you haven’t been gone over with a fine toothed comb by the medical doctors, it’s overdue. If that checks out clean, and the therapist you have is at a loss to make any progress, find a different therapist.

Not a doctor, so what I’m telling you isn’t medical advice. I’m encouraging you to seek out medical advice. The function you describe isn’t exactly normal. Neither was mine, for that matter. The goal ought to be to restore you to as close to a more or less normal average male in terms of sexual function as is possible. To find out why, doctors and therapists are going to have to look well beyond the obvious. If the problem were obvious and easy to discern, you could have it done at a drive thru window. Matters of sexual function are a lot tougher to diagnose than a hangnail or a case of hemorrhoids.

Yes, I've seen several doctors. One urologist, two andrologists, spoken briefly to another one too. I checked Testosterone and prolactine levels and they were in the normal ranges.

I don't know if I should re-check those levels in the case that the first and only analysis I did was somewhat not exact.

All andrologists think my problem is psychogenic without doubt. The urologist proposed that I should check my penis with an invasive exam that consists in injecting a substance directly in the penis in a controlled environment to check blood flow, but the doctor at the hospital who was supposed to do this flat out refused because I had no "risk factors" like age, smoke, substance abuse or inability to masturbate. He too was convinced it was all psychological

I myself was convinced that the problem was at least partially biological in nature, in a way that only with the power of porn I could get an erection surpassing this mild biological problem. But everyone says it's just anxiety. So I really don't know. At least I can masturbate without problems.

But you mentioned two hormones that I didn't check for: adrenaline and estradiol. In truth, I didn't speak to an actual endocrinologist. Maybe I should dig more deeply.

[Flavio]

Yes, I've seen several doctors. One urologist, two andrologists, spoken briefly to another one too. I checked Testosterone and prolactine levels and they were in the normal ranges.

I don't know if I should re-check those levels in the case that the first and only analysis I did was somewhat not exact.

All andrologists think my problem is psychogenic without doubt. The urologist proposed that I should check my penis with an invasive exam that consists in injecting a substance directly in the penis in a controlled environment to check blood flow, but the doctor at the hospital who was supposed to do this flat out refused because I had no "risk factors" like age, smoke, substance abuse or inability to masturbate. He too was convinced it was all psychological

I myself was convinced that the problem was at least partially biological in nature, in a way that only with the power of porn I could get an erection surpassing this mild biological problem. But everyone says it's just anxiety. So I really don't know. At least I can masturbate without problems.

But you mentioned two hormones that I didn't check for: adrenaline and estradiol. In truth, I didn't speak to an actual endocrinologist. Maybe I should dig more deeply.

Your post is a bit vague but yes, more medical tests are definitely a good idea. I find it strange that they didn't check your estradiol levels. Anyway, getting a second opinion is always a sensible thing to do and doctors are there to help us.

Sticking needles in the penis is not, however, a good idea. It's too early for that and there may be side effects, e.g. penile fibrosis.

If this is a case of psychogenic ED, it is easily treatable.

Check out this excellent article by Tom. F. Lue:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837321/

[Frank Talk Admin]

I really think you need to go to sexual medicine specialist. Urologists are surgeons and their approach is going to be fairly invasive. Also, endocrinologists do not have as much training and testosterone management as you might think. Most of them are very conservative in their approach. Do you happen to know your testosterone number? You also need to know the free testosterone. There are several complicating factors in dealing with testosterone where the total testosterone might look perfectly fine but that is not always indicate what is going on. Also do not ever let Dr. give you the "normal" line. Always know your numbers. For some doctors who are not trained anything over 300 is normal. 28 testosterone should definitely not be in the 300s. Also there is no way to test for adrenaline as far as it affects your penis.
Just from your writing I'm going to say I would like you to see someone about getting a diagnosis whether or not you have an underlying general anxiety disorder.
I'm curious about who the sex professional therapist was. I am glad they were ethical enough to say they could not help you anymore but they should have referred you instead of just dropping you. That is what they are supposed to do by a code of ethics.
I really would encourage you to not use the terms "in your head" or "psychogenic". Those are both unhelpful ways of looking at the situation. If they are anxiety-based, I want you to realize it means your body is behaving exactly as it is supposed to. Under extreme duress, the body absolutely should Cheryl of the penis so that you can fight or run. But we need to do is relearn how to have sex. Most men are performing and not playing. Because no one ever taught anyone how to have sex, most men are reproducing some version of a porn scene when they have sex. For example Bossman make out, play blues, do oral sex, penetrate, try to give her an orgasm you have an orgasm and then that is it acceptable and perfect sex scenario. That is not great sex. It's a great porn scene.
So please find a sexual medicine specialist who is going to specialize in your testosterone levels. But first, you must become an expert in testosterone. A colleague of mine, Nelson Vergel, just wrote a book which is basically a compilation of years and years of his work. It is free and downloadable here https://www.excelmale.com/forum/threads ... one.20174/
no, I have no connection with him financially at all. He's just a good guy

But overall if your masturbation erections are perfectly fine and for sex they are not great, it is probably caused by anxiety. Anxiety is a medical condition which must be treated. The best treatment for anxiety is medical intervention combined with talk therapy

Paul

[544kenmatt]

Not sure about the "use it or lose it" advice. Most guys with erectile function will have spontaneous erections throughout the day and night. As someone who had/has psychogenic ED throughout his life, I would say it has been a major struggle. As I got older, (50s) nobody questioned the source of my problem and doctors were more than happy to prescribe pills or injections for me.
The shots gave me the confidence of a guaranteed erection and opened up a whole new world for me. I understand that it comes along with potential side effects. When it came to getting an implant, again, no body questioned whether my problem was physical or mental ( it was a little of both.) so, I guess this is one of the few advantages of aging. No Fap seems like it would work in theory but it has to be very hard to abstain for such long periods. I to believe that porn has caused or exacerbated ED in many men, including myself.

[Turtle]

I really think you need to go to sexual medicine specialist. Urologists are surgeons and their approach is going to be fairly invasive. Also, endocrinologists do not have as much training and testosterone management as you might think. Most of them are very conservative in their approach. Do you happen to know your testosterone number? You also need to know the free testosterone. There are several complicating factors in dealing with testosterone where the total testosterone might look perfectly fine but that is not always indicate what is going on. Also do not ever let Dr. give you the "normal" line. Always know your numbers. For some doctors who are not trained anything over 300 is normal. 28 testosterone should definitely not be in the 300s. Also there is no way to test for adrenaline as far as it affects your penis.
Just from your writing I'm going to say I would like you to see someone about getting a diagnosis whether or not you have an underlying general anxiety disorder.
I'm curious about who the sex professional therapist was. I am glad they were ethical enough to say they could not help you anymore but they should have referred you instead of just dropping you. That is what they are supposed to do by a code of ethics.
I really would encourage you to not use the terms "in your head" or "psychogenic". Those are both unhelpful ways of looking at the situation. If they are anxiety-based, I want you to realize it means your body is behaving exactly as it is supposed to. Under extreme duress, the body absolutely should Cheryl of the penis so that you can fight or run. But we need to do is relearn how to have sex. Most men are performing and not playing. Because no one ever taught anyone how to have sex, most men are reproducing some version of a porn scene when they have sex. For example Bossman make out, play blues, do oral sex, penetrate, try to give her an orgasm you have an orgasm and then that is it acceptable and perfect sex scenario. That is not great sex. It's a great porn scene.
So please find a sexual medicine specialist who is going to specialize in your testosterone levels. But first, you must become an expert in testosterone. A colleague of mine, Nelson Vergel, just wrote a book which is basically a compilation of years and years of his work. It is free and downloadable here https://www.excelmale.com/forum/threads ... one.20174/
no, I have no connection with him financially at all. He's just a good guy

But overall if your masturbation erections are perfectly fine and for sex they are not great, it is probably caused by anxiety. Anxiety is a medical condition which must be treated. The best treatment for anxiety is medical intervention combined with talk therapy

Paul

Firstly, about numbers, I actually dug up the old analysis and found out that Beta-estradiol also was tested. Also TSH, FT3, FT4, FSH/S. Free Testosterone too. Everything was in the normal ranges given by the laboratory in which I did the testing. I don't know if they are reliable, I think so because they should be statistically computed from a number of patients who did a blood test in that structure. I remember also googling the ranges, finding out conflicting informations. I can post the numbers, should I?

About the sex therapist, maybe I worded it wrong. The last time I saw him, he said at the end of the session "are we going to see each other again?" and I said that maybe it will be difficult since I'm currently starting a new job so I will have less time, and he said "I'm happy you want to continue seeing me". Which I interpreted as "I don't have much more to give you apart from just talking about it". The point is that in the last sessions I really just kept saying the same things and he also kept replying the same things about sex. It's anxiety, I have to do autogenic training to calm myself before the encounter with the girl, this and that. I don't feel like I'm improving, erections behaved exactly the same in the past 3 years (therapy duration is currently about 1 year, maybe a bit less).
The big improvement is that I gained the ability to ejaculate. For the first 2 years it seemed impossible to me. When I managed to the first time with my girlfriend it was mindblowing. It would be perfect if my penis behaved correctly.
So it's not like he dropped me, but from his words and his body language I gathered that he doesn't know what to do apart from waiting maybe.

I'm confused about "sexual medicine specialist". I don't really know how it translates in my country. I'm in Italy and there are "andrology" specialists who specialize in male fertilty, erectile disfunction, delayed ejaculations... in short all sex problems of the male human being. Are you referring to these kind of doctors?
As I said I visited two of them, and they both told me to see a therapist, while prescribing erection pills.

it doesn't help that I'm also currently going through a breakup with said girl. The relationship ran its course I guess, which is sad but fine, but I will be left without the chance to try again and again to have sex to gauge improvements or lack of them.

[Flavio]

(…) I to believe that porn has caused or exacerbated ED in many men, including myself.

I couldn't agree more. Porn has nothing to do with real life sex, it is fake, filthy and generates more anxiety in men.