Second time a bit better

[Griz747]

Well I increased the trimix dose to 20, used the longer needle and got a slight improvement. Wife was happy, even with me not all the way there. Plan is next time to up the dose to 30 and see what we get. At what point if i am not back to full strength do i go for quad mix i think its called. Thanks for your support.

[bldoink]

What is the strength of your current mix?

[flyingduck2019]

bldoink is correct. Also, I would not increase more than 5 units each time. You could end up in the ER in a very uncomfortable position! You can see my strength in my signature. It is what I started with and still use today. My first "stick" in the uro office was 20 units and gave me a steel towel rack in about 5 minutes but with a terrible cock head ache. I have since found that 10 units gives me the same towel rack that lasts for about 2 hours with very little head ache. 5 units for a solo flight of 30-45 minutes.

[Griz747]

according to the vial my actives are Alprostadil 6.51 micrograms/ml Papavenne 17.73 miligrams/ml and Phentolamine Mesylate 0.5907 miligrams/ml

Not sure if this is a strong mix. Went up to 30 units and must of missed cause nothing. I would of thought of my being an EMT in the army would of helped me get the injection right. Life goes on

[bldoink]

That's a weak starter mix. Your technique should improve with practice. Be sure to read as many older posts in the injection sub-forum as you can as you'll find many technique suggestions.

[stephen54]

according to the vial my actives are Alprostadil 6.51 micrograms/ml Papavenne 17.73 miligrams/ml and Phentolamine Mesylate 0.5907 miligrams/ml

Not sure if this is a strong mix. Went up to 30 units and must of missed cause nothing. I would of thought of my being an EMT in the army would of helped me get the injection right. Life goes on

No, it is the opposite of "strong".

Your mix is unfortunately comically weak and it leads me to question your physician's knowledge base on injections (or, their assertiveness/confidence). Or both.

I'm not sure if you've posted prior explaining your process with your physician and what that dialogue has been like, and - critically - what your physician's particular experience and comfort levels are with injectable ED drugs...but before you resign yourself to injections not working as you'd like them to work, please set aside some time and really read through posts here relating to dosing and the blends of drug guys use. There is an encyclopedic treasure trove of information and experiences. Set aside a couple hours, take notes, and get back with your physician ASAP with the goal of identifying a proper starting dose and a reasonable step-wise approach to titrating you up to the drug concentration and drug volumes which will give you your desired effect. Not your physician's desired effect. Yours.

Below was my 9 year trajectory with TriMix. And while I ultimately walked away from injections and went implant last year, I had almost a decade of success with TriMix. Over 7 of those years was pure superman stuff - ridiculous steel bar hardons which went forever. The kind of hardness and duration that, unless you experience it, is really difficult to believe possible and difficult to even adequately explain.

Consider the following:

Papaverine / Phentolamine / Prostaglandin (Alprostadil)
mix #5: 30mg 1mg 10 mcg's - my starter dose
mix #8: 30mg 2mg 20 mcg's
mix #9: 30mg 4mg 40 mcg's
mix #13: 30mg 6mg 60 mcg's
mix #16: 30mg 6mg 100 mcg's

I think you'll usually see the three drugs expressed in the above order on most vials (alphabetical by default).

Your so-called starter dose is, roughly, half what I started on. Everyone is different, of course, and your mileage will vary compared to mine and everyone else's for that matter. So I'm just sharing this with you so you can scrutinize and consider...at least directionally...whether your physician is or is not familiar enough and capable enough with managing TriMix to meet your needs and your expectations.

I was on my starter dose for several years, maybe around 4 years give or take. I began at 20-25 units and, over a prolonged period of time, with drug tolerance developing as it commonly does, I found I needed to work myself up to increasing volumes of this same starter mix in order to maintain the same effects. And the effects are glorious. Once you know what's possible...you cannot un-know it. You'll very much want the magic hardons you've now been experiencing.

When I got to a full syringe (100 units or 1ml) my physician, with the strong advice of my extremely competent compounding pharmacy, moved me up to the next mix. That next mix was double the phentolamine and double the alprostadil. So I started at 50 units. This takes some getting used to but if you think about it, a blend with double the drug concentration, given at 50 units, is equivalent to a dose that's half the concentration at twice the volume. Hope this makes sense. Starting below 50 units on the next mix would in this case have effectively delivered less drug vs where I was at prior, which of course is nonsensical. I share this because, in the early going, I had an aggressive compounding pharmacist (a PharmD who was actually one of the pioneers of bringing TriMix to market...a guy who literally wrote and conducted the clinical trials) who had to school my urologist on relative potencies, etc.

Don't presume your doc, whether a urologist or primary care or endocrinologist or whomever...is necessarily blessed with some esoteric knowledge of how to effectively manage injections. My urologist at the beginning, after having what he said was a long conversation with my PharmD, told me he was blown away by the level of knowledge from the pharmacy and by what he...the urologist...had learned. And while I'm not with that urologist any longer, I give him credit because no part of me believes that most physician specialists will easily or openly acknowledge that a pharmacist taught them something.

So please...make sure you really get up to speed with as much information as you can...and then, armed with tangible information and with diligent notes...challenge your doc. Be aware that he or she is unlikely to enjoy being challenged. That is not in their DNA, most of them. But you are entitled to a robust, open dialogue with your physician. If they behave in a way which is contrary to an open, constructive dialogue...find a new doc with haste. There are docs out there who really know their shit with this stuff, and I just advise you to not spin your wheels with someone who lacks either the requisite confidence or the required knowledge to drive you forward to your goals.

If you would find value in connecting with my prior pharmacy/pharmacists, send me a message and I'll connect you.

Good luck. Press on. Push your doc hard.

[T-Bone]

stephen54, that is one interesting summary of your decade with injections, I'm about 2 years into the use of these medications, in my early 50s, I'd like to ask you about 50 questions after reading this post, very informative, I'm definitely going to take a look at your past posts when I have time, now you have me pondering the question of how many drop out of injection treatments because their urologists and doctors are uninformed

[stephen54]

stephen54, that is one interesting summary of your decade with injections, I'm about 2 years into the use of these medications, in my early 50s, I'd like to ask you about 50 questions after reading this post, very informative, I'm definitely going to take a look at your past posts when I have time, now you have me pondering the question of how many drop out of injection treatments because their urologists and doctors are uninformed

Hey T-Bone:

Thank you for your note. I'm by no means an expert and there are as many experiences with injections as there are guys out there...just happy to share what I've come up against and how I've navigated through to anyone where it may help.

Spent my career first in pharma and now in medical devices, so I've been close to physicians for a lot of years and in my opinion that is one of the most difficult angles to all this - what I mean is, the difficulty inherent in a lay person successfully challenging the physician's default ways of thinking and working to get them on board with you as an individual and what you specifically are experiencing. The best and brightest and most capable of them can absolutely get blinders on and get stuck in linear ways of thinking. Or, worse yet, their egos just won't let go and allow a patient to question things. Most physicians don't react favorably to being challenged, even when it's done politely and with serious research/backup/data coming from the patient.

So a big part of the equation is also knowing when to simply cut bait and move on and find the doc which is the right personality fit for you and the right clinical fit for your personal goals.

Happy to chat anytime, take good care.