My story and whether I should consider an implant

[Simbarn]

Thanks for the response. Yeah so it is no different masturbating. With myself erectile function is just as bad, maybe even worse. I have a very hard time getting an erection and keeping it. I have some form of arousal problems since stopping the AD for sure and probably some nervous system issues since I tend to get a lot of muscle spasms I’ve noticed as well. It could be hard flaccid or pelvic floor issues as well spawned by discontinuation. I do sometimes have nocturnal erections as I will half wake up in middle of night to one but never have morning erections or spontaneous erections throughout the day.

As you mention muscle spasms, I feel even more strongly that you should investigate a possible pelvic floor dysfunction.
It is also possible IMO that since stopping the antidepressants, arousal in the brain itself may be affected simply because the elevated levels of particular neurotransmitters have changed.
Your body had become accustomed to a new balance of neurotransmitters for 5 years, which is not a short period. You then suddenly altered that delicate balance. It has not been able to return to those settings, so to speak.
This happens with hormones very clearly if they are interrupted.
The lack of arousal could indicate a persistent low level of depression that is still evident.
Did the doctor try and run the same antidepressant you had discontinued again for a reasonable period to see if the body was able to readjust to that, seeing it had become so accustomed to this? It was very interesting that you had no sexual issues whilst on this drug.

I also hope you have been able to see the gems that were in the posts by Lost sheep. I am sure your wife will be a lot more understanding than you may realise. Women are generally much more understanding about this than men without the issue.

I mention the consistent use of Cialis on a daily basis again, as you seem to be a bit hung up on the “planning issue”. In reality this is just a minor thing that can be adjusted too. My partner and I have planned for sex for years, it’s no big deal. Sex is just as fun and intense as if it were spontaneous.
Also sometimes in our very busy lives, you have to make time for sex and that involves planning too.
I was starting to experience some loss of sexual sensation at times before I began the everyday protocol with Tadalafil. I have noticed definite improvements with this over the past 18 months. There is also evidence that this class of drugs may have beneficial effects on the brain if used in this fashion.
Another fascinating development also, is that I have had asthma all my life, which was worse in my childhood. I have been on asthma medication throughout this time. Recently since being on the above protocol I discovered that I no longer needed that medication. My Asthma is virtually gone. It used to be particularly prevalent during exercise, where I would have to use Ventolin. This is no longer the case.
I have done more research on this since and found that asthma and ED are indeed linked.
I mention the above because quite often conditions in the body can be connected.

[Markc2008]

I am sure that I have messed up arousal in the brain from quitting the antidepressant. I’m just concerned that after a year and a half it would return to normal. I don’t think it is depression as I never had depression to begin with. I had anxiety from a sick wife years ago is why I got out on them. I know it’s something more than just depression as I hardly have any feeling in my penis and definitely nothing pleasurable there so something is going on. I can feel touch and hot and cold but sensation is dull. So could be an imbalance of chemicals since stopping but don’t know what to do to get my old life back. I’ve tried buspirone and wellebutrin to see if it helped and didn’t change much although wellebutrin Seemed to to be doing something positive longer I took it. But still not normal. I have not taken the viibryd again which is what caused all this to see if something improved. There have been cases of people getting worse trying to get back on the meds that causes these issues, so I have been reluctant. It is on my list to consider though if nothing changes.

[Markc2008]

One other side of this I think I failed to mention as much that had me kicking around the implant idea is that I have always been a shower. I was probably mid 4” flaccid roughly. Since the medication debacle I have shrinkage issues when flaccid which is as troublesome as the Ed and other issues. I don’t know if it’s some flight or fight reaction my body is doing, or lack or bloodflow because my libido is low? But It’s very troublesome and embarrassing. Most times this last year it’s drawn up and well below 3”. So that has been something I’ve been weighing in as well because I’d assume with an implant it would only be able to hang the size of the implant flaccid so it would eliminate that issue as well. For those that says who cares about flaccid size, I get it with a normal man. A healthy man when getting aroused by the time your undressing size is growing so who cares. Yet with me since I have arousal issues it’s still this small flaccid size when initiating everything so it is a big deal. Then it takes a lot of manual stimulation to work. So again, just trying to lay everything out there for the best advice.

[Bangkok12]

What you have might be pelvic floor dysfunction leading to hard flacid. try the therewand its helpful. calm the anxiety do pelvic floor stretches. and most importantly see a physical therapist that works of cases like hard flacid syndrome.

[Bangkok12]

Your body might have more estrogen happens when you quit certain medications i am a sufferer of this for over 2 years now. get your blood work done. then start physical therapy.
you can contact me if you need to know more i have the same problems as yours.

[Markc2008]

While I think I could have a variation of hard flaccid from stopping antidepressants, I don’t think it goes beyond that. I have labs regularly with trt, and my estrogen is within range. All my levels are good. I do need to try more exercises for pelvic floor but there is more going on. I have no libido at all

[Simbarn]

I am sure that I have messed up arousal in the brain from quitting the antidepressant. I’m just concerned that after a year and a half it would return to normal. I don’t think it is depression as I never had depression to begin with. I had anxiety from a sick wife years ago is why I got out on them. I know it’s something more than just depression as I hardly have any feeling in my penis and definitely nothing pleasurable there so something is going on. I can feel touch and hot and cold but sensation is dull. So could be an imbalance of chemicals since stopping but don’t know what to do to get my old life back. I’ve tried buspirone and wellebutrin to see if it helped and didn’t change much although wellebutrin Seemed to to be doing something positive longer I took it. But still not normal. I have not taken the Viibryd again which is what caused all this to see if something improved. There have been cases of people getting worse trying to get back on the meds that causes these issues, so I have been reluctant. It is on my list to consider though if nothing changes.

If you did not have depression, I do wonder why the doctor put you on a drug designed primarily for major depressive disorder? It was researched for use in anxiety for a short period then that was terminated. There are other SSRI'S out there that are indicated for anxiety.
As you were obviously diagnosed with anxiety, you could still be having problems with this? I was not aware that this was your primary issue.
Anxiety causes levels of catecholamine’s in the body to be in excess. This can be a major problem for erections and it can also inhibit pleasurable sensation in the penis. You could be prone to anxiety during sex, and this will cause the inhibitory mechanism in the penis to be dominant.
If norepinephrine in the penis is constantly being stimulated, the NO pathway will be subjugated consistently. Inhibition of the NO-CGMP pathway reduces blood flow and possibly also sexual sensation in the penis itself due to a lack of NO.
Your PE is also consistent with a possible sympathetic dominance occurring in your nervous system caused by anxiety’s. Sympathetic hyperactivity has been suggested to reduce ejaculation control and promote PE. So it is quite telling that you have developed PE since quitting that antidepressant.

Anxiety can also cause pelvic floor issues. Pelvic floor issues may exacerbate the problem further compressing nerves and blood supply to the penis. This may also cause your penis to look smaller when flaccid.
The sympathetic hyperactivity in your nervous system will also contribute to the penis being in a more contracted state during the day.
Since quitting that particular antidepressant, which had a calming effect on your nervous system, your nervous system could be stuck in an elevated sympathetic state.
Your body had become adjusted to a particular level of serotonin, due to the AD keeping it at that level for a number of years. This was suddenly withdrawn. Receptors may be in hypoactive state.

Neurotransmitters responsible for sympathetic function may be elevating catecholamine’s more readily in stressful situations, since quitting the AD. This will definitely adversely affect erections and most probably sexual sensation. The two can be tied together in sexual function as I mention above.
The two AD’S you mention trying since being on the first antidepressant; Wellbutrin and Buspirone, are very different and work in different ways. This will not replicate the balance of neurotransmitters you had with the initial AD. That level of serotonin you had was not replaced with the above two drugs. Wellbutrin can cause anxiety in some people and may further exacerbate a problem with sympathetic hyperactivity, the last thing you may actually need.
I ask again, did your doctor suggest putting you back on the drug that you were initially on to see if that “working” balance of brain chemicals could be reinstated?

Find a good sexual health doctor. Not a urologist. Someone who is capable of exploring all of these things in detail. I am also not sure if all your hormones have been assayed to make sure an imbalance here is not causing an issue, such as prolactin.

IMO an implant is not something you should be considering now. There are many things that could be tried first with the help of a competent sexual health physician. There could be absolutely nothing wrong with your penis and it would be a cause for regret to destroy its internal parts if the problem can be rectified with other means.

Since writing the above, I see you have just posted that you are on TRT? Another complicating factor. How long for, why, and how is it being administered?

[Markc2008]

My dr put me on an ssri for anxiety taking into account I also had PE and they are used off label for that as well. I know now my anxiety was normal, I was young, had a sick wife with type one diabetes that was killing her. I shouldn’t have taken anything for that. I have not reinstated the viibryd because I was terrified to. I’ve read so much on pssd from ssri usage and people getting worse reinstating I thought it was a big risk. I am on trt and I have been on it almost a year. When I was trying to find out what happened I found my total t was borderline low at 398 and free t was low as well. I’m not jumping to an implant right now, but wanting to mentally accept it is a possibility being that I have been basically impotent for a year and a half because of this when I had no prior issues. I’m in good health otherwise, not overweight, active and 37 years old. I know it is caused by the antidepressant usage and stopping suddenly because all this started within two weeks of stopping.I just don’t know what it did, or how to fix it. Oddly enough the only window of improvement I’ve had was with the wellebutrin. But not while taking it regularly. That did nothing, but while tapering off it and taking it every other day the rebound days I was better. This lasted for about a month after stopping then I was back to this. I just figured logically if a medication doesn’t fix this, which drs don’t want to just dole out medication for what I have going on because they don’t understand it and some may not believe it, and if I don’t get better naturally, which creeping on two years is starting to be a long shot. I don’t know what other approach bypasses all my issues other than libido?

[Simbarn]

My dr put me on an ssri for anxiety taking into account I also had PE and they are used off label for that as well. I know now my anxiety was normal, I was young, had a sick wife with type one diabetes that was killing her. I shouldn’t have taken anything for that. I have not reinstated the viibryd because I was terrified to. I’ve read so much on pssd from ssri usage and people getting worse reinstating I thought it was a big risk. I am on trt and I have been on it almost a year. When I was trying to find out what happened I found my total t was borderline low at 398 and free t was low as well. I’m not jumping to an implant right now, but wanting to mentally accept it is a possibility being that I have been basically impotent for a year and a half because of this when I had no prior issues. I’m in good health otherwise, not overweight, active and 37 years old. I know it is caused by the antidepressant usage and stopping suddenly because all this started within two weeks of stopping.I just don’t know what it did, or how to fix it. Oddly enough the only window of improvement I’ve had was with the wellebutrin. But not while taking it regularly. That did nothing, but while tapering off it and taking it every other day the rebound days I was better. This lasted for about a month after stopping then I was back to this. I just figured logically if a medication doesn’t fix this, which drs don’t want to just dole out medication for what I have going on because they don’t understand it and some may not believe it, and if I don’t get better naturally, which creeping on two years is starting to be a long shot. I don’t know what other approach bypasses all my issues other than libido?

Mark, I think you misunderstood my question. I was not questioning that you were put on an SSRI, I was questioning why they put you on that particular drug. It was indicated for someone with a major depressive condition and not necessarily indicated for anxiety. There are other antidepressants better suited for anxiety. When I read about the medication I just found it odd that this was prescribed. Not that this is of great importance now, we can’t turn back time.
I mentioned the reinstatement of the original drug, as from what I understand if someone suddenly stops an AD and has significant issues, normal protocol is for them to be put back onto that exact drug for a period of time to allow the body to find homeostasis again quickly. Once this is achieved, then the drug can be slowly discontinued to give the body time to adjust. Putting a completely different medication into the system could either create more chaos or have little beneficial effect.

It is interesting and a little concerning that you were put on testosterone just 6 months post the use of this drug.
What were the ranges of the Total T tests you did as 398 is not that awful a result, if the ranges were standard? How many morning tests did they do?
How are you taking the testosterone and what amount? If TRT is not done well, it can also add to your sexual function issues considerably. This is why I said earlier “another complicating factor”. Whatever you do now, will be further complicated by the addition of another big change in your body; suppression of your natural hormones.
What benefits have you got from being on TRT? Did you have symptoms of low T before it was prescribed as you haven’t really mentioned any of that?
Was any attempt made to try and boost your natural production with a SERM before T replacement was undertaken? Always preferable in a younger person.

There is one thing that needs to be said when TRT is being discussed. This is; that the shutdown of LH and FSH can negatively affect sexual function in some men, especially younger men.

[Markc2008]

Yeah I agree I should have probably reinstated the viibryd but I also don’t know if it is worth doing a year and a half later? My free T best I remember was 6. The ssri was used for premature ejaculation off label and anxiety. Yeah don’t know that helps now but that was the case. My protocol was 200mg/ml .24ml 3x a week and 350iu hcg three times a week with .125 anastrazole twice a week but I recently changed due to hair thinning and eliminated the hcg and anastrazole and lowered test dose to .20ml three times a week. I had some very slight libido improvement when starting that faded but I would say it seems to have improved erection quality some. Although since I’ve been on it a year now I have talked to the dr about coming off and seeing where I’m at naturally again. He wanted to simplify protocol first for a couple months and see how I felt and reacted. If this doesn’t help with everything I will be coming off and doing clomid for several weeks to restart natural production. But regardless before and on trt I’ve pretty much had the same issues from ssri. Still not in a good spot with function or desire.