My Story

[Hooper85]

Hello,

I’m writing as I’d like to introduce myself and gain some valuable insight and knowledge from this community.

About me: 36 years old, recently married— not much sexual experience before marriage (come from a conservative background).

Noticed that sex life in my short marriage has been mediocre to bad, mainly because of my inability to sustain a lasting erection for even a few minutes. Another thing is it’s also position dependent where it’s almost impossible for me to sustain an erection with me on top.

Went to a new PCP and he prescribed Viagra 50mg. Taken it on four separate occasions and only once had satisfactory results. Also did some blood work and noted I have a low but normal total testosterone result (324 in ref range of 200-800). I was also diagnosed with sub clinical hypothyroidism in July 2020 which now shows possible Hashimotos disease. I do notice that my interest in sex has lowered but I’m not sure if that’s due to Hashis.

I’ve scheduled a consult with a uro who works with sexual health next week.

All of this has been a shock to me as I never envisioned these issues before getting married and it’s severely impacting my new relationship.

Any advice or suggestions are welcome.

[wolfpacker]

Have you tried the Viagra while alone/masturbating? 50mg is the starting dose, have you tried doubling up to 100mg?

[GoodWood]

Welcome to FrankTalk. You will find a wealth of information here and will undoubtedly find others that have had experiences similar to yours. You’ll be able to learn what that did, what worked, what didn’t. That can be a huge help in determining what might work for you.

The good news is that there IS a solution. You WILL be able to get good erections again but it might take trying a few different things to get there.

You are doing EXACTLY the right thing by seeking treatment from a urologist that specializes in men’s sexual health. We can all share our experiences and there is a LOT of knowledge here, but a good relationship with a good doctor is key. One caution is this: if they offer you medication that you can ONLY purchase through them do your research and find out what the same medications would cost if you bought them from other reputable sources. Just make sure you aren’t being charged exorbitant rates for medications you can legally buy elsewhere.

I mentioned to my GP when I was 40yo that I was having difficulties staying hard while wearing a condom and that was new. He prescribed Levitra and that worked well for a while. When that stopped working a few years later I saw a urologist and started on injection medications. Those have served me well for several years now. I’ve needed to continue to adjust my dose from time to time but I’ve had a satisfying sex life with good erections. I’m 52 now and still happily married. I continue to work with my doctor to make sure everything is working the way I want it to. So far so good.

So checkout the different subheadings on the forum. There are years and years of useful posts. Dig in and start to learn all you can. It will help your working relationship with your doctor.

[Hooper85]

Have you tried the Viagra while alone/masturbating? 50mg is the starting dose, have you tried doubling up to 100mg?

I have not. Do you believe doubling dosage will yield better results?

[Benjohn]

Have you tried the Viagra while alone/masturbating? 50mg is the starting dose, have you tried doubling up to 100mg?

I have not. Do you believe doubling dosage will yield better results?

Absolutely. Never works for me on 50mg, but I've had a decent hit rate with 100mg.

[Martin6469]

Hooper85: You indicate that your libido is low. I would get that fixed first. I've been on synthetic testosterone for 20 years, and I get low libido when T level gets below 300 or so. I like to keep it around 500 where all is well (too high could cause prostate cancer). Know that testosterone does more than affect libido and erections: proper level keeps energy and mental attitude and optimism up.

[Hooper85]

Hooper85: You indicate that your libido is low. I would get that fixed first. I've been on synthetic testosterone for 20 years, and I get low libido when T level gets below 300 or so. I like to keep it around 500 where all is well (too high could cause prostate cancer). Know that testosterone does more than affect libido and erections: proper level keeps energy and mental attitude and optimism up.

Thanks. I have looked into T replacement. I was within the “normal” reference range but on the low side. Do you think this would be a good therapy in addition to the normal ED protocol?

[Martin6469]

The bottom of the normal testosterone range varies a little depending on which doc you see, but it seems to be around 230-250. But when I get in the 300s, I have less energy and feel a little depressed and don't think clearly. Then getting up around 500 changes me entirely; I'm back to my energetic and optimistic self. (There may be guys who respond differently, though, not everyone's the same; your "fade-out" number could be different.) I would shoot for 500, but get your doc's advice; he will monitor your level over some months, to calibrate your dose. Synthetic T works fast, 24-48 hours, and it comes in many forms, your choice. I like the pharmacy-compounded gel that you smear on your skin once a day; it's one of the cheaper forms. Don't try self-medication with the phony "testosterone" out there; you wouldn't know what you're getting, and of course you can't get a blood level reading.

So I would get T fixed first. You want to be thinking well before going into the involved choices of ED treatments. There's also your wife. If you're like me when I get low T, I'm much more likely to get into arguments with my wife. Then when I'm feeling ok, I apologize and wonder how I could have been so dumb!

[Hooper85]

Update.

Visited a Uro who works with sexual health.

He ordered up blood work :

FSH LH— result is 11.1 FSH and 4.0 LH
Testosterone total— result is 225 ng/dL (last month tested in the 340s)
Prolactin— result is 6.67 ng/mL

Doc believes the issue is hormonal and due to low T. He said a Doppler test isn’t necessary right now and prescribed Cialis and also wants to start Clomid 25mg immediately.

Thoughts?

[Simbarn]

Update.

Visited a Uro who works with sexual health.

He ordered up blood work :

FSH LH— result is 11.1 FSH and 4.0 LH
Testosterone total— result is 225 ng/dL (last month tested in the 340s)
Prolactin— result is 6.67 ng/mL

Doc believes the issue is hormonal and due to low T. He said a Doppler test isn’t necessary right now and prescribed Cialis and also wants to start Clomid 25mg immediately.

Thoughts?

225 is a concern. I am glad he is trying you on a SERM first before jumping on to TRT. Do some research on Enclomiphene citrate. It is the single isomer version of clomid(less side effects). If you are in the US, I think DEFY medical can supply this. It is the Zuclomiphene side of Clomid that gives men all the unpleasant side effects.
Clomid still works to raise T levels, but many men don't feel the benefits due to how it affects E receptors.
If your doctor is trying to push the pituitary to produce more gonadotropins, with the hope of it maintaining that new level after discontinuing the drug, a very long gradual taper is crucial.