Injury from jelqing - sharing and support are appreciated

[Fourtytwo00]

Doppler ultrasound has been performed lying down. Docs are reluctant to prescribe other exams if they find nothing and blood flow looks OK for them. Expecially if you're under 50 and look healthy. At least they wait a little.
Cavernosography is considered al little bit old fashioned compared to doppler ultrasound by many andrologists. Eventually they could consider an angiography (sort of) but not now.

[Simbarn]

Thanks Simbarm.

I'm not in the US. I'm writing from Italy.

About TRT: I don't have the right number now but my testo and LH were so low that fhe first thing I had to do was a MRI to check hypophysis. My head is ok so the urologist basically gave me two options: trying gonadotropin or testosterone injection. He didn't gave me many information and I went for gonadotropin just to avoid some side effect of testosterone injection. Gonasi 2000 UI two times a week. It's like Pregnyl. Last Saturday I checked it. It's 8.51 ng/ml which is sky high and LH is 0.07 so my urologist told me to do just 1 injection a week (2000 UI).

I see. I have no idea how the standard of treating low T is in Italy. I have found that much of the advances of understanding low T and modern treatment protocols seem to be in the US.

With respect to your description it sounds like your T level and LH and FSH were well below the lower range and I assume they repeated the tests on a number of occasions in the early morning?
By "hypophysis' I suppose you mean a tumour in the pituitary? Good to know that the MRI did not reveal that.
Treating low T with HCG is not usually very successful. That amount of HCG a week in one large injection usually causes estrogenic like side effects ranging from nipple issues, ED and the very thing you are trying to fix, sexual numbness and dysfunction. I have spoken to many guys over the years who have tried HCG monotherapy and it does not deliver the same effect as exogenous T and HCG combined. I also tried it myself. They also do not take it as your doctor has prescribed, the better method is to inject small amounts more frequently (250-300iu) to avoid these side effects. Injecting a large dose of 2000iu for an extended period has been suggested to desensitise the leydig cells in the testes to your own LH, possibly even causing some form of primary hypogonadism. I know of one very experienced HRT doctor in the US who consistently said to never inject more than 500iu of HCG in one dose. The initial dose of 4000 iu of HCG a week is more than excessive.
IMO most urologists are not very good at hormone issues.

If it were me as I cannot give you medical advice, I would have tried SERM therapy first to try and give the pituitary a push to produce its own gonadotropins again in higher amounts. This is far preferable in a young man; a life on TRT is the last resort if all else fails.
As your sexual dysfunctions have suddenly occurred after your supposed jelqing injury, I find it even more concerning that that the above doctor has further suppressed your natural hormonal system with HCG. Clomiphene citrate (SERM) should have been tried first, especially as your LH was low. A sudden form of stress on the body such as depression caused by your worry about your sexual dysfunctions can cause issues with your hormonal mileu. You may have had a semi low natural level of T normally, some men do. Their bodies are more sensitive to testosterone and they need less.
Do some research on Enclomiphene citrate. It is the single isomer version of Clomiphene citrate and has been shown to elevate gonadotropins without the side effects of Clomiphene.

About Shockwave (Li-Eswt): the purpose of the treatment was to strengthen erections. Now I figured out a different answer: money. My urologist when I say that even 10mg tadalafil makes me nothing tends to say "it's in your mind", "it's almost impossible to self damage without a major trauma" and so on. Here shockwaves treatments are cheaper compared with the US and could be refunded by insurances. Academic literature on the subject usually do not report significant adverse effects. It's not invasive and in case of mild ED *can* be beneficial. So it's a cheap shot. With hindsight it's inconsistent with his diagnosis (hormonal and psychological issues). And usually academic studies are performed with people fulfilling some sort of criteria which usually need several tests. Btw I'm gonna have doppler ultrasound with a different doctor.

I tend to agree with you here. Shockwave was probably not warranted and was a stab in the dark. I’m glad you sought another opinion. I do not agree that it is “almost impossible for you to self-damage without a major trauma.” Jelqing is a form of cumulative self-damage and most urologists agree it causes damage. It would not be classified as major trauma. Aggressive masturbation practices can also cause problems in the penis and pelvic floor.
A doppler ultrasound is not going to show neurological issues. The vasoactive injection that is used bypasses neurological stimulation of erection and directly relaxes smooth muscle in the penis so an erection occurs. These tests really only show if the penis still has adequate smooth muscle to enable full expansion in the corpus cavernosum and if the tunica albuginea is not compromised or damaged and if the cavernosal arteries are capable of suppling enough blood flow. I do not think they can show if there are dysfunctions with the endothelium and the NO pathway or if there is excessive adrenergic activation in the penis or if there are issues with neurological function. It is also possible IMO that the penis injections stimulate smooth muscle in the penis to relax in a manner which is beyond which normally occurs through NO activation.
This is evident in the fact that they are used once PDE5 inhibitors fail and they can generate a very strong erection in a considerably aged penis which would have a substantial degree of smooth muscle loss already. So are we testing the penis in false environment here?
Some urologists do not use phentolamine in the vasoactive injection used in these tests which makes them even more unreliable, as excessive NE may have a negative effect relaxing smooth muscle and this will show as CVOD or a venous leak as it is commonly called.

As I mentioned before I had two long and a little bit painful nocturnal erections. The first one a couple of days after a Shockwave session, the second one after my last Shockwave session 15 days later.
They lasted 2 and almost 3h. I maneged to resolve them peeing, running stairs, etc. After the second one my sensitivity dropped further. I can barely masturbate one time a week. I still have some sort of morning wood with few feelings. My mood is down and I was put on low dose quetiapine and trazodone (50/75mg and 37.5/12.5mg) for sleeping otherwise I can't rest. .

The long erections after the shockwave does seem to imply that it had an effect, however it also seemed to make your numbness worse. Trazodone can also cause erections that can be persistent in some men, it apparently does this by antagonising (blocking) the A2 adrenergic receptors in the penis.

My goal is to get a better diagnosis and recover a little bit of sensitivity. I don't think I will ever recover from this but I would like to be in a position where going for an implant could be an option.

I do agree, get a better diagnosis. If nerves have been damaged, they can take many months, even more than a year to repair. If you have also caused muscles in the pelvic floor to go into spasm, this will require treatment and exercises that the pelvic floor specialist will give you to do every day. I will repeat this, most urologists are not aware of pelvic floor issues. Find someone in your country that has experience with men, this is important.

[Fourtytwo00]

Thanks a lot Simbarm, you gave me a well articulated answer with lots of inside.

About TRT: this is an interesting topic. Last year when I was OK and I did blood works my T was 4.08 ng / mL. Actually I hadn't been tested several time before starting TRT. One time at the end of Jan. in the late morning (11.30-12), there were several covid restrictions in place and some delays. TRT protocols here can differ a little bit from one doctor to another. My feeling is that perhaps it's better to rely on a skilled andrologist or an endocrinologist for hormal issue than just an urologist. It's a broad generalization but I don't think it's far from truth. I started HCG monotherapy at 2000 UI two times a week, after one month and a half since T went to 8.51 ng/Ml doctor halved to 2000 UI one time a week. Another month then stop and check after 2/3 months. This is the plan atm.
My feelings: it's only a couple of week I halved the HCG dose but I feel a little bit better. I tend to feel less numbness 2-3 days after the injection. More right after the injection, less some day after. I'm not developing gymnecomnastia but could HCG cause me a sort of aromatization? Can Mesterolone help me?
I think my drop on testo was stress induced. I was barely sleeping 1-3 hours when I did blood works. My mood was often apathetic and sometimes depressed. I had to taper benzodiazepine because they weren't effective for my insomnia and was put on Seroquel 75mg. Perhaps drugs have a role too. Recently I started switching from Seroquel to Trazodone, I dislike the antihistamine effect of the former. HCG therapy helped to improve my mood and to be honest HCG has been offered to me as an option to not impair fertility and avoid shrinking.
At the end of the day I can report (some) improvements in the last two week after 1) halving HCG weekly dosage, 2) switching from 75mg Seroquel to 25mg Seroquel + 50mg Trazodone. I can't say if they are permanent or it's just a window. Anyway I think you have a point: at 2000IU / 2 times a week I could barely masturbate once in a week. Halving the dose I could, at least 2-3 days after the injection. I just want to improve my baseline. I'm also a little bit tired of medicalization and overthinking about my penis.

Shockwave: compared to the US they are relatively widely used across Europe as a complementary first line treatment. Also the second urologist approved the attempt. There isn't a standard uniform protocol and a full consensus, but on average is considered preatty safe and even some public hospitals offer the treatment.

Pelvic floor rehab: found two specialist not too far from where I live. I didn't call them yet, they're both women and I'm not sure they are experienced in pelvic floor rehar for ED. Kegel, exercise and biofeedback yes. And yes urologists told me nothing about pelvic floor. The last one was more aware about jelqing but dismissed the idea of a damage perhaps because I did it 3 times and no more. About PDE5: he told me yes they can fail for psychological issues because erection still happens in your brain, stuff like stress, depression are erection killer. In case of anxiety it's adrenaline is the culprit. On the contrary injections (caverjet, alprostadil, etc.) are different. In short they are intended to generate a mechanical effect (sort of).
Actually when I still was "normal" I did some very simple pelvic floor exercises at yoga classes in my gym and I remember I started to have better feelings and sometimes better loads. I could spread my sperm very far after an intense orgasm. I don't know if they could help my recover but I will keep looking for pelvic floor rehab.

[Simbarn]

Thanks a lot Simbarm, you gave me a well articulated answer with lots of inside.

About TRT: this is an interesting topic. Last year when I was OK and I did blood works my T was 4.08 ng / mL. Actually I hadn't been tested several time before starting TRT. One time at the end of Jan. in the late morning (11.30-12), there were several covid restrictions in place and some delays. TRT protocols here can differ a little bit from one doctor to another. My feeling is that perhaps it's better to rely on a skilled andrologist or an endocrinologist for hormal issue than just an urologist. It's a broad generalization but I don't think it's far from truth. I started HCG monotherapy at 2000 UI two times a week, after one month and a half since T went to 8.51 ng/Ml doctor halved to 2000 UI one time a week. Another month then stop and check after 2/3 months. This is the plan atm.
My feelings: it's only a couple of week I halved the HCG dose but I feel a little bit better. I tend to feel less numbness 2-3 days after the injection. More right after the injection, less some day after. I'm not developing gymnecomnastia but could HCG cause me a sort of aromatization? Can Mesterolone help me? .

I’m glad the information helps.
TRT is a very involved topic. I have spent decades of my life trying to understand low T.
If you received a lab result for total T of 4.08 and I think you mean nmol/ml not ng/ml, and you were ok with no symptoms, I would be very suspicious of such a result and retest again. Lab errors happen frequently.
Getting a test at midday will give a lower result than early morning; first mistake. Only having one test before undertaking TRT is the second mistake and quite frankly bad medicine. Three early morning tests at about 7-8 am should be undertaken.
You are correct, doctors who are not skilled in this area generally have low expertise when it comes to TRT. This has been my experience. The doctor who put you onto TRT after just one test should be dumped. This was also evident from the fact that he started you on 4000iu of HCG a week. Is he trying to fry your testicles!
HCG can and will cause estrogenic side effects, how much depends on the individual. Men produce HCG naturally in tiny amounts, women produce it in larger quantities when they are pregnant, so there can be issues in men especially when using massive doses such as 2000 and 4000iu.

Therefore yes, aromatisation effects in males frequently occur. This can show in different ways in some men. Some may get gynocomastia, some may get dramatic mood changes, worsened erectile dysfunction, erratic sexual function and anxiety. This is by no means a complete list of issues that excess estrogen can cause in the male. Trying to combat the above with another drug such as Mesterlone is just asking for more trouble. Rather than trying to fix an issue caused by an excess of one drug by using another drug, it is better to reduce the ill effects of the initial drug by lowering its dose first. In this case lower the amount of HCG! If I was to use HCG, (as I cannot give you medical advice) doses of around 250-300 iu injected approximately 3 times a week is what I would try first, then after a month I would check my total T levels to see how this amount generates a natural level of T. The problem with HCG monotherapy as I have outlined before is that the amount of HCG needed to bring T levels up to a level which will ameliorate low T symptoms, will at the same time cause some estrogen receptor issues, thus cancelling out some of the positive effects from an increased T level. The individual feels no better.

I will repeat this again: For young men with healthy testicles it is far better to try SERM therapy first. Clomiphene citrate is a SERM (selective estrogen receptor modulator). Enclomiphene citrate is the superior form of this, but not available in many countries.
The proposition of SERM therapy is to try and get your natural hormonal system running again at a better set point than before, then very slowly the treatment is reduced and finally stopped. HCG does not do this and will supress your HPTA.
The only time it is used in conjunction with SERM’s in a restart protocol is when an anabolic steroid user has shut down their testicles completely for an extended period of time. The testes have literally gone to sleep and atrophied. HCG in this instance can give the testes a strong stimulus to restart as the testes can be the slowest to respond when compared to the pituitary when both have been turned off after long periods of steroid use. In a normal male with just low T, the testes are awake and functioning so this is not required. SERM therapy is usually enough on its own. HCG is generally only needed if the testes have atrophied.

I think my drop on testo was stress induced. I was barely sleeping 1-3 hours when I did blood works. My mood was often apathetic and sometimes depressed. I had to taper benzodiazepine because they weren't effective for my insomnia and was put on Seroquel 75mg. Perhaps drugs have a role too. Recently I started switching from Seroquel to Trazodone, I dislike the antihistamine effect of the former. HCG therapy helped to improve my mood and to be honest HCG has been offered to me as an option to not impair fertility and avoid shrinking.
At the end of the day I can report (some) improvements in the last two week after 1) halving HCG weekly dosage, 2) switching from 75mg Seroquel to 25mg Seroquel + 50mg Trazodone. I can't say if they are permanent or it's just a window. Anyway I think you have a point: at 2000IU / 2 times a week I could barely masturbate once in a week. Halving the dose I could, at least 2-3 days after the injection. I just want to improve my baseline. I'm also a little bit tired of medicalization and overthinking about my penis.

Yes, that is what I was trying to say in the last post, your drop in T could have been stress induced. Such a small amount of sleep would affect your T levels and it is telling that your test was done at that time. I do understand that the doctor was trying to avoid infertility and testicle shrinkage with the use of HCG. This is the reason HCG in small amounts is often used alongside injectable testosterone, so that the testes keep functioning and do not atrophy. However, IMO it should not be the first therapy as explained above.
I am not surprised that halving the HCG therapy has made you feel somewhat better. But still not in line with what I mentioned above.

I always encourage younger men to try and get their natural testosterone up if it has stalled. The biggest problem with TRT is the loss of “upstream hormones”. These are LH, FSH, GNRH and Kisspeptin. These hormones are integral with sexual function and to be honest it will never be the same without them. Testosterone is only one part of the puzzle with male sexual function. The medical community is slowly learning this. These upstream hormones are also responsible for other processes in the adult body, so it is far preferable IMO to keep them circulating in your body.
Sexual function can be quite adversely affected in many men without them. This why I am so adamant about trying SERM therapy first for young men.
With regard to older men, this is a different matter. Often they feel better on T therapy itself, this is simply because the testes have aged as has the pituitary and sexual function has also declined considerably. The boost they feel from exogenous T in the body as a whole will be very noticeable. Trying to reinstate higher T production in aged testes usually fails.

Shockwave: compared to the US they are relatively widely used across Europe as a complementary first line treatment. Also the second urologist approved the attempt. There isn't a standard uniform protocol and a full consensus, but on average is considered preatty safe and even some public hospitals offer the treatment.

I have been very interested in shockwave therapy and have read many studies on the treatment. The studies do seem to show beneficial results, but from what I can see these results seem to be temporary and the treatment needs to be constantly repeated. I am concerned however, as I have not read one positive account of the treatment on this forum.
It has turned into a big money making ED treatment in the US with high level marketing. This is a concern.

Pelvic floor rehab: found two specialist not too far from where I live. I didn't call them yet, they're both women and I'm not sure they are experienced in pelvic floor rehar for ED. Kegel, exercise and biofeedback yes. And yes urologists told me nothing about pelvic floor. The last one was more aware about jelqing but dismissed the idea of a damage perhaps because I did it 3 times and no more. About PDE5: he told me yes they can fail for psychological issues because erection still happens in your brain, stuff like stress, depression are erection killer. In case of anxiety it's adrenaline is the culprit. On the contrary injections (caverjet, alprostadil, etc.) are different. In short they are intended to generate a mechanical effect (sort of).
Actually when I still was "normal" I did some very simple pelvic floor exercises at yoga classes in my gym and I remember I started to have better feelings and sometimes better loads. I could spread my sperm very far after an intense orgasm. I don't know if they could help my recover but I will keep looking for pelvic floor rehab.

Pelvic floor issues may or may not be part of your problem. But I do think it is seriously worth following up.
I also completely agree that stress and depression are also not good for erectile function. PDE5 inhibitors can fail if there is too much adrenalin or if adrenergic function is too strong in the penis itself. This can be a difficult condition to fix and is at the root IMO of psychogenic ED.
It could also be that all these things are affecting you at once. Stress, depression, low hormones, and spasm in the pelvic floor, all interconnected and feeding of each other.
All of these things may need to be addressed.

[Mike_b]

I jelqued went from 4 inches to 5 inches erect. Big gain. But I had a larger than usual erection and I fractured my penis masturbating too vigorously. I shoulda been happy with what God gave me. Instead I am 38 almost done healing a 16 year disease.

[Fourtytwo00]

Thanks Simbarm for your wisdom.

Well.. unfortunately I think I had just a window. Back to square 1. I had my last injection (2000 IU) two days ago. Now I have to wait for a couple of months without taking nothing then I will do blood analysis again. I think I'll go to an endocrinologist. Is it OK waiting for a couple of months? Should I expect a drop in morale (which is already low)?

I'm reading again my doppler ultrasound results and I'm not fully convinced. The urologist reported only two values: PVS (45cm/sec both sides) and RI (resistance index) 0,8 which is borderline. Injected 10mg PGE1 I hadn't a full erection. Tumescence level II - III (IV = 90-100% erected).
Could it be a Venous Leak? Does anyone has some experience in reading ultrasound doppler results and Venous Leak?

[Simbarn]

Thanks Simbarm for your wisdom.

Well.. unfortunately I think I had just a window. Back to square 1. I had my last injection (2000 IU) two days ago. Now I have to wait for a couple of months without taking nothing then I will do blood analysis again. I think I'll go to an endocrinologist. Is it OK waiting for a couple of months? Should I expect a drop in morale (which is already low)?

I'm reading again my doppler ultrasound results and I'm not fully convinced. The urologist reported only two values: PVS (45cm/sec both sides) and RI (resistance index) 0,8 which is borderline. Injected 10mg PGE1 I hadn't a full erection. Tumescence level II - III (IV = 90-100% erected).
Could it be a Venous Leak? Does anyone has some experience in reading ultrasound doppler results and Venous Leak?

Sorry, not sure what you mean by "I think I had just a window"? Did things improve for a brief period for you?
The problem with taking such a high dose of HCG is that it can suppress your HPTA. This may take time to bounce back, hence why SERM therapy is used to give the HPTA a push as I described in detail for you previously. However, in your case it may all return to baseline in a few months on its own.
As the doppler ultrasound was performed with just PGE1, adrenergic action in the penis was not addressed during the test, it has been well documented that these tests can give incorrect results if phentolamine is not included in the injection. Are you sure it was just PGE1 in the injection?

[Fourtytwo00]

"Caverject 10mg" it's what the urologist wrote down in the report. It seems to me he told me "alprostadil" while doing it. He reported only PVS and RI. Nothing about diastolic, which is usually reported too.

About serms: here there is Clomid.