Any advice for what I think is psychogenic ED?

[Drail1]

I'm 44 years old, I battled psychogenic ED for many years and I can assure you this is easily treatable.

Thanks for the input Flavio. My question is is there any hope I can get back to baseline where I can just get hard from thinking without having to use any pills or other medical interventions? You'd imagine that being psychological it should be resolvable some how if nothing's mechanically broken.

The thing about depression is that I don't think I'm depressed at the moment, and I certainly wasn't for the bulk of the 5 year period I had ED. Sure I had low self esteem and was in a relationship that I had a lot of conflicting thoughts about, but it was never depression to the point where it would affect my functioning. I think I'm more resentful than usual at the moment because I'm living alone during a lockdown that's gone on for months at this point, but outside of that I do admit the resentful thoughts have always been there to some degree.

The thing about anxiety is that I've had on and off periods of anxiety from when I was 16. I've been diagnosed with generalised anxiety disorder, but the thing about it is before that first experience it never gave me any issue getting hard. At times I think I would jack off specifically to take my mind off the anxiety and calm down. I could be jumping out of my skin anxious and yet still get hard no problem. People always bring up anxiety as an erection killer but then how could anyone get laid, because everyone has some level of anxiety during sexual arousal, in fact the two physiological responses are related.

I should also mention in this thread that I've just started a low dose of Finasteride at 0.5 mg every other day. I initially did 1 mg every day for 4 days but stopped because I noticed some pain/tightness in the left breast. I came off it for a month, got an ultrasound and they couldn't find any gynecomastia so I'm now trying this low dose to get back on. I know the drug is controversial and it does cause me a bit of anxiety, but I have more anxiety over how I'll look if I just let the balding continue, my left temple has thinned out heaps just over the past year and I feel I have to do something.

[Simbarn]

My advice, if you already have sexual function issues, throw the finasteride in the bin.
DHT is important for ALL men. We produce it in adult life for good reason, one of those reasons being maintenance of the tissues in the penis. Many of testosterones actions in the body are mediated by DHT. It is becoming evident how important this hormone actually is and also how detrimental finasteride and duasteride are.
I have also lost my hair. I know how it feels, but I decided that my health far outweighed cosmetic anxiety about hairloss. I clippered my head down to a zero and I am really comfortable with it now.
The last thing you need is another potential ED causing factor in the mix whilst you are trying to fix your current problems.

I am glad you are seeing a counsellor. A sex therapist may be even more help.
The anxiety and over-thinking of your difficulties is almost palpable in your post. I think you will need the help of an experienced therapist in men's sexual problems. It may also take some work to resolve.

[Flavio]

I'm 44 years old, I battled psychogenic ED for many years and I can assure you this is easily treatable.

Thanks for the input Flavio. My question is is there any hope I can get back to baseline where I can just get hard from thinking without having to use any pills or other medical interventions? [...]

Absolutely!

The whole idea is to start with oral pills and then gradually decrease the doses until you no longer need any meds. Again, only your doctor can determine the exact regimen and say what's right for you.

Like Simbarn said, this doesn't happen overnight. It may take some time and work but you will get there.

[confused95]

Do you have problems when you masturbate dude? What about nocturnal erections?
I’m on 5mg Tadalifil every other day and masturbation is fine 95% of the times.
Sometimes unfortunately I lose my erection when I’m stressed or not that concentrated on sexual stimuli.
If your problem is psychological a counselor will help for sure.
Don’t make the mistake I did of starting taking antidepressants, they kill your libido and erections.
As somebody here said, keep calm. We live in 2021 and we have tons of solutions, from PDE5 to implant. And even though the implant is a very remote hypothesis given your situation, you can be sure you’ll live a super nice sexual life!

[Sean762]

Might try reading this study:

https://www.nature.com/articles/s41443-020-00399-z

What it's sort of hypothesizing is that by using a very lose dose injectable....you may be able to overcome anxiety induced ED.

Might be worth a try....

[Simbarn]

Might try reading this study:

https://www.nature.com/articles/s41443-020-00399-z

What it's sort of hypothesizing is that by using a very lose dose injectable....you may be able to overcome anxiety induced ED.

Might be worth a try....

Thanks Sean, it was a interesting read.
What I found most interesting is that all participants had failure with the use of PDE5i. It does show how strong psychogenic ED can be via the adrenergic pathway.
How could one or two treatments with ICI therapy conquer psychogenic ED permanently as was shown in the paper? This I am not sure, but would suggest that a new stronger neurological pathway in the brain develops very quickly once success is achieved, therefore giving the anxiety pathway less or little power.
This may be more the case with very young patients with a brief history of psychogenic ED.

[Sean762]

Might try reading this study:

https://www.nature.com/articles/s41443-020-00399-z

What it's sort of hypothesizing is that by using a very lose dose injectable....you may be able to overcome anxiety induced ED.

Might be worth a try....

Thanks Sean, it was a interesting read.
What I found most interesting is that all participants had failure with the use of PDE5i. It does does show how strong psychogenic ED can be via the adrenergic pathway.
How could one or two treatments with ICI therapy conquer psychogenic ED permanently as was shown in the paper? This I am not sure, but would suggest that a new stronger neurological pathway in the Brain develops very quickly once success is achieved, therefore giving the anxiety pathway less or little power.
This may be more the case with very young patients with a brief history of psychogenic ED.

Agreed. Someone struggling with it longer or with real underlying medical issues would undoubtedly not fare as well. I'd guess that it *could* help those men whose ED is predominantly psychological in nature....though it may take more than just a few treatments (sure seems hard to find a psychologist who really focuses on ED though to get to the underlying issues...at least here in Phoenix). I wonder if just having the injections available in the fridge might be enough to get rid of some of the anxiety some of us have.....after using it a few times to know it's an option that actually works.

[Drail1]

Been a while since my last post so I thought I'd give an update.

I've decided to keep on the low dose of finasteride, I'll stop if I notice any concrete sides.

My erections have oddly improved out of the blue since my last post. I can now pretty easily get most of the way hard but it requires physical stimulus. It also doesn't feel 100% hard but it's enough to have sex I think. Mental stimulus doesn't get me hard at all (this has been the case for 5 years straight now so nothing new). The counselor told me I shouldn't try and stress myself out by trying to do too much at the same time, so he recommended I use porn to practice mastubation which I've been doing the past couple of weeks. Again, the porn thing is neither here nor there for me, I've quit several times since I've had ED and I've only ever noticed a slight decrease in libido and EQ each time if anything. I'll try and cut it out further down the track as the ED improves. He also told me to jump on cialis 5 mg daily and keep on it, saying that my previous stint of 12ish days on it wasn't enough and that may have been why I had one success and two failures using it. So I've been taking one 5mg a day for the past few days, I think it's also given me a slight bump in EQ but again the mental side isn't there.

Do you have problems when you masturbate dude? What about nocturnal erections?

Yeah when its bad I can't even masturbate at all, but recently I've regained that ability at least for the moment.

As for nocturnal erections, they've always been there, even when my EQ was so low I couldn't even masturbate. I'm often some level of hard when I wake up, depending on my sleep schedule and quality. Just this morning I had some bad sleep or something and woke up 3 or 4 times in a row during the morning, and each time I had annoyingly hard, mildly painful erection, perhaps that's because of the cialis I'm on now.

Unfortunately I'm in lockdown at the moment so I haven't been able to get a partner to see if I've made any real progress with ED. There's a chance this recent bump could translate positively with a partner or maybe I'd still be mostly deflated, I can never know for sure. I'm going to try a bit harder to get a partner during lockdown through the apps, my friends' done it so I know it's possible.

Might try reading this study:

https://www.nature.com/articles/s41443-020-00399-z

What it's sort of hypothesizing is that by using a very lose dose injectable....you may be able to overcome anxiety induced ED.

Might be worth a try....

Interesting read but I don't think it translates to my situation. Like I mentioned I've had a few successes with and without pills, but the ED never fully went away. I never regained the ability to get mentally hard like I could before my incident, and severe ED is still the norm unless I take a pill. I should also note that I did get an injection one time for the ultrasound I got to check for venous leak. It was strange because it didn't get me fully hard and it was painful the entire time, even as the erection was subsiding.