Endovascular Repair Of Venous Leak My Disappointing Story

[jwpenn82]

Have you had any bloodwork done at all?
Any diabetes?
Do you get any morning wood at all?

Yes I had blood work no diabetes. All of my lab work checked out fine. My testosterone was borderline. My urologist said I could try clomid to boost my testosterone a little. Currently I’m on clomid and have been for almost a year. Testosterone levels are great now. All other lab work checks out good.

I have come to the understanding that dopplers will only show a limited amount of reasons why erectile dysfunction may be present and they can be fallible. Even the other tests you have had done (which are more detailed) do not show many of the reasons why a venous leak can occur. The reason for this is that the IC injection you receive to force an erection, by passes many of the micro process that need to happen to enable erectile function. Many of these micro processes if dysfunctional can cause a venous leak. A venous leak is generally not one, two or three small leaks, it can be hundreds if not more as it can be caused by the inability of the corpus cavernosum to expand sufficiently to effectively seal at the tunica. I wrote an in-depth post on this and the general misunderstanding of what a venous leak can be.
The IC injection itself can hide a malfunction in the process of venous occlusion.

It appears that you have been diagnosed with low T. Therefore hormonal disruption could be the cause of your ED. I see you are being treated with the use of Clomid. Clomid is very good at getting your T levels up, no doubt. However, it is also very good at causing sexual dysfunction in many men. This is because it not only blocks the estrogen receptor in some tissues but it can also stimulate the estrogen receptor in others. Many guys whilst on Clomid can have erectile function issues. A year on this drug is what I would consider long term and it appears your doctor is using it as a form of HRT rather than short term usage to give the HPTA a kick start. Long term usage of Clomid can cause many side effects and is not a very good form of HRT. My advice is to not use a urologist for hormone issues.
Your T numbers as you put it may be good, but any good effects from this improved level of T may be getting stymied by the estrogenic effects of Clomid. An aromatase inhibitor will not work in this case either.
As your T was borderline before Clomid use it may have improved with a restart protocol, depending on your age, state of health and fitness.
Any hormone issues should preclude any form of surgery to fix a suspected venous leak IMO.

Do you have nocturnal erections and if not how long have they been absent?

The big problem with low testosterone causing ED is that trying to remedy ED with supplemental testosterone rarely fixes the issue. The reasons for this are complex and are mainly concerned with the inadequacies of T replacement protocols currently available. This is why many men on TRT usually depend on some form of erectile enhancement ranging from PDE5i all the way up to an implant.

Great information right there. As far as the clomid goes my testosterone was in the low normal level prior to starting it. My urologist thought because of my age my testosterone should be higher. There might still be a chance that I want more kids in the future so that’s why he chose clomid. I guess there is less of a chance of infertility with it.

As far as other tests I have only had 2 Dopplers and the CT scan. I don’t wake up with morning erections anymore and doubt I get nocturnal erections but I’m not sure. I wish finding a urologist that would do more testing wasn’t so difficult. I’ve seen two urologists and all they want to do is the same treatments. Oral meds, injections, implant is all I ever hear.

On a side note oral meds have not worked for me since September of 2020. I switched to injections then. Everyone once in a while I try viagra or some oral meds in hopes it works again. Yesterday I took Levitra and surprisingly got an 85-90 percent erection and was able to have sex. Actually I was able to have sex standing up which hasn’t worked for me in year’s.

During the CT they used contrast and it fills your penis veins and tissue to look for the venous leak. I wonder if it cleared a blocked vein or something enough for Levitra to work. Any thoughts on this?

[Simbarn]

Great information right there. As far as the clomid goes my testosterone was in the low normal level prior to starting it. My urologist thought because of my age my testosterone should be higher. There might still be a chance that I want more kids in the future so that’s why he chose clomid. I guess there is less of a chance of infertility with it.

As far as other tests I have only had 2 Dopplers and the CT scan. I don’t wake up with morning erections anymore and doubt I get nocturnal erections but I’m not sure. I wish finding a urologist that would do more testing wasn’t so difficult. I’ve seen two urologists and all they want to do is the same treatments. Oral meds, injections, implant is all I ever hear.

On a side note oral meds have not worked for me since September of 2020. I switched to injections then. Everyone once in a while I try viagra or some oral meds in hopes it works again. Yesterday I took Levitra and surprisingly got an 85-90 percent erection and was able to have sex. Actually I was able to have sex standing up which hasn’t worked for me in year’s.

During the CT they used contrast and it fills your penis veins and tissue to look for the venous leak. I wonder if it cleared a blocked vein or something enough for Levitra to work. Any thoughts on this?

There is some controversy about what constitutes a normal level of T. For some men, a low normal level can be what is correct for them as their receptors for T can be more sensitive to what they have. There needs to be a number of symptoms present to establish if someone with a lowish level of T actually has low T or not. What were your other symptoms of low T?
I understand that your urologist suggested Clomid to try and keep all your natural hormones working which is preferable, however as I said many guys do not feel good on Clomid and sexual function just does not work very well.
If I was in your shoes, I would try discontinuing the Clomid very slowly over a couple of months and see if you feel any better and if your natural T level holds at a better level than it was prior to treatment. You could try this whilst seeing a sexual health doctor who has experience with men’s hormones. It is important to taper of slowly so as to not shock the HPTA. Have you lost any sexual sensation as well during the Clomid treatment?

Unfortunately, that is all urologists will offer you. This is generally all they have in their armoury to treat ED. Most will not try or know of anything not recognised by the FDA. I have been talking to someone recently who is about to try Botox injections in the penis to try and reduce the adrenergic inhibitive influence in the erectile tissues. There is growing evidence suggesting that excessive sympathetic action in the erectile tissues is a major contributing factor for ED in many men, especially those in middle age. This is an example of something cutting edge and off label and most urologists would not have even heard of the recent papers on this. This is one reason why Trimix works so well for some men as it has phentolamine in the preparation.

If you never wake with morning erections it is a fairly good indication that nocturnal erections are not working very well if at all. This is concerning as deterioration in the penis can occur over time due to this. These night time erections flush richly oxygenated blood through the penis a number of times a night keeping all the tissues healthy that are responsible for erectile function. Oxidative stress starts to occur if these tissues suffer from hypoxia. Night time erections are testosterone dependant, by that I mean if levels of T are very low they suffer. Your T levels are much improved now, however the estrogenic effects of Clomid may be inhibiting them.

Do some research on DEFY medical if you are in the US. They look to have good experience with treating low T and they have access to Enclomiphene citrate which is the better version of Clomid. Do some research on this drug yourself.
Natesto is also a newer form of TRT, which apparently does not shut down the HPTA. This could also be worth looking at. Keeping all the “upstream hormones” in place, plus being able to supplement testosterone is the ideal form of TRT in my opinion, as the loss of the gonadotropins and other hormones further up the chain can cause more problems for men undertaking testosterone replacement. These hormones are part of sexual function too, not just testosterone.

Not sure what to say about your sudden improvement with Levitra, is this PDE5i a recent addition to your protocol? A blocked vein will generally not hinder erectile function, a blocked artery could. Veins in the penis lie after the erectile tissues and are responsible for draining the blood away from these tissues. If you had a blocked artery this would have shown in the tests you had done, so I doubt it.

[jwpenn82]

Great information right there. As far as the clomid goes my testosterone was in the low normal level prior to starting it. My urologist thought because of my age my testosterone should be higher. There might still be a chance that I want more kids in the future so that’s why he chose clomid. I guess there is less of a chance of infertility with it.

As far as other tests I have only had 2 Dopplers and the CT scan. I don’t wake up with morning erections anymore and doubt I get nocturnal erections but I’m not sure. I wish finding a urologist that would do more testing wasn’t so difficult. I’ve seen two urologists and all they want to do is the same treatments. Oral meds, injections, implant is all I ever hear.

On a side note oral meds have not worked for me since September of 2020. I switched to injections then. Everyone once in a while I try viagra or some oral meds in hopes it works again. Yesterday I took Levitra and surprisingly got an 85-90 percent erection and was able to have sex. Actually I was able to have sex standing up which hasn’t worked for me in year’s.

During the CT they used contrast and it fills your penis veins and tissue to look for the venous leak. I wonder if it cleared a blocked vein or something enough for Levitra to work. Any thoughts on this?

There is some controversy about what constitutes a normal level of T. For some men, a low normal level can be what is correct for them as their receptors for T can be more sensitive to what they have. There needs to be a number of symptoms present to establish if someone with a lowish level of T actually has low T or not. What were your other symptoms of low T?
I understand that your urologist suggested Clomid to try and keep all your natural hormones working which is preferable, however as I said many guys do not feel good on Clomid and sexual function just does not work very well.
If I was in your shoes, I would try discontinuing the Clomid very slowly over a couple of months and see if you feel any better and if your natural T level holds at a better level than it was prior to treatment. You could try this whilst seeing a sexual health doctor who has experience with men’s hormones. It is important to taper of slowly so as to not shock the HPTA. Have you lost any sexual sensation as well during the Clomid treatment?

Unfortunately, that is all urologists will offer you. This is generally all they have in their armoury to treat ED. Most will not try or know of anything not recognised by the FDA. I have been talking to someone recently who is about to try Botox injections in the penis to try and reduce the adrenergic inhibitive influence in the erectile tissues. There is growing evidence suggesting that excessive sympathetic action in the erectile tissues is a major contributing factor for ED in many men, especially those in middle age. This is an example of something cutting edge and off label and most urologists would not have even heard of the recent papers on this. This is one reason why Trimix works so well for some men as it has phentolamine in the preparation.

If you never wake with morning erections it is a fairly good indication that nocturnal erections are not working very well if at all. This is concerning as deterioration in the penis can occur over time due to this. These night time erections flush richly oxygenated blood through the penis a number of times a night keeping all the tissues healthy that are responsible for erectile function. Oxidative stress starts to occur if these tissues suffer from hypoxia. Night time erections are testosterone dependant, by that I mean if levels of T are very low they suffer. Your T levels are much improved now, however the estrogenic effects of Clomid may be inhibiting them.

Do some research on DEFY medical if you are in the US. They look to have good experience with treating low T and they have access to Enclomiphene citrate which is the better version of Clomid. Do some research on this drug yourself.
Natesto is also a newer form of TRT, which apparently does not shut down the HPTA. This could also be worth looking at. Keeping all the “upstream hormones” in place, plus being able to supplement testosterone is the ideal form of TRT in my opinion, as the loss of the gonadotropins and other hormones further up the chain can cause more problems for men undertaking testosterone replacement. These hormones are part of sexual function too, not just testosterone.

Not sure what to say about your sudden improvement with Levitra, is this PDE5i a recent addition to your protocol? A blocked vein will generally not hinder erectile function, a blocked artery could. Veins in the penis lie after the erectile tissues and are responsible for draining the blood away from these tissues. If you had a blocked artery this would have shown in the tests you had done, so I doubt it.

Thank you so much for responding to my questions and this thread! I am definitely going to look at defy medical and research replacing the clomid or possibly discontinuing it. You definitely have a wealth of knowledge that far surpasses mine in the trt topic. I did make an appointment with my urologist but I think I’m going to cancel it and seek out a sexual health doctor with hormone experience.

I’ve seen some posts about Botox and this treatment intrigues me. I’ve read a couple clinical trials on this as well and it sounded promising. My concern with the Botox injections is the cost and there aren’t exactly any clinics near me that offer this. Could you please keep me updated on the persons response that you know. I’m curious about it not that I’m trying to rush into something like that just yet.

So the levitra was an old medication I had on hand. I also had some generic viagra on hand as well. Currently I’m on trimix injections and they work great. However I’m worried about the what’s next. Or the when will the trimix stop working. Honestly I just wished I could find some sort of doctor willing to investigate more and actually help me figure out the cause.

In response to the nocturnal erections and my lack of them and morning erections I did know this is not healthy for penile tissue. I was considering getting a pump and pumping twice daily in hopes of maintaining some oxygen to my tissue and preventing further loss. What are your thoughts on this? I’ve tried pumping before for intercourse and it wasn’t great.

Also I had some viagra on hand from before I started trimix. Last night I figured why not try it the levitra worked I am curious. My response was better than before. I did eat dinner but took the viagra 2-3hrs later. It took about 2hrs and I was able to achieve a 75-80 percent erection and complete intercourse.

Honestly I understand I will have ED for the rest of my life but my preference isn’t trimix. Personally I’d much rather take oral medications. I’m not sure how long this will last with taking viagra or levitra but I will try it out for a while.

[Simbarn]

Thank you so much for responding to my questions and this thread! I am definitely going to look at defy medical and research replacing the clomid or possibly discontinuing it. You definitely have a wealth of knowledge that far surpasses mine in the trt topic. I did make an appointment with my urologist but I think I’m going to cancel it and seek out a sexual health doctor with hormone experience.

I’ve seen some posts about Botox and this treatment intrigues me. I’ve read a couple clinical trials on this as well and it sounded promising. My concern with the Botox injections is the cost and there aren’t exactly any clinics near me that offer this. Could you please keep me updated on the persons response that you know. I’m curious about it not that I’m trying to rush into something like that just yet.

So the levitra was an old medication I had on hand. I also had some generic viagra on hand as well. Currently I’m on trimix injections and they work great. However I’m worried about the what’s next. Or the when will the trimix stop working. Honestly I just wished I could find some sort of doctor willing to investigate more and actually help me figure out the cause.

In response to the nocturnal erections and my lack of them and morning erections I did know this is not healthy for penile tissue. I was considering getting a pump and pumping twice daily in hopes of maintaining some oxygen to my tissue and preventing further loss. What are your thoughts on this? I’ve tried pumping before for intercourse and it wasn’t great.

Also I had some viagra on hand from before I started trimix. Last night I figured why not try it the levitra worked I am curious. My response was better than before. I did eat dinner but took the viagra 2-3hrs later. It took about 2hrs and I was able to achieve a 75-80 percent erection and complete intercourse.

Honestly I understand I will have ED for the rest of my life but my preference isn’t trimix. Personally I’d much rather take oral medications. I’m not sure how long this will last with taking viagra or levitra but I will try it out for a while.

It will be very interesting to see what happens with your nocturnal/morning erections when you come off the Clomid. You could also try nightly small dosing of Viagra to see if that helps these erections. It does seem to for some.
It surprises me how many doctors are unaware of the side effects of Clomid and how detrimental it can be long term. Enclomiphene may work better for you. It is the single isomer version of Clomid, without Zuclomiphene, which is the part of Clomid that generates most of the estrogenic stimulation and it also builds up in the body over time and its effects gradually increase and worsen. Body builders have been using these drugs for decades and it is well known in these circles the libido lowering effect of Clomid! Some men get quite emotional on Clomid and lose sexual sensation, others don’t.

Have you also tried daily dosing of Cialis/Tadalafil low dose to see if that helps? I have been doing this for a couple of years now and it definitely helps my night time erections. They are very strong every night now. However, it may be difficult to know until the Clomid is out of your system.
There are guys on the pump section on FT that have experience with using these for exactly that, keeping more blood flow in the penis during the day, so I would chat to them about this. I do know that using them gently is important also.

A sexual health doctor may be more equipped to investigate further than a urologist as they will look at the whole picture. It is also important to understand that medical science still has a way to go with understanding many of the causes of ED. There is a great amount of research still in the early stages on many topics such as sympathetic hyperactivity in the penis, oxidative stress, damage to the endothelium and loss of smooth muscle. I think current research on the excessive action of the inhibitive mechanisms in the penis, that is the tonic mechanisms that maintain the penis in a flaccid state will bring some helpful answers in the next few decades about improving erectile function for many men. This is where Botox fits in and I have been extremely interested in how this may work with muting the inhibitive mechanism in the penis.