My Story

[Flavio]

It's hard to say, your post is vague and ED is always a complex condition.

Two tips that may be helpful:

a) Combination therapy works! I'm also taking a PDE-5 inhibitor (udenafil) before sex but it works much better if if I combine it with an alpha blocker (oral phentolamine mesylate). This may, however, also increase the risk of side effects.

b) I'm sure you've heard this a million times before but it's true: the best possible way to increase T levels is regular exercise. Go hit the gym, preferably with the help of a PT.

You've already consulted a doctor so you're definitely on the right track.

Good luck and keep us posted on your progress.

[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?

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.

Thanks for the response.

Do you believe the clomid will help with the erections? The doc made it seem like the low T was the underlying issue. Is TRT a better option for solely helping with libido, erection quality? I guess I’m not completely sold that this clomid protocol will do anything for the sexual function even if it increases T levels on paper.

[oldbeek]

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.

Martin,, read Dr John Mulhall of Sloan Kettering.High T causing PC is a myth. Came from a study by one Dr in 1946 with 3 participants in the study group. He received a Nobel prize for it. ( so did Obama) That study would not qualify as a high school term paper today.

[Simbarn]

Thanks for the response.

Do you believe the clomid will help with the erections? The doc made it seem like the low T was the underlying issue. Is TRT a better option for solely helping with libido, erection quality? I guess I’m not completely sold that this clomid protocol will do anything for the sexual function even if it increases T levels on paper.

Clomid may or may not help as it seems to depend on the individual. You are correct, it may cause more issues with sexual function while you are on Clomid. less likely with Enclomiphene citrate.
The point of being on SERM (selective estrogen receptor modulators) is not the short term benefit. It is a treatment protocol designed to try and reinstate a higher T level that will stick hopefully after discontinuing these drugs. From my experience it can be a few months on with a very slow taper to finish.

TRT may help libido far more quickly, but once you undertake this, it will further shut down your natural hormone system (HPTA) and after time this can be difficult to restart.
It is far more preferable in a young man to try and improve natural testosterone first. If you are to do this with drug therapy, SERM treatment is first-line therapy.

I have not discussed natural methods of trying to increase T levels as I am sure you can research those. They can help quite a lot even in conjunction with the above protocol. In fact I would recommend the combination.
A life on TRT becomes very complicated and full of issues as every man is different and responds to exogenous T in different ways. It usually never replaces the high level of natural sexual function that normal healthy young men have because of the complete suppression of upstream hormones: LH, FSH and GNRH. These are part of the sexual function equation. Some men cope better without these hormones circulating, but many have issues and or notice that something is missing.

After re-reading your initial post, I would be concerned about your thyroid issue. Low thyroid hormones can cause sexual function issues. I think libido can be adversely affected. What has your doctor suggested doing with regard to your thyroid?
Some men have a natural level of T that is not very high. Do not fall into the trap of thinking that all young men need or have a T level of 500 and above. Some men are built so that their sensitivity to the hormone is such that they only need the lower amount.

[oldbeek]

Hooper 58,, Not much sexual experience before 36. I was a mess when first married because of my conservative background and lack of knowledge. Sex was taboo. My wife had aspirations of being a nun before she met me. Anything other than missionary sex was a sin. We met with a priest that assured us that everything that pleases us as a married couple was ok in the eyes of god. We right away started into our sexual adventure and have loved it for the past 57 years.. Find out if this may be your root cause of ED. The mind is a powerful tool.

[Hooper85]

Thanks for the response.

Do you believe the clomid will help with the erections? The doc made it seem like the low T was the underlying issue. Is TRT a better option for solely helping with libido, erection quality? I guess I’m not completely sold that this clomid protocol will do anything for the sexual function even if it increases T levels on paper.

Clomid may or may not help as it seems to depend on the individual. You are correct, it may cause more issues with sexual function while you are on Clomid. less likely with Enclomiphene citrate.
The point of being on SERM (selective estrogen receptor modulators) is not the short term benefit. It is a treatment protocol designed to try and reinstate a higher T level that will stick hopefully after discontinuing these drugs. From my experience it can be a few months on with a very slow taper to finish.

TRT may help libido far more quickly, but once you undertake this, it will further shut down your natural hormone system (HPTA) and after time this can be difficult to restart.
It is far more preferable in a young man to try and improve natural testosterone first. If you are to do this with drug therapy, SERM treatment is first-line therapy.

I have not discussed natural methods of trying to increase T levels as I am sure you can research those. They can help quite a lot even in conjunction with the above protocol. In fact I would recommend the combination.
A life on TRT becomes very complicated and full of issues as every man is different and responds to exogenous T in different ways. It usually never replaces the high level of natural sexual function that normal healthy young men have because of the complete suppression of upstream hormones: LH, FSH and GNRH. These are part of the sexual function equation. Some men cope better without these hormones circulating, but many have issues and or notice that something is missing.

After re-reading your initial post, I would be concerned about your thyroid issue. Low thyroid hormones can cause sexual function issues. I think libido can be adversely affected. What has your doctor suggested doing with regard to your thyroid?
Some men have a natural level of T that is not very high. Do not fall into the trap of thinking that all young men need or have a T level of 500 and above. Some men are built so that their sensitivity to the hormone is such that they only need the lower amount.

What natural methods would you suggest?

I started medication for hypothyroidism in January 2021 and my recent blood work showed signs of thyroid antibodies, therefore my PCP increased the levothyroxine dosage from 75mcg to 100mcg.

[Hooper85]

My update:

Been taking clomid daily as well as daily cialis (usually 5mg). Clomid appears to be helping with sex drive but not much improvement on the erection department.

I’ve managed to have penetrative sex once in the last two weeks, although didn’t last very long. My issue is it seems my erectile dysfunction is very position dependent. I can have a hard erection lying on my back but almost instantly starts deflating when I stand up or attempt missionary sex. Also, I noticed when I’m masturbating that my penis only gets super rock hard when I’m about to cum. After I stop stimulating it immediately softens and deflates within a minute.

Also I’m never in the mood to attempt sex at night, just too tired and sex drive not there. Any attempts are in the morning during weekends.

Not sure what the next course of action is. This is taking a huge toll on me mentally and my wife is supportive, but can’t help but think that this could ruin my marriage.

I’m considering injections, but I don’t know how I feel about them. I wish I had more sexual experience before marriage so I could have understood my limitations and maybe not choose to get married and bring someone else into this mess.

[whymenow]

Hooper,

Welcome to the forum.

We share so much in common. My T level was similar to yours when I got it checked last time, and my urologist was kind of angry with my when I tried to confront him saying that even though you say this is normal, it looks pretty low to me. He did not even consider it as a problem.

I understand how it affects your relationship. As I said, we have more in common you can imagine. But, hey! Just try to be strong.

Try using Cialis 20 mg. Here is the tricky thing about Cialis, at least for me. It sometimes kicks in 2 hours, and other times almost 14 to 16 hours. It gives decent erections for the next 2 days, sometimes up to 4 days without needing another pill. As I said, it is better than Viagra for me right now though 25 mg Viagra used to give me solid erections for 6-8 hours whenever I wanted to have sex, however; it lost its efficiency. That's why I can recommend you to be patient with Cialis at the beginning before you might try the injections. (Please advise your doctor before!)

Anyway, please keep us (or at least me) posted with what is going on with you in this journey!

Let me also know if you need any other information or support!