niarceel wrote:Interesting. You're telling us things no physician has ever said to me.
I am 71 so the ravages of age are starting to effect me. I am certain that I've had deterioration of the interior of my penis due to years of insufficient oxygen; I stopped having nocturnal erections about 5-10 years ago. As my research discovered, nocturnal erections are key to maintaining penile health.
Thank you for the links Niarceel, I will take a good look.
I think many doctors do not have the time to keep on top of all this research. I have a friend who is a vein specialist and I often send him articles. He just doesn’t have the time to look for these.
The lack of nocturnal erections is an issue for the health of the penis no doubt. Hypoxia over a period of time has been shown to cause changes in the structure of the trabeculae, namely fibrosis, smooth muscle loss and damage to the endothelium, compromising NO release.
It also accelerates oxidative damage. Sustaining nocturnal erections is very important to maintaining erectile function as you know!
It has been shown, as you have mentioned, that a certain level of testosterone is needed for them to occur.
There is something quite interesting about nocturnal erections as they occur mostly during REM sleep. During this period our brain shuts down the locus coeruleus, which controls sympathetic function, so essentially it is turned off. Without the inhibition of sympathetic activity in the penis, erections can happen far more easily, as this apparently is one of the pathways keeping the penis in a flaccid state during our waking hours. Another interesting fact is much research has shown that this sympathetic activity increases with age. Another factor which makes it more difficult for some of us to maintain an erection.
I have discussed sympathetic hyperactivity before. This really is an interesting avenue of current research into erectile dysfunction, not only for us mature males, but also for younger men with what is labelled as psychogenic ED.
It has only been in the last 12 months that I found a lot of the research suggesting that the chronic use of PDE5 inhibitors could be more beneficial for us than on demand use which just inhibits PDE5. The studies suggest many benefits from firstly preserving penile health and secondly reversing some of the damage caused by hypoxia and oxidative stress and thirdly, restoration of smooth muscle! I was quite amazed to read how beneficial they may be. These effects do not seem to stop in the penis either. The vascular system in the rest of the body may benefit from this too, as the penis has been described as just an extension of the peripheral vascular system. I have read numerous study’s that point to the restorative effect PDE5 inhibitors may have.
Your experience with the pine pollen sounds interesting did you start this at a similar time to the daily Cialis?
I have been taking daily Cialis for about 8 months now. It is still not in generic form here. I get a generic from the UK, which I trust to be genuine. I have used some from India before and they are not the same. Because of the expense of Cialis in AU, I did not entertain the idea of everyday use until I was able to get the genuine generics.
Taking Tadalafil daily has given me almost normal erectile function. It means the drug is constantly in my system and the low dose helps to sustain blood flow at higher rate most of the time. Like you, my nocturnal erections are stronger and when I wake out of a dream state they are always there and quite persistent. The only time I have issues now is during sex at specific times and I am quite sure this is due to sympathetic hyperactivity. I am going to try another drug called phentolamine mesylate soon to try and combat this. This is a adrenergic a1 and a2 blocker. I have discussed this in other posts as well.
Performance anxiety will be worse for us older guys, as the receptors for norepinephrine in the penis are either more sensitive or have increased in number. If all the other degenerative changes are not enough, mother nature has to throw this one at us too. Duck lads!
I am also on testosterone replacement. How is that working for you? What protocol are you on? I was a member of Dr Crislers forum; “all things male” for over 15 years. It was a great place to discuss and learn about TRT.
He had a very good understanding of hormone replacement for the male and a wealth of experience. Many of the other guys on that forum also had very interesting and helpful hints to offer.
There was always a large amount of new people posting who were having difficulties with their treatments or protocols from doctors who had very little idea of how to administer TRT correctly.
Not to mention many of the dubious TRT clinics that were appearing all over the US, almost pushing TRT as a cure all for all men, and also using protocols doing more harm than good. Many lawsuits ensued and much damage was done in relation to TRT therapy and for those that actually do need it. This was I think one of the main reasons that Androxal didn’t make it to approval by the FDA. A drug that could have helped so many. I discussed Androxal recently in more detail in another post.
There is a large body of evidence supporting that androgen's are vital for penile health. The lack of androgen's will firstly lessen or stop nocturnal erections, as you found out! Aside from the increased blood flow from these nighty erections testosterone stimulates, it also preserves smooth muscle in all areas of the penis, prevents extra cellular matrix deposition: collagen (fibrosis), in place of smooth muscle. Fibrosis changes the elasticity and compliance of the penis, compromising its ability to expand and most likely causing COVD or venous leakage. I discussed this in detail in my other post to you. Testosterone has also been shown to help preserve the structural integrity of the tunica albuginea, another vital component for venous occlusion.
Your observations of the improvement in the appearance and the function of your penis since using Tadalafil daily and bee pollen supplement is encouraging. I have also noticed that my penis when not erect appears larger and healthier, whereas before this protocol, it would often look quite shriveled as though I was subjecting it to a cold environment. When I was younger it rarely looked like this, only if I went swimming in very cold water or I was in full “flight and flight mode”! Thus now it appears more like it did 10-15 years ago.
I attribute some of this excessive shriveling that older men experience to sympathetic hyperactivity. The constant tonic influence of norepinephrine having a greater effect, which logically would encourage the penis to look even more contracted and less impressive in the flaccid state. However, loss of smooth muscle and fibrosis also contributes to this phenomena. Is rarely ever one thing that is the cause of erectile dysfunction.
Low testosterone levels also may contribute to this. While on this topic, excessive testosterone levels will also contribute to the above, as the conversion of T into excessive amounts of E2 can cause many issues with erectile function.
I also feel the too high a level of T, may cause other issues with sympathetic activity in the penis as well as possible deleterious changes in the penile tissues. Exogenous testosterone administration needs to be kept within the confines of one’s own genetic requirement for testosterone, otherwise there will be problems. Many guys posting on Dr John’s forum, asking for help, were administering exo T in excessive amounts, causing many issues and then trying to combat these issues with more medications and supplements, creating one big complicated mess for themselves.
Another important and interesting change in my penis that I have noticed since the daily Tadalafil, is sexual sensitivity in the penis. I was having periods where my penis had little “sexual sensitivity” (as you have mentioned!). It still had normal tactile sensitivity, that is touch sense, but the erotic or good sensations were numbed, so to speak. On some days during masturbation and or sex they were there, others, they were quite low or even absent. This has improved substantially whilst taking low dose Tadalafil. Almost to the point of it being resolved! I was very concerned when this began occurring and it was slowly getting more frequent as the years went by. To have this almost corrected is quite amazing IMO. The increase in blood flow and possible repair of vascular tissue may be improving neural function in the penis itself.
I also find after a coffee in the morning or sometimes two, my penis will have a less relaxed look, it will be in a more contracted state. I also find it is less responsive, even with the Tadalafil in my system, trying to get an erection will be more difficult. This is most likely due to the increase in noradrenaline that caffeine stimulates. After a an hour or two, this effect wears off. As I am quite certain that I have an increased susceptibility to sympathetic influence in my penis now at my age, any drug or supplement that increases sympathetic activity has a much greater impact on my erectile function, than it may have had in my 20’s. Some men in my opinion are genetically more prone to this, even from a young age. Some urologists are recognising this now.
The improvement I have seen whilst using a PDE5 inhibitor daily, could be at this stage only be while I take the medication. If I was to stop, I will most likely just revert back. Time will tell. The aging process is going to plough ahead, so it would seem that there will never be a total cure for this, constant intervention will probably always be the answer.
Age 57, ED issues for 15-20 years. Testosterone replacement with Enanthate and Ovidrel. Currently using generic Tadalafil 2.5mgs and Resveratrol daily.
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