Is Maintaining Morning Erections Important?

[waterbottle1258@tutanota.]

Great discussion here. I'll be 68 next month, and I got on TRT a couple of years ago because my libido was shot and I wasn't getting any morning wood. Like ResearchIt, my total T was great even before TRT, but my free T was on the low end.

TRT has brought my total T and free T way up. A Quest Labs blood test last month shows total T at 1802 and free T at 277.5 (this is on just 100 mg of testosterone cypionate per week). I work with Dr. Rand in Santa Monica, and they like seeing free T in this range. So ResearchIt, by this standard your free T is too low, regardless of the Quest measuring stick.

The results for me have been very robust nocturnal erections and morning wood; a restored libido; more clarity of thought; and a generally more optimistic attitude.

So I'd recommend you consider TRT to bring your free T up and see the results. In my case, the results have been satisfying.

I would lower dose unless you feel really good. 68 year olds aren't supposed to have 1800 levels. Even half of those levels you most likely would feel great. Lowest therapeutic dose is always best option

 

[Ozzieville]

Waterbottle, thanks for the comment. Certainly 68-year-olds don't have 1800 levels "in the wild." But I've been getting advised by both Dr. Rand and Dr. Florence Comite (former professor of medicine at Yale and now head of the Comite Center for Precision Health and Medicine). Comite's team in particular conducts exhaustive blood labs (among other tests) on patients every quarter. I'm content to follow the advice of my medical team.

But I agree with your point about lowest therapeutic dose.

 

[SkiDaddy]

Source?

Besides personal experience.

How erectile dysfunction is connected to heart health

Erectile dysfunction and heart disease can be linked. Take steps to avoid both.

www.mayoclinic.org

Health Blog | CommonSpirit Health

Our CommonSpirit Health Blog features expert advice, health resources and information to support your health and wellness journey at every stage of life.

www.stlukeshealth.org

Is erectile dysfunction a warning sign for more serious health problems?​

An erection occurs when extra blood flow to your penis causes the blood vessels to swell. Anything that hinders the blood flow makes an erection challenging to get or maintain. Atherosclerosis is a common condition in which your arteries become hardened or clogged, affecting smaller blood vessels like those in the penis. As a result of this condition, ED can be a warning sign of heart disease. A four-year study found that men with erectile dysfunction experienced twice the number of cardiovascular-related events than men without ED.

 

[VacationMan]

I really appreciate the feedback. As I mentioned above, my only lab issue is lower range Free T and higher range SHGB. Total T and other labs are good. Taking a PDE5 inhibitor does assist in restoring my morning erections, but I never had to take that before and want to address the underlying issue if I can identify it.

I have already addressed sleep, exercise, diet, penile doppler ultrasound, etc.

I was thinking of trying a couple of things:

1) Hormones - enclomiphene first and then Natesto second. Attempt to increase my Free T to see if it makes a difference in nocturnal and morning erections.

2) Shockwave Therapy - After seeing the effect of hormone adjustment, I want to get off those and try shockwave therapy with a legit clinic and device (Duolith SD1 or Urogold 100).

I feel like my issue is that my body doesn't create nitric oxide so freely like it used to. Even though my sexual function is still fine, my penis feels less springy and less prone to an erection like in years past. And I am only 43 and healthy. I am not sure whether it is hormone related where enclomiphene or Natesto might help? Or if it is tissue related where shockwave therapy might help?

Does this seem like a good worthwhile plan? Any comments or suggestions?

Forget the shockwave therapy. Designed to do little more than empty your wallet. Maybe consider PRP, but that too isn't a silver bullet.

For a nitric oxide boost, try beet root.

 

[Dudley]

It's routinely stated that nocturnal erections are important for penile health, providing necessary blood flow and thus oxygenation [R]. In hindsight my attenuated nocturnal erections could have been the canary in the coal mine, warning of the overt hypogonadism to come in a few years. Conventional TRT did restore nocturnal erections, but not with consistency. I've only regained consistency in the past year or two with unconventional protocols.

Hey Cataceous, what unconventional protocols have given you good erections? Mine sometimes are weak, other times become eventually but it sure takes a lot of time and effort to get there. Thanks.

 

[Cataceous]

Waterbottle, thanks for the comment. Certainly 68-year-olds don't have 1800 levels "in the wild." But I've been getting advised by both Dr. Rand and Dr. Florence Comite (former professor of medicine at Yale and now head of the Comite Center for Precision Health and Medicine). Comite's team in particular conducts exhaustive blood labs (among other tests) on patients every quarter. I'm content to follow the advice of my medical team.

But I agree with your point about lowest therapeutic dose.

It's not just that 68-year-olds don't have these levels. This is nearly three times the level of the average healthy young guy. Malpractice is maybe too strong a word, but I have to wonder about a doctor who's fine with running patients at such levels as long as there aren't overt problems—yet. Imagine if it were some hormone other than testosterone. Are these doctors carefully monitoring your cardiac function to catch early signs of toxicity? Why take such risks when you could still be close to the top of the reference range with half the dose?

 

[Cataceous]

Hey Cataceous, what unconventional protocols have given you good erections? Mine sometimes are weak, other times become eventually but it sure takes a lot of time and effort to get there. Thanks.

The protocols were developed in an attempt to fix the things that TRT had broken, and the current one is described in detail here. Unfortunately it's not as if there's one exact recipe to fix everyone's problems. These are just some of the tools with which to experiment. For me the GnRH was one of the more important pieces of the puzzle. It's been pointed out that multiple daily doses are more practical if one has access to a gonadorelin nasal spray.

 

[Fernando Almaguer]

The protocols were developed in an attempt to fix the things that TRT had broken, and the current one is described in detail here. Unfortunately it's not as if there's one exact recipe to fix everyone's problems. These are just some of the tools with which to experiment. For me the GnRH was one of the more important pieces of the puzzle. It's been pointed out that multiple daily doses are more practical if one has access to a gonadorelin nasal spray.

With your protocol do you have any concerns or complaints? Did it fix you up completley?

 

[Cataceous]

With your protocol do you have any concerns or complaints? Did it fix you up completley?

My primary concern is the long-term use of enclomiphene. To what extent is it reducing estrogenic activity in non-target areas? Complaints? It would be nice if it didn't require multiple daily injections. You need determination bordering on compulsion to "stick" with this. However, it's totally worth it to be "fixed up". It's not like it made me 20 again, but it pretty much resolved the issues I was having with TRT, including fading libido and erratic sexual function.

 

[Seth]

It is interesting that using low-dose Cialis does make my morning erections come back most days. Since that is the case, it seems like the other mechanisms involved in a morning erection (brain, nerves, signaling, venous closure, etc) are working, it's just a case of the body not generating enough nitric oxide during the morning erection process and that's where the PDE5 inhibitor comes into play, it allows you to make the most of the nitric oxide your body does produce. Does that seem right? If so, I am wondering if the decreased NO is hormonal or tissue related, hence the tests I wanted to run on myself.

Other factors can be at play as well. For example, some mornings I just wake up feeling really good, and with this, usually comes a very rigid erection. Like this morning, it was straining against my boxers, standing straight up and proud! Other days, it's wood, but it usually disappears after I'm up for a bit.

 

[Fernando Almaguer]

My primary concern is the long-term use of enclomiphene. To what extent is it reducing estrogenic activity in non-target areas? Complaints? It would be nice if it didn't require multiple daily injections. You need determination bordering on compulsion to "stick" with this. However, it's totally worth it to be "fixed up". It's not like it made me 20 again, but it pretty much resolved the issues I was having with TRT, including fading libido and erratic sexual function.

well that sounds like a winner to me. Congrats and thanks for your input. I find it hard to pin eod, take supplements pills and powders so I can only imagine pinning everyday multiple compounds. Sounds like you are getting er done.

 

[bluerage]

Guys how are you able to tell if you've had nocturnal erections if you're sleeping? I have no idea since I usually sleep through the night. I've never kept track but I feel like I have morning wood 2 out of the 7 days. I take it this isn't healthy?

 

[Cataceous]

Guys how are you able to tell if you've had nocturnal erections if you're sleeping? I have no idea since I usually sleep through the night. I've never kept track but I feel like I have morning wood 2 out of the 7 days. I take it this isn't healthy?

If you're fortunate enough to be sleeping that soundly then you're probably just unaware of most of them. If you really want to know then there are some self-tests, such as the stamp test:

Erection Self-Test: Purpose, Risks, and Procedure

An erection self-test is a procedure a man can do by himself to determine if the cause of his erectile dysfunction is physical or psychological.

www.healthline.com

 

[madman]

Guys how are you able to tell if you've had nocturnal erections if you're sleeping? I have no idea since I usually sleep through the night. I've never kept track but I feel like I have morning wood 2 out of the 7 days. I take it this isn't healthy?

Not a given that everyone will experience morning wood 7 days a week.

What is more important is that you are having nocturnal erections throughout the night.

Almost a given that I will have morning wood when awaking during REM.

Neurotransmitters, vascular health, and healthy hormones all play a big role in EF.

Getting quality sleep is also critical.

The at-home stamp test is outdated and unreliable.

You would need to have nocturnal penile tumescence (NPT) testing done using a nocturnal monitoring device (NMD).

Testing can be done in a sleep lab or at home.

Even then NMD has advantages/disadvantages.

What is the nocturnal penile tumescence (NPT) test?

When a man has problems with erections, it is sometimes difficult to know if the cause(s) are physical, psychological, or both. The nocturnal penile...

www.issm.info

What is the nocturnal penile tumescence (NPT) test?
Reviewed by the medical professionals of the ISSM’s Communication Committee

When a man has problems with erections, it is sometimes difficult to know if the cause(s) are physical, psychological, or both. The nocturnal penile tumescence (NPT) test can give the doctor some clues.

Men typically have 3 – 5 erections per 8 hours of sleep, usually at night. This is called nocturnal penile tumescence (NPT). The NPT test shows whether these erections have occurred.

The test may be done at home or at a sleep lab. The most accurate method involves a special electronic device with two rings connected to it. One ring is placed at the tip of the penis; the other is placed at the base.

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While the man sleeps, the device monitors his nocturnal erections, including how many occur, how long they last, and how rigid they are.

The NPT test is not used often and is not a routine way to evaluate erectile function. It might be used for hard-to-diagnose cases, for young patients, or in legal cases. But otherwise, its use is rare.

The test has some limitations, too. There is not much scientific data to support its use. Men need to sleep using the device for two consecutive nights, which can be inconvenient. It is also an expensive method and is not widely available.

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If a man has nocturnal erections, it is likely that psychological issues are affecting his erectile function. The fact that he can have erections during the night shows that his body is working normally. Men might consider seeing a sex therapist or counselor at this point, although a physician should always be consulted for erection problems.

 

[madman]

https://gesiva.com/rigiscan/

 

[madman]

 

[ResearchIt]

• Ultrasound is a non-invasive test that can show early atherosclerotic plaque formation (even before it is narrowing an artery) in blood vessels such as the neck (carotid) arteries or the aorta.
• Coronary Calcium Score is a non-invasive test that uses a low radiation CT (computed tomography) scan without any injected dye (contrast material) to identify the calcified part of any atherosclerotic plaque in the arteries supplying blood to the heart muscle. The only thing that causes calcium in the coronary arteries is plaque. The higher the calcium score, the higher your risk for events such as the development of angina or heart attack. The coronary calcium score does NOT represent the degree of narrowing of a coronary artery.

I agree, these two tests are useful to identify or rule out certain cardiovascular issues. I had both of them done.

The penile doppler ultrasound conducted on me showed no plaque, no scar tissue, no venous leakage, and very strong blood flow. They take these measurements while flaccid, half hard, and fully hard and generate the erection with some type of Trimex like injection. Afterwards it took about 2 hours for the erection to half way go down even after relieving myself like they instructed me to do lol.

My coronary calcium hardness score came back zero, meaning no plaque.

Besides these two tests, are there any other cardiovascular tests that are useful when troubleshooting the absence of morning erections?

 

[madman]

 

[ResearchIt]

Like ResearchIt, my total T was great even before TRT, but my free T was on the low end.

So do you believe the increase in Free T is what restored morning erections for you?

 

[ResearchIt]

For a nitric oxide boost, try beet root.

I have tried beet root and some other nitric oxide type foods and supplements (watermelon, pomegranate, etc) they do make somewhat of a difference in erection and orgasm quality but haven't brought back morning erections for me. Before turning 41/42, I never needed to ingest anything special or do anything special though, things just worked perfectly every time. Maybe the answer to my quest is just to accept that I am getting older lol and that's the way things go, but if possible I would like to find out exactly what changed in me hormonally, chemically, or physically.