Is Maintaining Morning Erections Important?

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ResearchIt

Active Member
For me the GnRH was one of the more important pieces of the puzzle.
Are there any permanent side affects to trying out GnRH like there can be with TRT in terms of shutting down endocrine systems? Or is supplementing with GnRH like using enclomiphene in that you can try it and then stop it with low risk of any permanent disruption?

Also, do you know of any blood tests to measure GnRH levels and production ability or is testing LH and FSH the proxy for that? Are there any other tests to evaluate the function of the hypothalamus?
 
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ResearchIt

Active Member
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.
Silly question here, but did it make you feel like you are 30 or 35 again? I am not shooting for 20 or 25, but if I could lock in my sexual function of 30 or 35 that would be awesome.
 

ResearchIt

Active Member
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.
I agree, mine have mostly gone away but have come back very strongly a few days here and there. It makes me think the change is more hormonal/chemical than some permanent physical change. It seems to be related to multiple factors which makes troubleshooting it's disappearance tricky.
 

ResearchIt

Active Member
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?
The Rigiscan device madman posted seems like it would produce some useful data (frequency, duration, hardness, etc). I haven't tried it yet, but I did call the manufacturer last year to find out about them. There aren't many of those devices in the US and you can't buy one personally, you have to be a doctor's office to own one. They cost like $30k or $40k too. They did say you can rent one from a doctor who has one and it costs like $1k for a week.

The maker of the Rigiscan also makes these "Snap Gauge Penile Bands" that are worn on the penis at night similar to the stamp test, but they have three plastic bands that break under different amounts of pressure and are used to indicate how hard your nocturnal erection was. They are stupidly expensive for what they are ($15 each), but I bought some last year. One night I only broke through two of the plastic bands. The other night I broke through all three plastic bands. I have one left to try. They were interesting to use, but the data from the Rigiscan would be much better I think.

 

Cataceous

Super Moderator
Are there any permanent side affects to trying out GnRH like there can be with TRT in terms of shutting down endocrine systems? Or is supplementing with GnRH like using enclomiphene in that you can try it and then stop it with low risk of any permanent disruption?

Also, do you know of any blood tests to measure GnRH levels and production ability or is testing LH and FSH the proxy for that? Are there any other tests to evaluate the function of the hypothalamus?
While short-term experimentation with reasonable doses of gonadorelin probably would not be harmful, I wouldn't recommend it while your HPTA is intact. I think I get benefits from it because my endogenous production had been completely suppressed by TRT. Kisspeptin-10 is a little more interesting, and it has been shown to stimulate the HPTA even in normal individuals. However, too little is known about it to recommend, and you cannot obtain a pharmaceutical-grade product in the U.S. anyway. This leaves enclomiphene and/or Natesto as the best options for someone who wants to get a boost without completely trashing the HPTA.

There are blood tests for GnRH, example, but I'm not sure how useful they'd be given the pulsatile delivery and very short half-life. LH is the better proxy, but it's also pulsatile, which limits the information you get from such measurements. Basically there are three states: very low—as when suppressed by TRT; high, as in primary hypogonadism; and everything in between, which only indicates that you are making some GnRH.

Silly question here, but did it make you feel like you are 30 or 35 again? I am not shooting for 20 or 25, but if I could lock in my sexual function of 30 or 35 that would be awesome.
More like 40s, though my 40s were still very good until I made the mistake of using finasteride. By "very good" I mean zero problems with sexual function and libido that's good, but not borderline excessive as in earlier years.
 

opus11

New Member
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.
Could you tell me what is your "unconventional protocols"?
 

Cataceous

Super Moderator
Could you tell me what is your "unconventional protocols"?
 

Flimpy

New Member
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?

I also had a doppler ultrasound and have similar challenges. What were your numbers? The diameter of the left cavernosal artery for me was 1.0mm, and the right was 0.9mm. Inflow (peak systolic rates) were 53 cm/s and 50 cm/s on the right and the left was 37 cm/s and 33 cm/s. End-diastolic (outlfow) was 0 cm/s on both sides.

I would have loved to try and make my erection go away on my own, they didn't even give me the option, they injected me with phenylephrine to cause detumescence. I've since wondered if that can cause any scarring or other issues.

Did you get a copy of your doppler images?
 

ResearchIt

Active Member
I also had a doppler ultrasound and have similar challenges. What were your numbers? The diameter of the left cavernosal artery for me was 1.0mm, and the right was 0.9mm. Inflow (peak systolic rates) were 53 cm/s and 50 cm/s on the right and the left was 37 cm/s and 33 cm/s. End-diastolic (outlfow) was 0 cm/s on both sides.

I would have loved to try and make my erection go away on my own, they didn't even give me the option, they injected me with phenylephrine to cause detumescence. I've since wondered if that can cause any scarring or other issues.

Did you get a copy of your doppler images?

For me, the diameter of the left cavernosal artery was 0.8mm, and the right was 0.8mm.

At full erection (100%), Inflow (peak systolic velocity) was 82 cm/s on the right and 109 cm/s on the left. Outflow (end diastolic velocity) was 0 cm/s on both sides.

I am working on getting a copy of the images.

I was worried too about the injection of Trimix at the beginning. Needles down there scare me lol. However, they said it wouldn't cause any scarring or any issues. I don't think it has.

Do you mind me asking what is your age?
 

Flimpy

New Member
For me, the diameter of the left cavernosal artery was 0.8mm, and the right was 0.8mm.

At full erection (100%), Inflow (peak systolic velocity) was 82 cm/s on the right and 109 cm/s on the left. Outflow (end diastolic velocity) was 0 cm/s on both sides.

I am working on getting a copy of the images.

I was worried too about the injection of Trimix at the beginning. Needles down there scare me lol. However, they said it wouldn't cause any scarring or any issues. I don't think it has.

Do you mind me asking what is your age?
Not at all, I'm 40. I wasn't so much worried about the Trimix but after the test was done they injected me a second time with phenylephrine to make my erection go down. In hindsight I wish I had asked to handle that part myself instead of risking an injection of yet another substance. You're inflow rates are impressive.

The reason I'm asking about your images is because they told me that mine suggest some fibrosis near the base of my penis. That *could* cause venous leak. I know hormones play into my issues because when everything is working well I get very good nocturnal erections, but other times I don't. Obviously any internal physical damage isn't changing week to week, so hormones do factor in to it. By the way I'm happy to share my doppler images as well if you'd like.
 

ResearchIt

Active Member
Not at all, I'm 40.
Interesting, so some similarities here, age and all. I know it's just anecdotal, but I spoke with 4 friends about this, ages 40-46, and every single one of them say morning erections have faded and "something has changed down there". Sex still works fine enough and they haven't explored what actually changed to determine if they could do anything about it. It's not the end of the world (yet lol), but hopefully there is something to be done. I am willing to spend some time and resources to find out.

The reason I'm asking about your images is because they told me that mine suggest some fibrosis near the base of my penis. That *could* cause venous leak.
When I get my images, I'll be happy to share and compare with you. I wonder if it would be useful to have a second radiologist or urologist examine your images to see if they also identify any fibrosis? I might get a second read on my images as well, perhaps even a second ultrasound from a different clinic. I'm glad I had the ultrasound done so I have a baseline for comparison when I get older. I wish I had blood labs from when I was 25, 30, 35, and even 39 when things were still working perfect.

I know hormones play into my issues because when everything is working well I get very good nocturnal erections, but other times I don't. Obviously any internal physical damage isn't changing week to week, so hormones do factor in to it.
Yes, I agree and the same for me.
 

Flimpy

New Member
Have you had any hormone labs done? What do your levels look like?
I'm definitely going to try and get a second ultrasound. It's difficult as I live in a smaller town. I am currently on TRT, but it's been difficult to dial in and I'm not convinced I needed it. It was recommended to me by my urologist because my SHBG was high (57) but my total t was also relatively high. He said to try this to see if it would fix my issues, but in hindsight, messing with hormones shouldn't be done lightly.
 

RickD

Member
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.
Could you elaborate on the "unconventional" protocols....
 

RickD

Member
Loosing Morning erections is the First and very important sign of Heart issues, better take it seriously, if not in a couple of years it will let you know in a way you DO NOT WANT.
Not necesarily... PAD (Peripheral Artery Disease) is the usual cause of loss of morning wood as it's the small vessels that get hard and/or partially blocked. While it often goes hand in hand with Coronary Artery Disease, it's not usually by itself the direct cause of ED IMO. Loss of Nitric Oxide as we age (needed for blood vessel dilation) seems to be the root cause of a lot of ED
 

Cataceous

Super Moderator
Could you elaborate on the "unconventional" protocols....
 

MIP1950

Active Member
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
Contrarian opinion; There isn't a 'supposed to' regarding age and total and free testosterone. If the man is feeling and functioning well and his general labs are within range and, importantly, his doctor is okay with what he or she sees, no problem.
 
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