TestBoosted
New Member
Good morning all,
Hope everyone is well.
I am a 33 year old man, currently weighing 88kgs and height 1.83 cm (6 foot).
I have been battling erectile dysfunction for 10 years or so, starting from when I was 22 or 23 years old. I have posted about my journey in this thread (Help with blood test results and erectile dysfunction - Excel Male Health Forum).
Below is a quick summary of what was said in the other thread:
i) Started experiencing ED at 22 or 23 years old.
ii) At first, doctors blamed anti-depressants I used to take.
iii) Blood test confirmed I had secondary hypogonadism and was put on testosterone.
iv) After being put on Nebido (testosterone undecanoate), erections came back full force after 3 months. I was finally cured and happy but this only lasted 2 years.
v) After I got Covid, erections deteriorated again.
a) Nowadays, I wake up with weak morning wood.
b) Erections are soft, where the shaft is semi-rigid and the head of the penis does not engorge and is soft.
c) I can't maintain erections standing up. I can only maintain soft erections when sitting down e.g. on the toilet.
d) I don't respond to 5mg Cialis, 20mg Cialis, 20mg Viagra, 100mg Viagra. I used to respond in the 2 years when my erections came back.
e) Caverject (penile injection in Europe) and Vitaros only give me a partial erection (still soft)
f) I am only able to get and somewhat maintain a decent erection with an acceptably engorged head if I wear a tight and oversized cock ring.
vi) Started investigating issue again.
a) Cardiologist did 24 hour blood pressure test and echocardiogram. Everything is good.
b) Found that I had some insulin resistance and cholesterol. Went to dietician 4 months ago and lost 7 kg (results attached). Insulin resistance and cholesterol are good now.
c) Have been going to psychiatrist to try and change anti-depressant medication. Have tried fluvoxamine 100mg daily, brintellix, anafranil 10 mg, anafranil 25 mg daily, adding wellbutrin 150mg to anafranil 25mg. All to no avail.
d) Did 2 Doppler tests. For both Doppler tests, I was given 20mcg Caverject injection. Both doppler tests showed good artery inflow but high end diastolic velocity. In fact, the diastolic velocity on both sides of the penis for both tests were greater than 10cm/s (results attached). Caverject only gave me weak erection.
e) Experimented with TRT dose. Changed to testosterone enanthate. Initially, SHBG was 16 nmol/L. Tried with 50mg twice a week, 30mg 3 times a week, 22.5mg EOD. Attached testosterone results at trough, all were good but no change in ED. (Results attached)
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Now here is the catch guys. After going through all of this, especially given the Doppler test results, the fact that I no longer respond to PDE5 inhibitors and caverject, as well as the fact that the only thing that helps is a cock ring, I was 100% convinced that it must be a physical issue.
My urologist kindly ordered a Nocturnal penile tumescence test using Rigiscan, where they measure my erections during the night. The test stated that I had 3 erectile episodes lasting 1 hour with 85% rigidity. This was a suprise honestly as I wake up with weak morning wood and my penis was very shrunken before the test, given that I even stopped taking 5mg Cialis before the test. I still take 5mg CIalis till this day even though I don't respond that much to it, but it helps a bit.
Thus, the conclusion from the Nocturnal penile tumescence test was that I have phsycological ED and was recommended to a sex therapist. The thing is I can never get decent erections, neither when waking up, masturbating alone, with a partner, nothing. Sometimes I think the reason I got these erectile episodes during the test was due to the fact that my bladder was full of urine, and sometimes it creates enough pressure to get an erection. I also noticed this way before, that when I wake up to pee, I have better erections.
At this point, I don't know what to do honestly. I am trying to experiment the psychological side more, going to try some more medication under the guidance of my physicatrist.
What do you guys think? Is my ED physical, hormonal or phsycological? Should I try going to a pelvic floor therapist, try PRP or shockwave? What would you do in my situation?
Current medications I take
------------------------------------
Vitamin D + K2
2 capsules Omega 3 (2g each)
25mg Anafranil (Clomipramine)
150mg Wellbutrin
Cialis 5mg
Atorvastatin 20mg
Hope everyone is well.
I am a 33 year old man, currently weighing 88kgs and height 1.83 cm (6 foot).
I have been battling erectile dysfunction for 10 years or so, starting from when I was 22 or 23 years old. I have posted about my journey in this thread (Help with blood test results and erectile dysfunction - Excel Male Health Forum).
Below is a quick summary of what was said in the other thread:
i) Started experiencing ED at 22 or 23 years old.
ii) At first, doctors blamed anti-depressants I used to take.
iii) Blood test confirmed I had secondary hypogonadism and was put on testosterone.
iv) After being put on Nebido (testosterone undecanoate), erections came back full force after 3 months. I was finally cured and happy but this only lasted 2 years.
v) After I got Covid, erections deteriorated again.
a) Nowadays, I wake up with weak morning wood.
b) Erections are soft, where the shaft is semi-rigid and the head of the penis does not engorge and is soft.
c) I can't maintain erections standing up. I can only maintain soft erections when sitting down e.g. on the toilet.
d) I don't respond to 5mg Cialis, 20mg Cialis, 20mg Viagra, 100mg Viagra. I used to respond in the 2 years when my erections came back.
e) Caverject (penile injection in Europe) and Vitaros only give me a partial erection (still soft)
f) I am only able to get and somewhat maintain a decent erection with an acceptably engorged head if I wear a tight and oversized cock ring.
vi) Started investigating issue again.
a) Cardiologist did 24 hour blood pressure test and echocardiogram. Everything is good.
b) Found that I had some insulin resistance and cholesterol. Went to dietician 4 months ago and lost 7 kg (results attached). Insulin resistance and cholesterol are good now.
c) Have been going to psychiatrist to try and change anti-depressant medication. Have tried fluvoxamine 100mg daily, brintellix, anafranil 10 mg, anafranil 25 mg daily, adding wellbutrin 150mg to anafranil 25mg. All to no avail.
d) Did 2 Doppler tests. For both Doppler tests, I was given 20mcg Caverject injection. Both doppler tests showed good artery inflow but high end diastolic velocity. In fact, the diastolic velocity on both sides of the penis for both tests were greater than 10cm/s (results attached). Caverject only gave me weak erection.
e) Experimented with TRT dose. Changed to testosterone enanthate. Initially, SHBG was 16 nmol/L. Tried with 50mg twice a week, 30mg 3 times a week, 22.5mg EOD. Attached testosterone results at trough, all were good but no change in ED. (Results attached)
----------
Now here is the catch guys. After going through all of this, especially given the Doppler test results, the fact that I no longer respond to PDE5 inhibitors and caverject, as well as the fact that the only thing that helps is a cock ring, I was 100% convinced that it must be a physical issue.
My urologist kindly ordered a Nocturnal penile tumescence test using Rigiscan, where they measure my erections during the night. The test stated that I had 3 erectile episodes lasting 1 hour with 85% rigidity. This was a suprise honestly as I wake up with weak morning wood and my penis was very shrunken before the test, given that I even stopped taking 5mg Cialis before the test. I still take 5mg CIalis till this day even though I don't respond that much to it, but it helps a bit.
Thus, the conclusion from the Nocturnal penile tumescence test was that I have phsycological ED and was recommended to a sex therapist. The thing is I can never get decent erections, neither when waking up, masturbating alone, with a partner, nothing. Sometimes I think the reason I got these erectile episodes during the test was due to the fact that my bladder was full of urine, and sometimes it creates enough pressure to get an erection. I also noticed this way before, that when I wake up to pee, I have better erections.
At this point, I don't know what to do honestly. I am trying to experiment the psychological side more, going to try some more medication under the guidance of my physicatrist.
What do you guys think? Is my ED physical, hormonal or phsycological? Should I try going to a pelvic floor therapist, try PRP or shockwave? What would you do in my situation?
Current medications I take
------------------------------------
Vitamin D + K2
2 capsules Omega 3 (2g each)
25mg Anafranil (Clomipramine)
150mg Wellbutrin
Cialis 5mg
Atorvastatin 20mg
