My Story and success. aka Play the Long Game. (no Pun)

[WillPower]

My history and regimen dealing with ED. It’s meant to…

* Help me organize my thoughts,
* Help the professionals trying to help me,
* And for peers with similar struggles.

Divorced in 2005. I was 42 years old and starting to show some signs of ED—mostly difficulty keeping an erection. For roughly the next 10 years, I was busy trying to stay in my kids’ lives. No time to pay attention to my general health, much less my sexual/penile health.

By 2015, family life was much, much better, but health issues caught up to me: diabetes, AFib, high BP, a mechanical heart valve in 2019, and I had a foot amputated in 2020 due to a bone infection (osteomyelitis). Erectile dysfunction was really… erectile No function. I’ll keep it simple and concentrate on the ED. Honestly, everything else is mostly controlled or beaten. My general health is much improved. Praise God. Important to note that nothing else would have helped without this overall improvement first.

Cialis and Viagra at first did absolutely nothing. Caverject & MUSE (alprostadil) had some mediocre results but ached severely. I started experimenting with constriction bands with some success, but alprostadil and a band together were out of the question.

In 2020, a urologist insisted an implant was my last option. I believed him. No one would do the procedure, however, because of blood thinners (anticoagulation) for the mechanical valve. I was disappointed at first, but it turned out for the best.

Somewhere in this time period, I started using penis pumps therapeutically—on and off daily. I started testosterone injections for low testosterone. I also started taking Cialis 5 mg/day. My nighttime erections returned (though weak). The pump, nighttime erections, and induced erections helped my vascularity, and this is when my body started healing itself.

I also tried every supplement I came across—horny goat weed, maca, yohimbe, ginseng, citrulline, and others—with debatable or zero noticeable results. I diagnosed myself with a venous leak / veno-occlusive dysfunction (VOD). As things progressed, my improving overall and penile health gave me good flow in; it just doesn’t stay there well. PRP shots are out because of my blood thinner meds. I’ve done low-intensity shockwave therapy. It’s a big discussion. I believe it to be an adjunctive treatment to everything else, and it helps maintain my improvements. It is expensive, though. I’m evaluating its place in my regimen.

My 24-year-old self is my baseline erection — 100%
52-year-old (2015) — 0%
62 y/o (2025) — as follows…

Assume daily Cialis 5 mg is consistent:

* Nighttime or spontaneous erections, or inducing with arousal/stim = 40–50%
* Constriction band + arousal with physical stimulation = 65–85% (not always good enough)
* Band + arousal/stim + Viagra 100 mg (1 hr prior) = 80–90% (a little more reliable)
* Band + arousal/stim + Trimix = 90–105% (sometimes more rigid than pre-ED, and nearly always usable)

These numbers are about 5–10% higher than they were a year ago.

Notice: The band is my best tool.

* None of this is perfectly reliable. Unknown factors affect things. Maybe when Mars and Venus are un-aligned or something—I’ll probably never know.
* I lose rigidity if stimulation stops, or just by being distracted—anything that lowers arousal.
* Position is important. Supine is weakest. Standing or sitting up straight is best.
* Pressure in the perineum, and a brief pelvic clench, add rigidity.
* Getting near and during orgasm adds rigidity.

As of right now, things are actually darn good. But if I came this far, why not a little more?

Next/current steps

New Trimix Rx:
From 8.33/0.83/22.5 to 20/2/30. (alprostadil (mcg/mL) / phentolamine (mg/mL) / papaverine (mg/mL) I’ll get this in a few days. By maximizing blood flow in (as opposed to just “adequate”), I can overcome VOD to a point—I think. From what I’ve learned, smooth muscle tissues relax to help seal the blood in. It is actually part of the same mechanism of the penis becoming engorged. I used to think they were two separate actions.

Pelvic floor therapy:
I’m resigned to accepting that I’ll never rid myself of VOD. I’ve ruled out invasive and non-invasive procedures. They seem unreliable, and being on blood thinners is a big consideration. The only remaining option to directly address VOD seems to be pelvic floor therapy. A brief pelvic clench, nearing orgasm, and pressure to the perineum all increase rigidity noticeably. This suggests that strengthening the muscles of the pelvic floor may help.

PT-141:
I’m hoping this increases libido/arousal/sensitivity, even if it doesn’t increase rigidity or blood flow. It certainly won’t affect VOD. I’m nearing the point of diminishing returns from more vascularity (I think anyway). Maybe mentally it can help me get and maintain things so I don’t have to work so hard. We shall see.

Experts and people that have similiar issues may pick much of what I said apart. But one thing I know for certain. I've gone from Zero erection to one that can sometimes be better than my 24 year old self. There is no disputing that.


Hang in there, (ok thats a pun) don't forget to play the long game while you're trying the quicker fixes.

[GoodWood]

You have certainly done a lot of work to dial in the best combination for your erections.

As long as that continues to work for you, that’s great.

I used pills for 5 years and then shots for 11. I tweaked/increased the strength of my injection medications, found a cock ring was a good booster, and daily cialis helped as well.

Eventually I hit the wall, maxed out the concentration and dose of the injection meds. Nothing left to tweak. No runway left.

At that point implant was my last option. I found the best surgeon in my area and went ahead with implant at that point. It has turned out great.

We need to be active participants in this fight against ED with a great doc. Keep at it.

Have you and your cardiologist explored having a cardiac ablation to treat your afib so you can get off blood thinners? If you haven’t discussed it with them, ask them if it is right for you.

[WillPower]

I had 4 ablations, 2 AFIB 2 flutter. All that is in my past. My heart is very healthy. By Grace and some good medical help. Thanks for the response though. Best wishes.