30 year old

[HeavyMetalFan]

30 years old. I’ve had ED since my mid teens. I can almost always get erections, but they last anywhere from 5 seconds to 5 minutes. Nocturnal erections come in waves; usually dependant on the drugs I’m on. All of my relationships have failed because of this.

I have tried moving on with my life and accepting that it will be sex-free, but I am not able to do so. Any attempt I make at enjoying my hobbies doesn’t last long when I realise I’d rather be working on a relationship and sex.

I’ve tried, in no particular order:
-sildenafil up to 300mg
-tadalafil up to 120mg
-cabergoline up to 1.2mg per week
-pramipexole
-mt2 up to 3mg on demand
-pt141 up to 3mg on demand
-testosterone
-DHT
-proviron
-Masteron
-primobolan
-letrozole, anastrozole, and exemestane
-HCG
-2 hours of exercise per day (split between HIIT and resistance)
-getting better sleep (with the aid of melatonin)
-a whole-foods vegan diet
-all sorts of supplements
-doxazosin
-losartan and telmisartan
-12 sessions of shockwave therapy
-at-home EMS on the glans, perineum, and lower back
-intraurethral alprostadil
-VED

I have tried the above in isolation, and in combination. I have regular blood tests for my testosterone, lipids, estradiol, hba1c, thyroid, and RBCs.

I am very physically fit. I have even broken a fitness-related world record (unofficially).

I have spent 9000 hours (mostly in the form of exercise and preparing healthy meals) across 6 years trying to sort my ED. And at least £20,000. I am no closer to getting fixed.

Going forwards, this is what I plan to do:
-experiment with my estradiol at different levels
-consider a Vertica if the US study is promising
-get a Doppler. Consider revascularisation if applicable

I am cautious about ICC injections and an implant due to long-term complications. Neither option seems worthwhile if I plan on living another 60 years. Implants sound great, but complications arise from revisions, and if/when I get my ED sorted, I don’t think I could psychologically deal with it ever again.

[otter17]

You are 30 and it sounds like the unreliable erections have kept you from achieving successful relationships with women. How important is it for you to move past this hurdle in your life? It sounds like you have already invested a lot of time, money, and effort into this issue. I used to be in the same boat. It sounds like you have what I have, venous leak. I did not realize how psychologically tortured I was by my inability to have stress-free sex until I finally could.

If you want, try a cheap silicone cock ring with the viagra and see how things go.
Do not be afraid to move to the next step if needed. A penile implant is a good solution, but it is not a minor procedure and it is irreversible. Injections were tough to wrap my mind around at a relatively young age, but I promise you, if you have a normal sex drive, they are infinitely better than not being able to have sexual relationships.

[Kimball]

Sorry to hear that you've had no luck with finding an solution for your ED. Have you tried a penis pump (VED) and tension band(s)? This method works very well for me, and others. I can understand why single and/or younger men would prefer to skip the few minutes of prep with the pump, wearing a ring at the base of the penis, etc., but it's the safest method and can be done with or without erectile medications. Pumping is also therapeutic for the penis, which is important even for men without ED, as they age. Pumping with a VED will not work for men who have had medical problems that prevent blood from flowing into the penis. Wishing you the best of luck.

[GoodWood]

You have been WAAAAAY more thorough than most regarding oral meds for ED. Your ED is more profound than oral meds are capable of treating.

The remaining options are:
VED with a constriction ring
Injections
Implants

I can’t and won’t tell you what to do, but I’ll share my experience and that might help you consider your choices.

I had no interest in the VED & constriction ring option. It’s time limited and you have to have the gear with you. So for spontaneous sex away from home, or hooking up, it was a no-go.

I went with injections. They worked great for me for 10 years. I never developed any scarring. They were still limited if a spontaneous opportunity for sex happened away from home. But planned sex away from home was fine. I just brought a prefilled syringe with me in a case the size of a pen or a cigar. I would excuse myself to the bathroom when things looked like they were going to heat up, inject, then return. I had partners for years that never knew I injected. They had no idea I had ED. All they knew is that I got hard and we had a great time.
The other limitation of injections worth mentioning is the time lag between injections. You shouldn’t inject more than once every 48 hours. On occasion you can go again sooner than that, but not as a regular thing.

My ED continued to progress (as most of ours will) and injections became less and less effective. I got an implant in March of this year. I had researched the options and surgeons. I met with three men who had been implanted to talk about their experience and see the device. I knew what I was getting into.
I couldn’t be happier. I lost no size. My sensation is the same. In fact sex feels better to me because now I have a rigid cock and my brain interprets that as “OMG I’m so turned on!” I can have sex all afternoon or evening if we want. I can have sex multiple times in a day if asked. It’s a bit like having a superpower.
My surgeon did a great job and my implant is very discreet. The pump in my scrotum, although firmer/denser than a testicle gets mistaken for a testicle. Most of my partners don’t know I have an implant despite hands and mouths being all over it.

I know there is a lot of concern about implant being irreversible. But what is there to reverse to? Profound ED that keeps me from having a fulfilling sex life? Waiting for some other breakthrough means continuing to live a life on hold. And the years don’t stay on hold. They keep ticking by. You are 30 and some of the best years of your sex life have already passed you by. I wouldn’t let anymore time pass without taking action.

When I was in the situation you are in now, I went to injections and dialed in a dose that worked. Then I was backed in the corner by my ED again years later, I went to implant. It was the right choice for me. I would do exactly the same thing again. I have zero regrets.

Feel free to shoot me a PM if you want to discuss any further details.

[ElbowRoom]

My opinion:

Do NOT do a revascularization procedure. Almost all the literature notes that these procedures are no more than 30% effective, and I think the real numbers are worse than that. I have known of maybe 5-6 men who have had them…NONE of them had any relief from their EF, and at least half were left completely impotent. Look at posts by user AntonS and the hell his procedure put him through.

You have done your due diligence, and have tried every reasonable measure to restore your function…or more truthfully, create a normal function you have never possessed. It’s time to create the conditions that will allow you to have normal, healthy relationships with women free of the anxiety and frustration that our condition creates.

Do a deep dive on implants, and seriously consider one. Everything else is a treatment, an implant it a cure for ED.

Again, just my opinion and YMMV, but in my mind you have suffered enough and need to move forward so this doesn’t continue to dominate your life.

[HeavyMetalFan]

How important is it for you to move past this hurdle in your life?

If you want, try a cheap silicone cock ring with the viagra and see how things go.
Do not be afraid to move to the next step if needed. A penile implant is a good solution, but it is not a minor procedure and it is irreversible. Injections were tough to wrap my mind around at a relatively young age, but I promise you, if you have a normal sex drive, they are infinitely better than not being able to have sexual relationships.

I’m a believer in “Maslow’s hierarchy of needs”. So I find it hard to get on with much in life without being able to have sex.

I find that rings are not sufficient for me. I still lose the erection even with a very tight ring.

My concern with the injections is that repeated use causes scarring. And that may leave me ultimately worse off in the long run.

[GoodWood]

My concern with the injections is that repeated use causes scarring. And that may leave me ultimately worse off in the long run.

It is reasonable to be wary of scarring with injections. But they are not inevitable. I injected for nearly 10 years with no scarring.

If you are someone that is prone to developed scarring you will know very early. You are familiar with the feeling/texture/density of your penis. The day after an injection you can feel to see if you notice any change. If you notice anything concerning, just don’t inject again.

On rare occasion (maybe once a year) I noticed a little lump inside at the site of the injection about the size of a pea. But a day or two later it would be gone again.

I kept an eye on it and would have just stopped injecting if the tissue of my penis changed at all. But there was never a problem.

[HeavyMetalFan]

The remaining options are:
VED with a constriction ring
Injections
Implants

Thanks for the detailed message. It was worded very well.

I find that part of my apprehension to injections (and by extension, implants) is that my ED is widely variable dependant upon the drugs I’m taking.

A lot of the drugs I’ve taken have both pro-erectile and anti-erectile effects, and some pro-erectile and anti-erectile effects are massively delayed. Some effects build a tolerance, whereas others do not.

For example, pt-141 microdosed at 300mcg every day worked very well. But I built a tolerance fast. So I started taking 3000mcg twice a week before sex. This worked well, but made me feel so sick, and due to it taking a few hours to work properly, took spontaneity away. The sickness also causes me to lose sleep quality.

So somewhere between “I built a tolerance to a daily dose and it doesn’t do anything” and “I took the pro-erectile drug at a time where I didn’t want sex, and also I am tired and nauseous as fuck” is a dosing protocol that works best. But where is it? I’m not sure.

Same sort of thing with other drugs. There is a perfect dose for them, but I’m not sure where it is. I’m collecting data on my symptoms and the drugs I’m taking, but it could take decades before I could draw strong conclusions. It doesn’t help that the chaos of life muddies the data.

So while injections or an implant could skip troubleshooting a dozen different drugs, it also means committing to the drawbacks of injections or an implant.

[HeavyMetalFan]

My concern with the injections is that repeated use causes scarring. And that may leave me ultimately worse off in the long run.

It is reasonable to be wary of scarring with injections. But they are not inevitable. I injected for nearly 10 years with no scarring.

If you are someone that is prone to developed scarring you will know very early. You are familiar with the feeling/texture/density of your penis. The day after an injection you can feel to see if you notice any change. If you notice anything concerning, just don’t inject again.

On rare occasion (maybe once a year) I noticed a little lump inside at the site of the injection about the size of a pea. But a day or two later it would be gone again.

I kept an eye on it and would have just stopped injecting if the tissue of my penis changed at all. But there was never a problem.

Yeah, good point. It is to my understanding that in the case of alprostadil (which is all we can get here in the UK) it is the needles themselves that cause the scarring, and not the alprostadil. I inject testosterone subcutaneously, and get a lot of lumps, but none that persist beyond a week.

Another apprehension is if I commit to using injections regularly, my standards for sex will readjust, and my baseline sexual function will be one I wouldn’t want to engage with. This would make it challenging to adjust other drugs and gauge their effectiveness at treating my ED. Because why would I attempt shitty sex when I could shoot up and have great sex?

Alprostadil is very expensive here (around £20 an injection). I could get it on the NHS, at one injection per week, which doesn’t feel sufficient. I would like to have sex at least 4 times per week. And at £20 a dose I would simply avoid sex.

If I knew that exploring drug therapies was doomed to be fruitless, I’d hop on injections right now and make the best of a shit situation. But I’m being strung along with the hopes that a few pills, at just the right dose, will be all that I need.