High Dose Trimix

[btgamer]

Age 44, dealing with serious ED for the last year and a half. I have been following the usual path but doesnt seem to be having the success i would like. Tried Tadalafil and Sildenafil, it never really did anything for me other than mild sensations by themselves.

Started on TRT (100 mg weekly once), for first couple months it was a dream. Hardness, libido. It spiked my PSA and E2. Came off it after 8 months or so when I started working with a Urologist to ensure I didnt have any prostate issues. Test went back to low levels (~200) and PSA and E2 went back to normal levels.

Urologist started me on Trimix while going through all that. I have gone through 3 cycles of usual titration - start 10-15, bump by 5-10 until we get to 50-60 units and he upgrades me a stronger dose. Trimix worked but never had any priapism risk, never had an erection more than 1-1/2 hours even with highest doses. Now on my fourth Trimix strength and hit 60 units again.

In the last round, uro put me back on lower dose and twice a week (50 mg per 2x weekly) and I started using 5 mg Tadalafil daily. I just had my blood test and it looks like my E2 spiked again. Lowered the dose to 30 mg x 2 weekly immediately. Libido is fine. No symptoms of E2 other than on trimix i am less harder. I was never 100% hard but lets say 60-70% instead of 80-90%.

I am accustomed to injections so i don't think my issue is injecting wrong. I seem to be getting erections every injection, just seems to be at high doses and less hard than needed when I am on TRT.

My last experiment was mixing in pills with high dose - 10 mg Tadalafil in the morning, 50 mg Sildenafil an hour before and 60 mg of Trimix latest strength... I would say still not as hard as I would like and erection went away after sex after about 30-40 min as usual. Arguably E2 still might be higher.

I feel like i have a serious case of Venous Leak. Anytime i am in a position when penis is pointing up (woman riding positions), i lose erection. The standing positions always worked best. I tried cock rings after trimix takes effect, little better.

I did the whole Uro workout - Doppler. they did not find anything out of ordinary and referred me to a heart doctor. I am probably healthiest i ever been - Run and exercise daily, eat high protein low processes diet, look and feel fit especially when I am on TRT. Heart doctor ran EKGs/Ultrasounds and blood work... everything is green and good.

I am meeting my Uro again tomorrow. These are my questions:
- Could I have corporal fibrosis despite normal Doppler?
- Would Quad-Mix (never tried) help or just delay the inevitable? or should we bump the strength again?
- Am I a reasonable implant candidate given this history? (I find it crazy at 44 this is what it might come to)
- Should we assess for neurogenic ED — pelvic MRI or nerve studies?
- Should I stop TRT (to fix E2 long term) and introduce HCG and HGH (I have researched some people having success with this stack though they keep using TRT)

Any other suggestions to explore? Anyone here struggled with high dose Trimix + Daily Tadalafil

I feel lost as libido is as good as ever but my penis is not responding to my needs. I have to have Trimix to have sex (just dont get erections without it). Thanks for your suggestions

My Trimix dose history:
Trimix T105 PAP 30 mg/mL, Phentolamine 1 mg/mL, PGE 10 micrograms/mL
Trimix T106 PAP 30 mg/mL, Phentolamine 3 mg/mL, PGE 25 micrograms/mL
Trimix QM4 PAP 30 mg/mL, Phentolamine 3 mg/mL, PGE 300 micrograms/mL
Trimix (Custom) PAP 40 mg/mL, Phentolamine 4 mg/mL, PGE 300 micrograms/mL

[GoodWood]

I have been on the path you are on.

High dose Trimix. Large dose. So so results.

Switched to quadmix. Got a slight improvement but not a game changer.

Added daily cialis. 2.5mg. Then 5mg. Then 10mg. It helped but not a game changer.

Added a good cockring. It helped but not a game changer.

I know you had a doppler which didn’t find anything but clearly you have severe venous leak or severe arterial insufficiency. This isn’t in your head.

In my experience cialis and a cockring helped. If you are OK with shots and aren’t developing scarring (feel the consistency of the tissue of your penis on a regular basis so you can detect any problems) then keep going up on the prescription strength. Make it QuadMix. Add daily cialis. Add a cockring. You’ll know when have hit the wall with this stuff.

I did shots for about 10 years. Once my prescription was maxed out and the compounding pharmacy said they couldn’t make it any stronger. And with that script, 10mg daily Cialis and a cockring I was getting 10-20 minutes of erection I knew it was time for an implant.

There is nothing in your history that would make you a poor candidate for implant. If you reach that point, seek out the absolute top, high volume surgeon you can. That’s what I did. I’m two and a half months post op and I love this thing. Works great. Feels great. I’m glad I did it.

I created a post that is a journal of my implant experience. The link is in my signature block below.

[CanGetItUpButNotOff]

I'm on a similar path - check my sig for all the modalities I've tried.

My current challenge, likewise, is variability of response to PDE5's and Tri-mix . I'm finding it very difficult to hone in on a dose that is effective but doesn't cause priapism. If I were you, I would keep increasing everything until I reach the point of near priapism, then stop. And then go for the implant.

re: Neurogenic ED… My uro referred me to Dr. Choll Kim in San Diego. He's a rare spine surgeon who has a keen interest in sexual health and would be a good starting point for assessing neurogenic ED. In my case, I found him very professional but in the end the tests did not indicate that he could help me but he was very forthright in that assessment.

[btgamer]

I have been on the path you are on.

High dose Trimix. Large dose. So so results.

Very similar journey. Thanks for sharing. I know multiple 60+ years old guys in my circle who uses Trimix successfully for years at 10-15 units... Going crazy that I am experiencing this severe ed at age 44. I will start asking for an implant consult.

[btgamer]

I'm on a similar path - check my sig for all the modalities I've tried.

My current challenge, likewise, is variability of response to PDE5's and Tri-mix . I'm finding it very difficult to hone in on a dose that is effective but doesn't cause priapism. If I were you, I would keep increasing everything until I reach the point of near priapism, then stop. And then go for the implant.

Thank you for sharing. I really feel the strength changes doesnt really impact anything for me as i went thru the same cycle - start at 10-15, titrate all the way up to 60, increase strength. Which makes me think I have serious case of venous leak as I loose erection pretty quickly in positions where i am not standing and penis is pointing up. the challenge is Uro did not come to any conclusions after Doppler etc.

I get erections every time and never ever felt like i was at risk of priapism. After sex (albeit with limited hardness), erection goes away within a reasonable time every time - never exceeded 2 hrs ever... at best (which is not consistent) 1-1:30hr. I had Sudafed ready since day 1 and never had to use it. Are you suggesting go above 60?

[GoodWood]

I get erections every time and never ever felt like i was at risk of priapism. After sex (albeit with limited hardness), erection goes away within a reasonable time every time - never exceeded 2 hrs ever... at best (which is not consistent) 1-1:30hr. I had Sudafed ready since day 1 and never had to use it. Are you suggesting go above 60?

Like you I NEVER got anywhere close to priapism. Never.

And I learned that doses above 60 (60u-100u) had minimal increase in strength or duration.

Once I got up to around 60u a dose it was time to go up to the next strength.

[btgamer]

Like you I NEVER got anywhere close to priapism. Never.

And I learned that doses above 60 (60u-100u) had minimal increase in strength or duration.

Once I got up to around 60u a dose it was time to go up to the next strength.

It is so perplexing... daily 10 mg tadalafil, 2x50 sildenafil 1 hr before sex + 60 units of trimix... was my last experiment... No incremental effect... i am at a loss.

[qcswral]

I wouldn't ignore your doctor's recommendation to see a cardiologist. ED is a precursor to blockages around and to the heart. I know it happened to me. The artery feeding your penis is much much more narrower than your arteries feeding your heart. (LAD for example) So the penile artery is the canary in the coal mine so to speak...it is usually the 1st artery to become partially blocked enough to restrict blow flow and therefore causing ED. Google ED as a precursor to ED and there are numerous articles and studies indicating the connection. There is usually a 3-5 year on-set of coronary blockages after ED begins to raise it's "ugly" head.. ( no pun intended) So go for a cardio work-up, the least that can happen is they tell you there's little to no blockages in your coronary arteries.

[CanGetItUpButNotOff]

I was the opposite… cardiac issues preceded ED. Maybe I wasn't paying attention but my first MI came 11 years ago and I didn't begin noticing the ED until 5-7 years ago.