E.D. and TRT

John,

Your testosterone is in the normal range, although towards the lower end (NHS reference range for age ≥ 50, 6.68 - 25.7 nmol/L), so I think it's right you were refused.
Why do you think that's the cause of ED?
Are you low on libido? That would normally result in no interest in sex (and hence not caring about ED), rather than just ED.

I see you had brachytherapy. Your bio doesn't mention hormone therapy though.

Can you say when ED started?
Was this during the brachytherapy, or something ongoing for longer?
Have you tried PDE5 inhibitors (Sildenafil, Tadalafil, etc)?

Edited by member 13 Jan 2021 at 23:15  | Reason: Not specified

Lack of testosterone tends to cause ED via loss of libido, so the fact you have libido suggests you might have enough testosterone. Testosterone is not needed for erections, just for the desire to have erections (but don't underestimate the effect lack of libido can have on erections). Using Tadalafil as you did before, you could try enhancing your arousal and see if that helps, using same ways that can work with men on hormone therapy, such as sex toys (vibrating rings work for some men), reading erotica or soft porn (but make sure your partner is OK with this, or it could damage your relationship).

You also have ED which is not related to prostate cancer. That can be caused by furring up of arteries feeding the penis (for which PDE5 inhibitors can help providing it's not too bad), or by venous leakage, where the veins are not adequately blocked off by the swelling erectile material, so blood leaks out of the erectile material, or other issues. What you could try in the case of venous leakage is a gentle cock ring, not a pump constriction ring, but something like a Durex Pleasure Ring (although even that is tighter that required), again with Tadalafil. This puts pressure on the veins near the surface which carry the blood out of the erectile material (not the veins you can see, they're a few layers lower down), and might make up for the venous leakage. Relatively little pressure is required, because if it allows buildup of more blood in the erectile material, that usually takes over and blocks off the veins as it normally would. Never use rings for more than 30 minutes, and never allow yourself to fall asleep with them on.

These are some things you can easily try yourself, but you should also get a referral to urology, to have it properly diagnosed. This is because ED is an early symptom of lots of other seemingly unrelated issues, and it can be used to get those fixed before they become serious. A urologist told me just recently, the most common cause of ED they see is diabetes, often undiagnosed at time of presentation, followed by cardiovascular disease. Many men who have heart attacks started getting ED around 3 years before, because the arteries feeding the penis fur up similarly to coronary arteries, but they're smaller so tend to block first. Diagnosing things like that at the time can prevent a heart attack a few years later.

Edited by member 14 Jan 2021 at 15:34  | Reason: Not specified

I have tried various rings and a pump all to no avail. I have T2 diabetes but it is very well controlled, in fact I had an HBa1c last week and the result was "normal range". Furring up of the various blood vessels is very likely, I am old and somewhat overweight.

I have reached the conclusion that I will have to accept that erections are now a thing of the past. I will, however keep on trying, things like vibrating rings and porn are strictly not allowed by SWMBO. I think I might get a vibrating ring anyway and surprise her with it :-)

John

Thanks Lyn, I will see what the doc says re the single chamber Caverject, I hope the supply is better than the dual chamber Caverject, it takes months to come through!

John

I can't work out how to find it, but he's the guy who went for bipolar HT if I recall correctly, although it didn't work out in his case.

Something elser occurred to me...
1) We know men who are obese tend to get higher grade prostate cancer.
2) We know men who are obese tend to have lower testosterone.
Given this talk, it seems to me that 2) may well cause 1).

The argument being put forward here is that HT has no effect and that men either "die when they die regardless of HT intervention" and/or "Low T may make things worse and high T may make things better"?

If so, why do men progress when HT is halted for non PCa reasons (as opposed to PCa becoming hormone independent and HT halted as a result)?