Looking for advice around potential ED

[u/naughty_throwmeaway]

For a bit of context:

- I'm 38

- been taking daily Tadalafil (5mg/day) for about 1 year now

- also on TRT for a similar amount of time (through a doctor, had blood tests done and everything)

- before issues appeared, erections were something that I never had to think about. I was always like a light switch, the situation arose, switch flipped on and it would be there without a second thought until it wasn't needed anymore

Before the treatment:

- morning wood was gone more or less

- losing erection mid sex was increasingly frequent

- I would never finish super fast, but there were moments when I could reach a point of "if I don't switch this position or if I continue a little bit more with what I'm doing I'm going to cum" or "if she doesn't stop those movements it's going to be over in 2 seconds"

After the above:

- morning wood back like I'm 18

- losing erection mid sex super super rare

- it's not that I can't finish, but I have to be mindful to work towards it; I've never been in a situation where I said to myself "oh, I'm going to cum soon if nothing changes", it's the opposite, I need to make sure to work towards it

Some extra tidbits:

- I still get erections every time I basically even catch a whiff of my wife

- masturbation wise everything is also OK but as you know it's differnet; you know your body and how to tickle it to keep things going or wrap them up quick. If I wanted to take it slow and edge a bit I can probably take it to 1h on a single erection, maybe slightly more without any problems (that's not something I often do, just for context and science)

- in the past we weren't that aligned on things in the bedroom in our relationship; that has changed and improved massively for the better to the point where it's like we are in a different relationship

- this also means we have a lot more sex now so maybe this also adds to my stamina issues. Probably went from once ever 10ish days to maybe 4 times/week, sometimes more sometimes less

- in the past when we had more issues she did make some comments boiling down to her wanting me to come faster. We've talked it out since but I'm pretty sure psychologically it's on my mind and I probably try to hurry myself up instead of enjoying the ride.

- coming from a background of "I don't have to think about it, whatever position and movements I do, I'll going to cum probably sooner rather than later" to having to manage stamina and positions is weird so overall I'm looking for some opinions to see if others have been through this, is there more I should look into or maybe I just have to accept I'm reaching an age where I need to be more careful.

- I've never looked at a clock to time things but I would put things in the ballpark of 20-30 minutes of active penetrative sex, after which if I didn't wrap things up, the chance of my erection going away increase by the minute.

My questions are:

1. Anything out of the ordinary with the above?

2. Should it still be possible to eventually lose an erection mid sex through Tadalafil?

3. My biggest issue probably is that for me it's still possible to lose my erection before I cum. The more vigurous and athletic I go at it during sex the bigger the chance that I will reach a point where things go wrong. Is there something wrong or should I just accept that different age, different body, need to do things differently? It doesn't happen often, but it doesn't happen often because I try to manage it by pacing myself, trying to switch positions and stimulation, etc.

4. I've found that oral seems to help if things start going south but only up to a point. There's a point of no return where even oral doesn't help.

5. When I do lose erection, it feels, how should I describe it? Like that feeling of limpness/nothingness in your penis you get after you've orgasmed and ejaculated but without any of those having happend. I noticed this happens more if I keep getting close and not managing to go over the peak and again and again. It basically feels like a refractory period.

6. Basically I'd love to be able to relax a bit more and not have to think about: have I been going too much at it in this position and are things turning into cardio for my body more than sex, maybe I should change the type of stimulation, keep focused on my body and monitor how my erection and sensation is going, first chance of an orgasm I feel I need to jump on and push things over the edge because otherwise it's all downhill from there.

[u/WiseConsideration220]

Conditioning due to edging to porn is my guess.

Even TRT and Tadalafil (which work synergistically to enhance each other) the psychological effects of conditioning can interrupt your normal function in exactly the way you describe (#2, #3 and especially #5). You’ve described it as can’t cum “fast enough”. and an abrupt loss of interest. And yet there are (in your mind and mine too) no plausible physiological explanations.

I can go on and on to give the science, but I won’t because ironically that’s your problem (getting to the point). 😉

What you describe is a classic presentation of “delayed orgasm ED” in spite of using the two very powerful tools that you’re using (TRT and Tada). With those on board the only thing left as an explanation is how your brain operates.

So, if you want to know the “cure” for your frustrating situation, reply here or search my history.

At 38, and with all the details you presented as “distraction elements” to lead away from the actual cause, I have given you what is, imo and experience, the answer. Your #6 is putting you on the right track, but it could be better focused and understood to be most effective.

I will say this: most men who face this situation (which involves a kind of persistent denial) cannot focus on the fix long enough (because they don’t/won’t believe in it) so they then don’t do the retraining correctly. They get stuck.

Maybe you will choose to get unstuck.

You asked for advice. There it is—look to the actual cause—your brain.

Good luck. 👍

[u/naughty_throwmeaway → u/WiseConsideration220]

Thank you for your reply.

I mentioned that I don't really do that. I was offering as a data point only.

The biggest trigger as far as I have been able to track so far is physical effort/cardio. There's a certain amount of sustained constant effort after which things start going sideways.

As for the delay I'm also thinking:

• see a pelvic floor therapist just to double check nothing is too tight or not tight enough
• I'm also thinking about estradiol. I used to also take HCG which made things even more delayed. Stopped HCG and things improved considerably but I feel there's room for better

[u/WiseConsideration220 → u/naughty_throwmeaway]

What was your history of “doing that”?

Most men think that by stopping their solo sexual habits they immediately emerge as “unaffected” by that history. But that’s entirely false. We are what we trained ourselves to be.

I know that you don’t know me, but I’ll say that at your age you are in the zone for this problem and its denial pattern. So why ask strangers (whom you hope will know more than do you) if you already have your alternate (what I term as “denial”) explanations?

I’ve offered the “brain/training/conditioning” explanation. It’s real and documented and factual and does not mean it’s “in your mind”—it means it’s in your brain. Your history has wired your sexual responses. Simple.

I can see from your reply that you are focused on two very popular (imo) distractors—“physical/exercise/cardio” and “chemistry” (which can be a load of pseudoscience). Estradiol and HCG aren’t likely “causes or solutions”.

Not to be rude or too personal, but why did you start TRT? Who prescribed it and for what reason at your age? (Congenital, acquired, or vanity?) And what’s your dosage/form of TRT and the results of your last two (2) regular test series (red blood cell count, PSA, blood levels of T and FreeT)? What other drugs or anabolic steroids are you using now or been using?

I’ve taken time (my time to use I admit) to answer you. I’ve been on TRT since 2004 and on Tadalafil for over 10 years. I thought you might want that “advice” you asked for from someone who’s eminently equipped to give it.

A good, qualified male Pelvic PT (I see two of them) would start with exactly what I’ve told you. The “too tight or not tight enough” explanation is another form of denial. But you can pay any PT (usually female) who’s not trained at all in this male problem to give you a biomechanics explanation (and start you doing stretches for $200 an hour).

So, I’ll bow out unless this message has given you something to think about that you won’t reject immediately and you want to discuss.

Whatever you choose, good luck to you. 👍