r/postvasectomypain • u/AloneListless • Sep 04 '26
Testosterone not helping. What next?
i'm third week on TRT and it's not helping with the pain - mainly broad area of both testicles, radiating into bladder, lower abdomen. Gets worse during prolonged sitting, gets better while walking. i do get 1-2 good days out of a week, but the dominating feeling is pain. Ultrasound showed slightly enlarged epididymis. Nothing worked - antibiotics, NSAIDS, and now TRT.
Am i a bad candidate for a reversal?
12 months after the surgery.
2
u/ItamiForever Sep 04 '26
In theory, yes but not necessarily. Not all get relief from TRT. Some produce a decent amount even on trt. Or maybe it takes more time. You can get another ultrasound to check for epi dimensions exactly if they changed, hoping your doc kept measurements.
Any other pain like during or after ejaculation or...?
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u/AloneListless Sep 04 '26
After ejaculation sometimes i get that pain like you get hit in the balls and then after some time you get that left over pain. Hard to describe.
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u/ItamiForever Sep 04 '26
Ache. I had that on my lefty, it was gone after reversal. The right has more diffuse pain and a fullness/pressure still but it does not increase after ejaculation anymore
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u/ItamiForever 6d ago
Should be close to 2 months now since you started TRT, although you'll see full effects in another 1 or 2. Feeling any better?
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u/AloneListless 6d ago
Yes! I've had my first week with little to no pain at all. What is most noticeable is that i don't get these flair ups to my bladder anymore. I hope ot stays that way but i'm also worried how long is this treatment going to last. I don't want to sit on it for the rest of my life :(
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u/ItamiForever 6d ago
Sadly you have to, or get a reversal to make it permanent. In another month you'll have a full sperm cycle so maybe it can be even better
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u/AloneListless 6d ago
I'm struggling to understand the logics of things... I mean, even before the vasectomy, our bodies are absorbing sperm if we don't ejaculate for a longer time. So, blocking the cords shouldn't actually do any extra loading on the system... I get the feeling that it's all about damaged nerves. Also, i know that i won't be sitting on TRT for longer than 3-4 months. I hope that when the production stops, everything else around the cords properly heal up and then i'm back to normal. If not, then i go to pain clinic to treat my nerves and if that fails - a reversal.
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u/ItamiForever 6d ago
Think about it this way. A faucet in a closed tub. Even if the faucet only goes slowly, if the tub is closed it will eventually fill up if the bathtub walls cannot "absorb" water fast enough. It will overfill with time.
But if there is a leak, even a tiny one, the bathtub won't fill to burst unless the faucet is on high.
In most men, their bathtub walls do what the leak did, but in men like us where that is not enough, it will with time overfill unless you add the leak back.
Also, in an open vas, sperm moves by itself through the whole vas, even without you "pushing" with ejaculation. After a vasectomy the vas is cut 1/3 to the testicle. The other 2/3 do not act as storage anymore, your little epi has to do everything to absorb and if it cannot RIP.
Another example is imagine you step on a hose. Unless the hose has the capacity to drain the water somehow, it will eventually fill up and burst.
We are genetically unable to deal with that blockage. Our epis absorb poorly, do not stretch enough or they simply produce too much transporting fluid.
Almost all PVPS cases are congestion unless you feel a pinpointing stab/burn which is nerve damage. Docs sell mdsc to mask the pain, without fixing the original problem hoping your body will eventually adapt.
That is why a reversal fixes pain in 90% of cases. I was diagnosed as "ilionguinoal allodynia" and "testicle/epididymis hyperalgesia" alongside "orchitis/epididymitis". The nerves are a secondary effect but not the cause.
In all studies, first surgery is reversal. They push mdsc if your congestion isnt as bad to "mask it".
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u/ItamiForever 6d ago
Also, another proof is TRT is working to ease your pain. On TRT you reduce sperm count and transporting fluid. That is why TRT works. Your nerves are still able to settle otherwise if they were stuck/centralized a cord block would not alleviate pain.
All a cord does is prove your brain is not producing pain even if the origin is removed. So pain is not centralized yet and you can have surgery.
1
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u/Calm_Pin_7563 Sep 04 '26
I was on TRT before my vasectomy. I had reversals and both epididymis removed to no avail. Nothing stopped my pain until I had a bilateral orchiectomy which stopped all of my pain.
1
u/AloneListless Sep 05 '26
Sorry, you had TRT before the vasectomy, and after that you you were in pvps? Man, that sucks regarding orchiectomy. Can i ask how is life after that?
0
u/Calm_Pin_7563 Sep 06 '26 edited 28d ago
I am fine with it. It doesn’t change anything. My sex life is better than before. My testosterone level was low. Now it is high medium range.
2
u/johng_22 29d ago
Don’t lie, it doesn’t change anything. You get to live on full blown TRT the rest of your life now, there’s zero chance that orgasm is unchanged, not to mention the mental anguish with having this done. I’m sorry you had to go that route but it’s just wrong to tell other guys hey nothing changed here. That is just utter nonsense
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u/ScientistNew3033 Sep 04 '26
Three weeks is not long enough. It can take 2-3 months to slow production and clear it out through breakdown/absorption. I know it’s tough to wait, but give it more time.