Persistent ED after steroid cycle despite normal hormones, normal Dopplers, hormone optimization – could I still be missing a hormonal mechanism?

[Tn198989]

Hi everyone,
I have been trying to solve this for almost 8 years and would really appreciate any ideas, especially from people with experience in endocrinology or post-cycle recovery.

Timeline

First cycle (2017)
Used multiple anabolic steroids (honestly a mess).
Also used 1500 IU hCG every 10 days during the cycle.
After stopping, I developed ED.
Several months later I did a PCT with Clomid + Aromasin, and it completely fixed me.
When I say completely, I mean:
normal libido
normal morning erections
normal erections lying flat
full glans engorgement
normal sex

I stayed like this for about 5 months (March-August 2018).

Second cycle (August-November 2018)

This time the cycle was much simpler:

Testosterone 600 mg/week
Low-dose Proviron
No hCG during the cycle
After my last testosterone injection, before starting PCT, I injected one full Ovitrelle (6500 IU hCG).

The following morning I had probably one of the strongest erections of my life:

full shaft
full glans
extremely high libido

Unfortunately it lasted only one day.

Since the following day I have had persistent ED that has continued until today.

Current symptoms

Erections are significantly worse when lying flat.
Sitting (especially leaning slightly forward) often produces a much stronger erection.

Morning erections are almost absent.

If I abstain from masturbation for 2-3 weeks I begin getting some morning semi-erections again.

I have a persistent problem with glans/spongiosum filling.

I also have long-standing reduced penile sensitivity from years of daily porn/masturbation (this existed before steroids, so I consider it a separate issue).

Testing

Two penile Dopplers.

Both essentially normal according to experienced andrologists.

No significant arterial insufficiency.
No obvious venous leak.

Hormones

Over the last 8 years I have probably had 50+ blood tests.

I have tried virtually every "obvious" hormonal explanation.

Examples:

low testosterone
high testosterone
supraphysiologic testosterone
low estradiol
high estradiol
mid-range estradiol
optimizing free testosterone
SHBG optimization
TRT
hCG
hMG
Clomid (multiple attempts)
Aromasin
Proviron
DHEA
Pregnenolone
DHT cream

Nothing has reproduced the recovery I experienced after the first cycle.

I am currently on TRT.

I know many people will immediately say "low testosterone" or "high E2," but unfortunately I have explored those possibilities extensively over many years.

ED medications

Daily Cialis helps.

Intracavernosal injections help much more.
Interestingly, injections make the corpora cavernosa extremely rigid, but I still do not achieve the same overall fullness that I had before the second cycle, particularly regarding the glans/spongiosum.

The response is much better than baseline, but still not the same as before 2018.

My question

At this point I am no longer asking whether my testosterone or estradiol are "optimal."

My question is:
Is there any hormonal or endocrine mechanism that could still be altered despite repeatedly normal blood work?

For example:
neurosteroids?
altered androgen signaling?
LH/hCG-related mechanisms?
changes in nitric oxide signaling triggered by endocrine changes?
something else that current blood tests simply don't capture?
Or do you think I should stop looking at hormones entirely and assume that whatever happened after the second cycle permanently changed something outside the endocrine system?
I realize this is an unusual case, but any thoughts would be greatly appreciated.

Thank you.

 

[Guided_by_Voices]

Nothing jumps put at me as an obvious omission in what you've tried, but here area few thoughts.

- Have you tried the Nitric Oxide pills such as those from N1o1? If they help, then that is clue that Nitric Oxide is involved
- I assume you've tried a brief short-acting high dose of T to see if that has benefit
- Do you do HIIT? For me I find noticeable benefit for EQ and if blood flow is an issue, HIIT can benefit
- Some people report benefit from injectable DHT which has been discussed elsewhere here. It seems to work when other forms of DHT fail
- Are you getting plenty of Salt? Low salt can be an issue, counter to popular belief.
- If PT-141 or MT-2 give benefit, then that is a clue that the melanoocortin system is in play. Periodic mid-day strong sun exposure can help too assuming you are not too far north or south.
- Do you eat a balanced diet with plenty of animal protein?
- Have you added a low dose (less that 100mg) of nandrolone (preferably short-acting) to your TRT as an experiment? Some people find it benefits EQ
- Do you take supplements that benefit vascular health, specifically at least half a gram of C, nattokinase, D, K2 and Magnesium?

Hopefully others will chime in.

 

[Tn198989]

Nothing jumps put at me as an obvious omission in what you've tried, but here area few thoughts.

- Have you tried the Nitric Oxide pills such as those from N1o1? If they help, then that is clue that Nitric Oxide is involved
- I assume you've tried a brief short-acting high dose of T to see if that has benefit
- Do you do HIIT? For me I find noticeable benefit for EQ and if blood flow is an issue, HIIT can benefit
- Some people report benefit from injectable DHT which has been discussed elsewhere here. It seems to work when other forms of DHT fail
- Are you getting plenty of Salt? Low salt can be an issue, counter to popular belief.
- If PT-141 or MT-2 give benefit, then that is a clue that the melanoocortin system is in play. Periodic mid-day strong sun exposure can help too assuming you are not too far north or south.
- Do you eat a balanced diet with plenty of animal protein?
- Have you added a low dose (less that 100mg) of nandrolone (preferably short-acting) to your TRT as an experiment? Some people find it benefits EQ
- Do you take supplements that benefit vascular health, specifically at least half a gram of C, nattokinase, D, K2 and Magnesium?

Hopefully others will chime in.

I haven't tried the nitric oxide supplement you suggested.

I have experimented extensively with hormones over the years. I've tried higher and lower TRT doses (100-250 mg/week), different injection frequencies (daily, EOD and twice weekly), hCG monotherapy before TRT, Proviron, DHT cream, testosterone cream applied to the scrotum, lowering estradiol into the mid-20s, and also letting it rise as high as ~80 pg/mL. None of these reproduced the completely normal erections I had before the second cycle.

Some protocols improved libido or made erections easier to initiate, but they always seem to plateau at around 70% unless I'm in a favorable position. Lying on my back is consistently the worst position. If I'm sitting and leaning slightly forward, I can get close to 100%.

A vacuum pump can produce a full erection, but it deflates almost immediately once I remove the pump, even with a constriction ring unless it's uncomfortably tight.

I haven't tried PT-141.

Regarding the Dopplers, I've had two, both performed by experienced andrologists, and neither showed arterial insufficiency or an obvious venous leak. My current doctor has also started me on intracavernosal injections.

They definitely improve rigidity and make erections much more sustainable during sex, but they still don't recreate the completely full erection (especially the glans/spongiosum) that I had before the second cycle.

Morning erections are now rare and, when they do occur, they're usually weak.

At this point, I'm struggling to reconcile normal Dopplers with a position-dependent erection and an incomplete response even to intracavernosal injections, which is why I'm wondering if there's another mechanism I'm missing.

 

[Guided_by_Voices]

I haven't tried the nitric oxide supplement you suggested.

I have experimented extensively with hormones over the years. I've tried higher and lower TRT doses (100-250 mg/week), different injection frequencies (daily, EOD and twice weekly), hCG monotherapy before TRT, Proviron, DHT cream, testosterone cream applied to the scrotum, lowering estradiol into the mid-20s, and also letting it rise as high as ~80 pg/mL. None of these reproduced the completely normal erections I had before the second cycle.

Some protocols improved libido or made erections easier to initiate, but they always seem to plateau at around 70% unless I'm in a favorable position. Lying on my back is consistently the worst position. If I'm sitting and leaning slightly forward, I can get close to 100%.

A vacuum pump can produce a full erection, but it deflates almost immediately once I remove the pump, even with a constriction ring unless it's uncomfortably tight.

I haven't tried PT-141.

Regarding the Dopplers, I've had two, both performed by experienced andrologists, and neither showed arterial insufficiency or an obvious venous leak. My current doctor has also started me on intracavernosal injections.

They definitely improve rigidity and make erections much more sustainable during sex, but they still don't recreate the completely full erection (especially the glans/spongiosum) that I had before the second cycle.

Morning erections are now rare and, when they do occur, they're usually weak.

At this point, I'm struggling to reconcile normal Dopplers with a position-dependent erection and an incomplete response even to intracavernosal injections, which is why I'm wondering if there's another mechanism I'm missing.

Prolactin is another variable but it doesn't sound like that is the issue in your case. I take a cap of Chasteberry every other day just to keep it on the lowish side which may be worth trying. I would strongly consider the Nitric Oxide tablets and/or beet root powder. Pt-141 is certainly worth a try because it works via completely different pathways, but start with what most would consider a low dose of no more than 100-300 micrograms twice per week. Everything you can do to improve vascular health is going to be helpful so certainly do the obvious supps I mentioned and be sure to do high intensity cardio. I seem to vaguely remember a post on here about venous leakage that doesn't show up on doppler scans, but I don't remember the details, however maybe you can find it. As far as other hormones go, make sure your fasting insulin is below 6 or so, since chronically elevated insulin is cardiotoxic. You might also try a fast of at least 24 hours and see if that has any benefit. If it did, that could suggest some sort of food sensitivity is part of the issue. At this point, logic will only get you so far and just trying a lot of different things is likely your best course of action, particularly focusing on vascular health and neurotransmitters. Review @Gman 's posts for his commentary on the benefits of nandrolone in his case for erections.

 

[Seagal]

Hi everyone,
I have been trying to solve this for almost 8 years and would really appreciate any ideas, especially from people with experience in endocrinology or post-cycle recovery.

Timeline

First cycle (2017)
Used multiple anabolic steroids (honestly a mess).
Also used 1500 IU hCG every 10 days during the cycle.
After stopping, I developed ED.
Several months later I did a PCT with Clomid + Aromasin, and it completely fixed me.
When I say completely, I mean:
normal libido
normal morning erections
normal erections lying flat
full glans engorgement
normal sex

I stayed like this for about 5 months (March-August 2018).

Second cycle (August-November 2018)

This time the cycle was much simpler:

Testosterone 600 mg/week
Low-dose Proviron
No hCG during the cycle
After my last testosterone injection, before starting PCT, I injected one full Ovitrelle (6500 IU hCG).

The following morning I had probably one of the strongest erections of my life:

full shaft
full glans
extremely high libido

Unfortunately it lasted only one day.

Since the following day I have had persistent ED that has continued until today.

Current symptoms

Erections are significantly worse when lying flat.
Sitting (especially leaning slightly forward) often produces a much stronger erection.

Morning erections are almost absent.

If I abstain from masturbation for 2-3 weeks I begin getting some morning semi-erections again.

I have a persistent problem with glans/spongiosum filling.

I also have long-standing reduced penile sensitivity from years of daily porn/masturbation (this existed before steroids, so I consider it a separate issue).

Testing

Two penile Dopplers.

Both essentially normal according to experienced andrologists.

No significant arterial insufficiency.
No obvious venous leak.

Hormones

Over the last 8 years I have probably had 50+ blood tests.

I have tried virtually every "obvious" hormonal explanation.

Examples:

low testosterone
high testosterone
supraphysiologic testosterone
low estradiol
high estradiol
mid-range estradiol
optimizing free testosterone
SHBG optimization
TRT
hCG
hMG
Clomid (multiple attempts)
Aromasin
Proviron
DHEA
Pregnenolone
DHT cream

Nothing has reproduced the recovery I experienced after the first cycle.

I am currently on TRT.

I know many people will immediately say "low testosterone" or "high E2," but unfortunately I have explored those possibilities extensively over many years.

ED medications

Daily Cialis helps.

Intracavernosal injections help much more.
Interestingly, injections make the corpora cavernosa extremely rigid, but I still do not achieve the same overall fullness that I had before the second cycle, particularly regarding the glans/spongiosum.

The response is much better than baseline, but still not the same as before 2018.

My question

At this point I am no longer asking whether my testosterone or estradiol are "optimal."

My question is:
Is there any hormonal or endocrine mechanism that could still be altered despite repeatedly normal blood work?

For example:
neurosteroids?
altered androgen signaling?
LH/hCG-related mechanisms?
changes in nitric oxide signaling triggered by endocrine changes?
something else that current blood tests simply don't capture?
Or do you think I should stop looking at hormones entirely and assume that whatever happened after the second cycle permanently changed something outside the endocrine system?
I realize this is an unusual case, but any thoughts would be greatly appreciated.

Thank you.

How long did you try for example 250mg of testosterone?

 

[madman]

Hi everyone,
I have been trying to solve this for almost 8 years and would really appreciate any ideas, especially from people with experience in endocrinology or post-cycle recovery.

Timeline

First cycle (2017)
Used multiple anabolic steroids (honestly a mess).
Also used 1500 IU hCG every 10 days during the cycle.
After stopping, I developed ED.
Several months later I did a PCT with Clomid + Aromasin, and it completely fixed me.
When I say completely, I mean:
normal libido
normal morning erections
normal erections lying flat
full glans engorgement
normal sex

I stayed like this for about 5 months (March-August 2018).

Second cycle (August-November 2018)

This time the cycle was much simpler:

Testosterone 600 mg/week
Low-dose Proviron
No hCG during the cycle
After my last testosterone injection, before starting PCT, I injected one full Ovitrelle (6500 IU hCG).

The following morning I had probably one of the strongest erections of my life:

full shaft
full glans
extremely high libido

Unfortunately it lasted only one day.

Since the following day I have had persistent ED that has continued until today.

Current symptoms

Erections are significantly worse when lying flat.
Sitting (especially leaning slightly forward) often produces a much stronger erection.

Morning erections are almost absent.

If I abstain from masturbation for 2-3 weeks I begin getting some morning semi-erections again.

I have a persistent problem with glans/spongiosum filling.

I also have long-standing reduced penile sensitivity from years of daily porn/masturbation (this existed before steroids, so I consider it a separate issue).

Testing

Two penile Dopplers.

Both essentially normal according to experienced andrologists.

No significant arterial insufficiency.
No obvious venous leak.

Hormones

Over the last 8 years I have probably had 50+ blood tests.

I have tried virtually every "obvious" hormonal explanation.

Examples:

low testosterone
high testosterone
supraphysiologic testosterone
low estradiol
high estradiol
mid-range estradiol
optimizing free testosterone
SHBG optimization
TRT
hCG
hMG
Clomid (multiple attempts)
Aromasin
Proviron
DHEA
Pregnenolone
DHT cream

Nothing has reproduced the recovery I experienced after the first cycle.

I am currently on TRT.

I know many people will immediately say "low testosterone" or "high E2," but unfortunately I have explored those possibilities extensively over many years.

ED medications

Daily Cialis helps.

Intracavernosal injections help much more.
Interestingly, injections make the corpora cavernosa extremely rigid, but I still do not achieve the same overall fullness that I had before the second cycle, particularly regarding the glans/spongiosum.

The response is much better than baseline, but still not the same as before 2018.

My question

At this point I am no longer asking whether my testosterone or estradiol are "optimal."

My question is:
Is there any hormonal or endocrine mechanism that could still be altered despite repeatedly normal blood work?

For example:
neurosteroids?
altered androgen signaling?
LH/hCG-related mechanisms?
changes in nitric oxide signaling triggered by endocrine changes?
something else that current blood tests simply don't capture?
Or do you think I should stop looking at hormones entirely and assume that whatever happened after the second cycle permanently changed something outside the endocrine system?
I realize this is an unusual case, but any thoughts would be greatly appreciated.

Thank you.

Hormones

Over the last 8 years I have probably had 50+ blood tests.

I have tried virtually every "obvious" hormonal explanation.

Examples:

low testosterone
high testosterone
supraphysiologic testosterone
low estradiol
high estradiol
mid-range estradiol
optimizing free testosterone
SHBG optimization
TRT
hCG
hMG
Clomid (multiple attempts)
Aromasin
Proviron
DHEA
Pregnenolone
DHT cream




You already ruled out any vascular issues and it has nothing to do with your testosterone as you are not in a hypogonadal state seeing as you are on T therapy and your FT would be healthy as in high enough for normal erectile physiology.

Have you ever thought about getting a pelvic floor assessment?

A weak or dysfunctional pelvic floor can make it harder to achieve or maintain strong erections.

Hope you understand that it would be a waste of time dabbling with high T or more importantly trying to achieve a high or absurdly high FT when it comes to erectile function.

It's a myth that high T is needed for healthy erectile function.

A myth that is still being spewed by all those clueless men stinking up the forums that have no clue what they are talking about.

T is a threshold hormone.

Once testosterone is above the level needed for normal erectile physiology which is well within the physiologic range increasing it further produces little additional improvement in erections.

The goal here for normal erectile health/function would be achieving a healthy FT which would be well within the physiologic range.

Any doctor truly in the know as in the top experts in the field would tell you this.

Anyone telling you that you need a high/absurdly high FT or high/very high DHT to improve/cure your ED is out to lunch!


* Studies have shown that once T drops below a threshold of roughly 230 ng/dL, men can begin to experience ED.


* ED only occurs with very low testosterone levels


* Low testosterone levels can decrease sex drive and lead to weak erections, though this is rarely the sole cause of erectile dysfunction. Over time, the hormone deficiency can cause penile tissues to atrophy, making erections even more difficult. The condition is easily treatable with testosterone replacement therapy, which can also improve the effectiveness of oral medications. But it’s important to work alongside a doctor to monitor the condition.


* Testosterone replacement therapy can improve several aspects of sexual life, including erection, only in hypogonadal subjects but its contribution alone is clinically effective only in milder forms of erectile dysfunction


Look over post #3

Post in thread 'Testosterone + Men's Sexual Health'

Nov 10, 2024

PURE MADNESS!

Much more to the story when it comes to testosterones impact on libido/erectile function!


*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!



LIBIDO...

• madman

ED is multifactorial and vascular issues are the most common cause.

Endocrine problems 3%.

T plays a small role!

* only about 5% or less of erectile dysfunction is caused by hormone imbalances like a testosterone deficiency, surprisingly but its true because it has a smaller role with erections


* most erectile dysfunction is caused by vascular issues so vascular is the most common cause because many men have high blood pressure, cholesterol issues, heart disease and blood flow problems or even obesity which impedes blood flow, diabetes lots of different things

Thread 'Assessing the Decline in Libido: Hormonal Complexity, Vascular Health, and Psychosocial Stress'

Apr 9, 2026

Assessing the Decline in Libido: Hormonal Complexity, Vascular Health, and Psychosocial Stress - The Boca Raton Tribune

A Drop in Sexual Drive Among Both Men and Women in Middle Age Is Rarely Solely Due to Plummeting Hormone Levels; Clinicians Point to Erectile Dysfunction, Sleep Disruption, and the Overwhelming Influence of Relationship Quality and Mental Load. A notable decrease in sexual desire, or libido, is...

www.bocaratontribune.com

ED is multifactorial and vascular issues are the most common cause.

T plays a small role!

* only about 5% or less of erectile dysfunction is caused by hormone imbalances like a testosterone deficiency, surprisingly but its true because it has a smaller role with erections

* most erectile dysfunction is caused by vascular issues so vascular is the most common cause because many men have high blood pressure, cholesterol...

• madman
• ed Libido testosterone Vascular Health
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Dr. John Mulhall

* the whole link between TESTOSTERONE and ERECTILE FUNCTION it's a WEAK LINK, it's not a POTENT ERECTO-GENIC HORMONE, it's CERTAINLY a LIBIDO-GENIC HORMONE and an ORGASMO-GENIC HORMONE but if you take men who have got LOW TESTOSTERONE who have ERECTILE DYSFUNCTION and you treat them with T the AVERAGE CHANGE in ERECTILE FUNCTION is MINIMAL if you use the validated scores (the international index of erectile function scores) so the ELEVATION in those scores is MINIMAL so the CONTRIBUTION of T you DON'T NEED A LOT of T you need SOME you DON'T NEED A LOT of T for ERECTION FUNCTION!

Thread '70% of ED cases are vascular!: The Link Between Exercise, Vascular Health, and Erectile Function: Key Insights from Dr. John Mulhall'

Nov 26, 2024

Again everyone so caught up on T, DHT and estradiol LMFAO!

Much more involved than just having healthy hormones!

One of the top in the field love this guy!

Mulhall always breaks it down!

Listen closely as he hits the nail on the HEAD!


3:33-7:13

* if you look at men with ORGANIC ED we can talk about psychogenic ED a little later on if we have time but if you take men with ORGANIC ED PROBABLY 70% OF THEM ARE GOING TO HAVE A VASCULAR COMPONENT INFLOW OR OUTFLOW PROBLEMS and that includes men with diabetes, those high profile causes like medication induced or hormonal ED or...

• madman
• cvd ed hypogonadism testosterone
• Replies: 27
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Dr. Peter Bajic

* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE PHYSIOLOGYt, so the whole pathway that Viagra and Cialis work on or PDE5 inhibitors, PDE5 is a normal component in erectile physiology that pathway which Im not going to delve into because its super complicated even for me, you have to have an adequate amount of testosterone there for that whole thing to work, this is why men who are on androgen suppression therapy or hormone suppression therapy for prostate cancer most of them not all of them most of them when there testosterone goes to 0 they have a very hard time getting an erection and Viagra and Cialis don't work because they don't have any testosterone, but that NUMBER HOW MUCH TESTOSTERONE DO YOU NEED TO TURN THAT LIGHT SWITCH ON IS NOT A 1000 ng/dL LIKE SOME TESTOSTERONE SHOPS MIGHT TRY TO CONVINCE YOU, ITS PROBABLY SOMEWHERE IN THE RANGE 200-250 ng/dL OKAY SO HAVING JUST KINDA LIKE A NORMAL LEVEL, EVEN LOW-NORMAL IS USUALLY ENOUGH FOR THAT PHYSIOLOGIC FUNCTION

Thread 'Is erectile dysfunction a symptom—or an early warning sign?'

Aug 3, 2026

Listen closely 45:04-47:32

The T level needed for normal erectile physiology is much lower than many men are led to believe!




Dr. Peter Bajic

* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE...

• madman
• Diagnosis/treatment E Dysfunction Erectil venous leak
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

* On erectile dysfunction (ED), Gvili notes a growing number of young men presenting with ED, often linked to pelvic floor tension, psychological factors, or unrealistic expectations shaped by cultural narratives. He advocates for pelvic PT as a complementary treatment and stresses open communication between providers and patients.

Thread 'Treating Male Pelvic Floor Dysfunction'

Aug 28, 2025

* Symptoms range from urinary issues and erectile dysfunction to groin pain, constipation, and tip-of-penis pain. He stresses that pelvic floor therapy for men cannot simply replicate female treatment approaches; instead, therapy should be individualized, patient-centered, and focused on retraining underused or overactive muscles.

In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Adam Gvili, PT, DPT, a pelvic floor physical therapist and founder of Pelvis NYC, about his personal and professional journey in...

• madman
• pelvic floor Sexual Function therapy
• Replies: 2
• Forum: Health & Wellness

• 

* Pelvic floor is a group of muscles and tissues that support the pelvic organs, including the bladder, uterus, and bowel. One of the important roles of the pelvic floor is to contribute to the process of achieving and maintaining strong erections.


* During sexual arousal, the pelvic floor muscles contract, which increases blood flow to the penis and helps trap blood within the erectile tissue, resulting in a firm and sustained erection. However, weak or dysfunctional pelvic floor muscles may not contract effectively during sexual arousal, leading to difficulties in achieving or maintaining strong erections.


* The pelvic floor also plays a role in ejaculation. As the muscles contract during orgasm, they help propel semen through the urethra and out of the body. Good pelvic floor health is essential for sexual function and overall quality of life. Regular exercise and pelvic floor muscle training can help maintain strong and healthy muscles, which can improve sexual function and prevent sexual dysfunction. Pelvic floor exercises, also known as Kegels, are a simple and effective way to strengthen the pelvic floor muscles.

Thread 'Why Your Pelvic Floor Matters for Strong Erections'

May 30, 2023

Dr. Noble is a pelvic floor therapist who works with all types of people to resolve sexual function challenges. She has specific expertise in helping people address erection and ejaculatory issues.


Timestamps

0:00 - Introduction
01:11 - What is the Pelvic floor
03:32 - Pelvic floor therapy
04:46 - Role of Pelvic floor in erections
06:54 - Signs of Pelvic floor issue
09:05 - Indicator that Pelvic floor is not involved in ED
10:08 - Should you see a Pelvic floor therapist?
12:08 -...

• madman
• erectile dysfunction pelvic floor sexual health
• Replies: 0
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

TAKE-HOME MESSAGES

● Pelvic floor physical therapy should include a complex multi-faceted treatment approach in males with sexual dysfunction.

● Physical therapists should choose a multidimensional methodology when assessing and caring for individuals suffering from ED and PE, focusing on musculoskeletal dysfunction and behavioral involvement.

● PFM training is simple, safe, and non-invasive and should be employed as a preferred approach in the management of ED and PE.

Thread 'The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction'

May 2, 2021

ABSTRACT

Introduction: Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. Objectives: To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.

Methods: We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.

Results:...

• madman
• pfr/sexual dysfunction
• Replies: 3
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

 

[Tn198989]

Hormones

Over the last 8 years I have probably had 50+ blood tests.

I have tried virtually every "obvious" hormonal explanation.

Examples:

low testosterone
high testosterone
supraphysiologic testosterone
low estradiol
high estradiol
mid-range estradiol
optimizing free testosterone
SHBG optimization
TRT
hCG
hMG
Clomid (multiple attempts)
Aromasin
Proviron
DHEA
Pregnenolone
DHT cream




You already ruled out any vascular issues and it has nothing to do with your testosterone as you are not in a hypogonadal state seeing as you are on T therapy and your FT would be healthy as in high enough for normal erectile physiology.

Have you ever thought about getting a pelvic floor assessment?

A weak or dysfunctional pelvic floor can make it harder to achieve or maintain strong erections.

Hope you understand that it would be a waste of time dabbling with high T or more importantly trying to achieve a high or absurdly high FT when it comes to erectile function.

It's a myth that high T is needed for healthy erectile function.

A myth that is still being spewed by all those clueless men stinking up the forums that have no clue what they are talking about.

T is a threshold hormone.

Once testosterone is above the level needed for normal erectile physiology which is well within the physiologic range increasing it further produces little additional improvement in erections.

The goal here for normal erectile health/function would be achieving a healthy FT which would be well within the physiologic range.

Any doctor truly in the know as in the top experts in the field would tell you this.

Anyone telling you that you need a high/absurdly high FT or high/very high DHT to improve/cure your ED is out to lunch!


* Studies have shown that once T drops below a threshold of roughly 230 ng/dL, men can begin to experience ED.


* ED only occurs with very low testosterone levels


* Low testosterone levels can decrease sex drive and lead to weak erections, though this is rarely the sole cause of erectile dysfunction. Over time, the hormone deficiency can cause penile tissues to atrophy, making erections even more difficult. The condition is easily treatable with testosterone replacement therapy, which can also improve the effectiveness of oral medications. But it’s important to work alongside a doctor to monitor the condition.


* Testosterone replacement therapy can improve several aspects of sexual life, including erection, only in hypogonadal subjects but its contribution alone is clinically effective only in milder forms of erectile dysfunction


Look over post #3

Post in thread 'Testosterone + Men's Sexual Health'

Nov 10, 2024

PURE MADNESS!

Much more to the story when it comes to testosterones impact on libido/erectile function!


*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!



LIBIDO...

• madman

ED is multifactorial and vascular issues are the most common cause.

Endocrine problems 3%.

View attachment 57860




T plays a small role!

* only about 5% or less of erectile dysfunction is caused by hormone imbalances like a testosterone deficiency, surprisingly but its true because it has a smaller role with erections


* most erectile dysfunction is caused by vascular issues so vascular is the most common cause because many men have high blood pressure, cholesterol issues, heart disease and blood flow problems or even obesity which impedes blood flow, diabetes lots of different things

Thread 'Assessing the Decline in Libido: Hormonal Complexity, Vascular Health, and Psychosocial Stress'

Apr 9, 2026

Assessing the Decline in Libido: Hormonal Complexity, Vascular Health, and Psychosocial Stress - The Boca Raton Tribune

A Drop in Sexual Drive Among Both Men and Women in Middle Age Is Rarely Solely Due to Plummeting Hormone Levels; Clinicians Point to Erectile Dysfunction, Sleep Disruption, and the Overwhelming Influence of Relationship Quality and Mental Load. A notable decrease in sexual desire, or libido, is...

www.bocaratontribune.com

ED is multifactorial and vascular issues are the most common cause.

T plays a small role!

* only about 5% or less of erectile dysfunction is caused by hormone imbalances like a testosterone deficiency, surprisingly but its true because it has a smaller role with erections

* most erectile dysfunction is caused by vascular issues so vascular is the most common cause because many men have high blood pressure, cholesterol...

• madman
• ed Libido testosterone Vascular Health
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Dr. John Mulhall

* the whole link between TESTOSTERONE and ERECTILE FUNCTION it's a WEAK LINK, it's not a POTENT ERECTO-GENIC HORMONE, it's CERTAINLY a LIBIDO-GENIC HORMONE and an ORGASMO-GENIC HORMONE but if you take men who have got LOW TESTOSTERONE who have ERECTILE DYSFUNCTION and you treat them with T the AVERAGE CHANGE in ERECTILE FUNCTION is MINIMAL if you use the validated scores (the international index of erectile function scores) so the ELEVATION in those scores is MINIMAL so the CONTRIBUTION of T you DON'T NEED A LOT of T you need SOME you DON'T NEED A LOT of T for ERECTION FUNCTION!

Thread '70% of ED cases are vascular!: The Link Between Exercise, Vascular Health, and Erectile Function: Key Insights from Dr. John Mulhall'

Nov 26, 2024

Again everyone so caught up on T, DHT and estradiol LMFAO!

Much more involved than just having healthy hormones!

One of the top in the field love this guy!

Mulhall always breaks it down!

Listen closely as he hits the nail on the HEAD!


3:33-7:13

* if you look at men with ORGANIC ED we can talk about psychogenic ED a little later on if we have time but if you take men with ORGANIC ED PROBABLY 70% OF THEM ARE GOING TO HAVE A VASCULAR COMPONENT INFLOW OR OUTFLOW PROBLEMS and that includes men with diabetes, those high profile causes like medication induced or hormonal ED or...

• madman
• cvd ed hypogonadism testosterone
• Replies: 27
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Dr. Peter Bajic

* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE PHYSIOLOGYt, so the whole pathway that Viagra and Cialis work on or PDE5 inhibitors, PDE5 is a normal component in erectile physiology that pathway which Im not going to delve into because its super complicated even for me, you have to have an adequate amount of testosterone there for that whole thing to work, this is why men who are on androgen suppression therapy or hormone suppression therapy for prostate cancer most of them not all of them most of them when there testosterone goes to 0 they have a very hard time getting an erection and Viagra and Cialis don't work because they don't have any testosterone, but that NUMBER HOW MUCH TESTOSTERONE DO YOU NEED TO TURN THAT LIGHT SWITCH ON IS NOT A 1000 ng/dL LIKE SOME TESTOSTERONE SHOPS MIGHT TRY TO CONVINCE YOU, ITS PROBABLY SOMEWHERE IN THE RANGE 200-250 ng/dL OKAY SO HAVING JUST KINDA LIKE A NORMAL LEVEL, EVEN LOW-NORMAL IS USUALLY ENOUGH FOR THAT PHYSIOLOGIC FUNCTION

Thread 'Is erectile dysfunction a symptom—or an early warning sign?'

Aug 3, 2026

Listen closely 45:04-47:32

The T level needed for normal erectile physiology is much lower than many men are led to believe!




Dr. Peter Bajic

* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE...

• madman
• Diagnosis/treatment E Dysfunction Erectil venous leak
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

* On erectile dysfunction (ED), Gvili notes a growing number of young men presenting with ED, often linked to pelvic floor tension, psychological factors, or unrealistic expectations shaped by cultural narratives. He advocates for pelvic PT as a complementary treatment and stresses open communication between providers and patients.

Thread 'Treating Male Pelvic Floor Dysfunction'

Aug 28, 2025

* Symptoms range from urinary issues and erectile dysfunction to groin pain, constipation, and tip-of-penis pain. He stresses that pelvic floor therapy for men cannot simply replicate female treatment approaches; instead, therapy should be individualized, patient-centered, and focused on retraining underused or overactive muscles.

In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Adam Gvili, PT, DPT, a pelvic floor physical therapist and founder of Pelvis NYC, about his personal and professional journey in...

• madman
• pelvic floor Sexual Function therapy
• Replies: 2
• Forum: Health & Wellness

• 

* Pelvic floor is a group of muscles and tissues that support the pelvic organs, including the bladder, uterus, and bowel. One of the important roles of the pelvic floor is to contribute to the process of achieving and maintaining strong erections.


* During sexual arousal, the pelvic floor muscles contract, which increases blood flow to the penis and helps trap blood within the erectile tissue, resulting in a firm and sustained erection. However, weak or dysfunctional pelvic floor muscles may not contract effectively during sexual arousal, leading to difficulties in achieving or maintaining strong erections.


* The pelvic floor also plays a role in ejaculation. As the muscles contract during orgasm, they help propel semen through the urethra and out of the body. Good pelvic floor health is essential for sexual function and overall quality of life. Regular exercise and pelvic floor muscle training can help maintain strong and healthy muscles, which can improve sexual function and prevent sexual dysfunction. Pelvic floor exercises, also known as Kegels, are a simple and effective way to strengthen the pelvic floor muscles.

Thread 'Why Your Pelvic Floor Matters for Strong Erections'

May 30, 2023

Dr. Noble is a pelvic floor therapist who works with all types of people to resolve sexual function challenges. She has specific expertise in helping people address erection and ejaculatory issues.


Timestamps

0:00 - Introduction
01:11 - What is the Pelvic floor
03:32 - Pelvic floor therapy
04:46 - Role of Pelvic floor in erections
06:54 - Signs of Pelvic floor issue
09:05 - Indicator that Pelvic floor is not involved in ED
10:08 - Should you see a Pelvic floor therapist?
12:08 -...

• madman
• erectile dysfunction pelvic floor sexual health
• Replies: 0
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

TAKE-HOME MESSAGES

● Pelvic floor physical therapy should include a complex multi-faceted treatment approach in males with sexual dysfunction.

● Physical therapists should choose a multidimensional methodology when assessing and caring for individuals suffering from ED and PE, focusing on musculoskeletal dysfunction and behavioral involvement.

● PFM training is simple, safe, and non-invasive and should be employed as a preferred approach in the management of ED and PE.

Thread 'The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction'

May 2, 2021

ABSTRACT

Introduction: Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. Objectives: To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.

Methods: We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.

Results:...

• madman
• pfr/sexual dysfunction
• Replies: 3
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Yea I agree with you. In fact I probably never even needed trt since on paper my testosterone was back to baseline and slightly higher a week after the end of that cycle. But when you can't figure it out and the issue persists logic sometimes goes out the window. The latest doc I am seeing is a urologist/andrologist who also specializes in trt (not the one who prescribed it to me), he believes that I may have some veno occlusive issue but not structural venous leak since two dopplers came back clean. So still no proof. He said something interesting though.
After 8 years trying to figure out what happened back then after the cycle makes little difference and that for ed there are only a handful of treatments available no matter the cause.
Since hormones are ok there is nothing to see there, so he suggested shockwave, daily cialis ( which I am already on) and caverject injections for sex. Problem is, that even the injections while they do help, still don't give normal erections, the 70% cap still applies unless I am in a sitting position and slightly tilted forward.

Anyway, i haven't Had a pelvic floor assessment and yes maybe I should since that would explain why at 37 (and since 29) I can't get normal erections with meds that would probably make even 80 year Olds get them.

But it doesn't explain the initiation. Unless a hormonal crush right after a cycle does something to the pelvic muscles then it doesn't make sense that this could be the cause. Still though it's worth looking into that

 

[Tn198989]

How long did you try for example 250mg of testosterone?

It's been 3 years since that attempt and it was for around 3-4 months. My total t was around 1350 on trough with that dose and I was injecting twice a week. My shbg is always around 30-35 so my free t was also supra physiologic

 

[Guided_by_Voices]

Yea I agree with you. In fact I probably never even needed trt since on paper my testosterone was back to baseline and slightly higher a week after the end of that cycle. But when you can't figure it out and the issue persists logic sometimes goes out the window. The latest doc I am seeing is a urologist/andrologist who also specializes in trt (not the one who prescribed it to me), he believes that I may have some veno occlusive issue but not structural venous leak since two dopplers came back clean. So still no proof. He said something interesting though.
After 8 years trying to figure out what happened back then after the cycle makes little difference and that for ed there are only a handful of treatments available no matter the cause.
Since hormones are ok there is nothing to see there, so he suggested shockwave, daily cialis ( which I am already on) and caverject injections for sex. Problem is, that even the injections while they do help, still don't give normal erections, the 70% cap still applies unless I am in a sitting position and slightly tilted forward.

Anyway, i haven't Had a pelvic floor assessment and yes maybe I should since that would explain why at 37 (and since 29) I can't get normal erections with meds that would probably make even 80 year Olds get them.

But it doesn't explain the initiation. Unless a hormonal crush right after a cycle does something to the pelvic muscles then it doesn't make sense that this could be the cause. Still though it's worth looking into that

My two cents...the body is a highly complex system of systems that we only partially understand. At this point, a lot of your attention IMO should be on overall health with the hope that something you do will render improvements. I could probably count 50 different things I do that might help, but I have no idea how much each one contributes. I would look for anything extreme in your overall life (stress, diet, exercise, etc. ) and bring those things into a balanced state. It sounds like you're in Europe so if you can find a way to source Bimix or Trimix that might be worth a try, and the confidence boost that users of those report could be a major benefit in itself since you may have given yourself a psychological barrier that didn't initially exist. If your situation allows, you may also want to time sex for early in the morning since nor-epinepherine levels are lowest at that point which gives the body its most pro-erection period, and you can also take Levitra right before sleep to hopefully amplify the effect. If you focus on nocturnal erections, that will take some of the psychological factor out of the equation. Some people have had success using Doxazosin due to its alpha-1 blocking affect IIRC so that might be worth looking into. Search this site for the link here to the thread (now on the Wayback machine) Ultimate Adrenergic Control of erections.

 

[Tn198989]

My two cents...the body is a highly complex system of systems that we only partially understand. At this point, a lot of your attention IMO should be on overall health with the hope that something you do will render improvements. I could probably count 50 different things I do that might help, but I have no idea how much each one contributes. I would look for anything extreme in your overall life (stress, diet, exercise, etc. ) and bring those things into a balanced state. It sounds like you're in Europe so if you can find a way to source Bimix or Trimix that might be worth a try, and the confidence boost that users of those report could be a major benefit in itself since you may have given yourself a psychological barrier that didn't initially exist. If your situation allows, you may also want to time sex for early in the morning since nor-epinepherine levels are lowest at that point which gives the body its most pro-erection period, and you can also take Levitra right before sleep to hopefully amplify the effect. If you focus on nocturnal erections, that will take some of the psychological factor out of the equation. Some people have had success using Doxazosin due to its alpha-1 blocking affect IIRC so that might be worth looking into. Search this site for the link here to the thread (now on the Wayback machine) Ultimate Adrenergic Control of erections.

The thing that could be an issue is porn and masturbation and it could contribute.
I am also on 20mg fluoxetine which of course doesn't help, I know. I would have included those in the original post, but since both of those where there before the cycle and then I could function normally (with some delayed ejaculation from fluoxetine but no erection issues) I didn't want to confuse people cause those two, especially fluoxetine are easy to blame in such situations. But in mine I ve tried stopping both and of course there is improvement in libido and sustainability of erections but not to the 70% cap and it being a position dependant.

Also, where I am trimix isnt available but I do have caverject which helps but again the cap remains.