Thank you, Ribeye. I'm sorry Botox didn't work long-term for you but I appreciate the analysis and advice and the hope that I might get your initial results.
40mg daily of Tadalafil is very interesting. When this adventure began for me, about 5 years ago, 25-50mg of Sildenafil worked quite well. My doc said there was no reason not to take the max, especially since the generic prices were coming way down, so I began taking 100mg. But now, the effect has become less certain. I began daily 5mg Tadalafil which had no benefit - my doc conceded that 5mg was intended more for just its placebo effect and took me to 10mg daily. He likes the combination of daily Tadalafil plus as-needed Sildenafil so he recommended 50mg Sildenafil. But I've recently upped it to 100mg with early positive results. At 40mg, your Tadalafil is pretty powerful on its own, but have you ever tried the combination?
How about sensitivity? I also suffer from delayed ejaculation to the level of anorgasmia (with both ED and DE, is hard for me to know what is actually failing me when I get hard enough for penetration but it doesn't last long enough for ejaculation). You reported that Botox had favorable effects on your ejaculation - does the super dose of Tadalafil do anything in that regard? Any other tips if Botox doesn't do it for me?
Thanks for passing on all your learnings!
Mark7, in case you did not know, sildenafil or Viagra is not absorbed as well with food too. Especially a meal with a little fat in it, like a good juicy steak. That could be part of why it doesn't work as well. Also I don't know how the doses of tadalafil compare to that of sildenafil, but the dose of tadalafil I am on is very high, typically given for pulmonary hypertension. My doc felt if little old ladies with Pulm hypertension can tolorate it, I should be able to as well. It does give me some sinus congestion at times, but Allegra usually is very helpful. I do also get a little flushing sometimes, but that has faded with repeated dosing. As to the effects, clearly as I went up in dose each 5 mg of tadalafil, the benefit was significant for erection quality, ease to get and keep erections, along with sensitivity improvements that are very nice as well. I have to tried both sildenafil and tadalafil together but I don't know or understand what the upside would be over what I take now. I also suffer from delayed ejaculation. It can be very frustrating, and in my case it seems to be related to the quality of the erection. It is also more difficult to reach orgasm if I inject Tri Mix in a large enough dose to really keep an erection for at least a good hour. The docs generally like you to have a "worry free" erection for an hour so there can be lots of foreplay first and then the main event! LOL. I have pretty significant or severe ED, from prostate cancer treatment, and an idiot urologist who put me on finasteride for far too long. Finasteride is bad news. There are other drugs to help, including the tadalafil is indicated to treat BPH, that will help without having to take a penis killer for BPH. So, I take a combination of tadalafil, and Tri mix, most of the time. Sometimes I use a ring and no Tri Mix and orgasm definitely comes easier but the erections are not as good. Tri Mix definitely helps if you have had a beer or two. I have also used Vyleesi, and it works incredibly well and Empower's version of PT141 which also works. I don't recall if you still have to mix PT 141 or bremelanotide from Empower, but when reconstituted, about 17-18 units is very close to equal to a Vyleesi dose. Both of these worked for me, but, smaller doses of Empower PT 141 didn't work as well, I needed the full dose. My problem with both of them at the full dose, were the side effects. The first three or four times I used Vyleesi, it worked incredibly well, and I got a few body aches but not severe and nothing else....then the next time I took it, it nearly blew me up. I got nausea so bad I was hugging the toiled for nearly a day. After that, even with Zofran, (for nausea) ibuprofen, for aches, and Allegra for the sinus congestion I still felt like crap from about 5-6 hours post dose for a 24 hour stretch. It was great for the 5-6 hours and after that I was miserable with body aches, sinus congestion, and a sour stomach. Like I said for me, it produced incredible erections, lots of sensitivity, amazing orgasms, but I felt sick as a dog for the next 24 hours. That is not to say everyone will get this. It seems most do not get quite this severe a reaction but it can happen even if you don't the first few times, it could still rear its ugly head. So, keep some Zofran from your doc around just in case. For me the Tadalafil at 40 mg qd is working great. It's really been a big plus for me. With the tadalafil and a little Tri Mix I can go for an hour or more, and still have an orgasm usually in 20-3- minutes, and after a little rest, go on for another half hour or more depending on my mood. I have two girlfriends who can't believe I can go this long with losing the erection, but they don't know about everything I take either. I am very fortunate to have a really good sexual medicine doc who is willing to try things and willing to let me, being careful try combinations of meds. the key to increasing the tadalafil dose is to take the dose up no more than 5 mg at a time gradually. Don't just go from 5 mg to 40mg overnight. I went from 5 to 10 in a three week period or longer, and then from 10 to 15 in another month, and so on.