Penile Implant For Young Patient Who Exhausted Usual Treatments. Advice.

[Bentiger07]

If you don’t want to go thru my long history that I'll share below my questions, you can skip that part, and I hope you'll at least review the questions I have at the top here:

Hope all’s well. I'm 34, from NY. I feel that after years without success with typical treatments of erectile dysfunction, penile implant may be on the table now. Any useful advice is appreciated thru here or any form of contact. In respect of your time, I’ll try to describe years of ED as shortly as I can.

1) I’ve mostly seen data of high satisfaction rates reported by mostly elders, and not much data on how satisfied a young person still is with implants 15-40 yrs later. Are you aware of such data? Is there anyone out there who got a implant while young, and can report how satisfied they are 15-40yrs later?

2) Being young, I'll likely do more revisions as I get older than elders, so the impact from multiple revisions will effect me more. Does pain, penis shrinkage, & infection chance ACCUMULATE after EACH revision? If so, how much should I worry about it?

3) How do most patients describe their pain level and how long it took before they can satisfyingly use the implant with none-moderate pain?

4) I’ve heard a mix of good/bad stories on penile prosthesis. Most forums and medical studies I’ve came across show positive data, but then I've seen some places share bad stories. There's no financial benefit to sharing bad stories, but good stories can be marketing. The bad stories makes me question if the good stories might be marketing. Any advice on that is appreciated.

5) I’m considering Dr. Francois Eid or Dr. Andrew Kramer, but am open to researching more doctors. Recommendations? Anyone regret getting penile implants, especially from these 2 docs?

6) My history of treating ED naturally and thru typical treatments have been a failure. I'm at a decent weight (180lbs, 5'11), decent diet, and some muscle from exercising moderately. There is one thing I haven't tried, more weight loss. I'm wondering if I should spend the next 2-3 months eating less to reach 155lbs to see if that resolves ED. Do you think it's worth the time to try that 1st, before trying an implant that disables my natural function forever? Genetically, I have borderline high cholesterol since young, so I was thinking more weight loss might help, as I already have a much better diet than the average american.

7) Is there any other advice you can give for someone young considering an implant who exhausted usual treatments?

 

[Bentiger07]

To best understand why I feel penile implant is my best option now, I would need to share my long history. This part can be ignored if you don't have the time:

I’ve had ED at least since around 19. None-minimal morning wood. I get an erection when desired about 65% of the time, and can hold it successfully for intercourse about 33%. Oddly, my libido and ability to hold an erection appears to get worse if I’m standing, which I read may be venous leakage.

I tried eating better and exercise even though I was a good weight. As it didn’t help much, I visited local doctors. In my mid 20s, I was prescribed tadalafil. As it was expensive back then compared to now, I bought tadacip (generic tadalafil) online from an indian pharmacy. I wasn’t sure if pills were real, but they likely were as reviews from many sites were good. It worked well, but then stopped working after 2 weeks. Not even 20mg of generic tadalafil a day helped at that point. Maybe I built up tolerance & needed a break. Although I’m unsure if it was the pills, the high dose probably bothered my back badly, but it’s ok now.

Later, doctor did a penile doppler scan that shows arteriogenic dysfunction. He believed the cause to be congenital or due to a penis injury, but I don’t recall any. He recommended bimix/trimix. Tried it and wasn’t happy for the usual reasons. Also, the response was unpredictable. Sometimes I’d stay hard longer than I wanted to, which was a problem if I needed to be in public.

My testosterone labs often came back on the high end of low - low end of normal, and my estradiol often came back low. I did some thorough research online and found a TRT specialist with positive reviews, from DefyMedical. While he wasn’t so much an ED specialist compared to being a TRT specialist, the idea was that if my levels increase to a therapeutic level, ED may go away. He honestly told me TRT may be a 6-12month process before it fixed ED, if it does at all. He tried testosterone and hcg shots, plus Anastrozole. The dosage was similar to standard therapy, usually around 28-32cc (56-64mg) testosterone cypionate twice a week, HCG 400-500iu twice a week, 0.3mg anastrozole twice a week, and 7mg tadalafil a day as needed. This combination improved my ED only somewhat. He routinely checked my blood work every 3-6 months. Generally kept my lab values of testosterone near the high end of normal - low end of high. After 1-2 yrs, I realized this protocol wasnt helping enough so I tapered off.


Based on my research, I think my plan will be:
-Retry tadalafil one more time, but this time from a source I’m sure is legit as I know generic is now available legally in the states.
-I'm already at a decent weight of 180lbs at 5'11, but I can spend the next 2 months slowly dropping my weight to 155lbs and see how my ED is.
-If no success, consider a penile implant.
If you know of any other better alternatives, or new better treatments that are coming out fairly soon, let me know.



Medical conditions that may be causes/contributors to ED:
----- I know I had high cholesterol since youth, and maybe that led to ED. I recall my primary checked cholesterol around my late teens. He told me it was high for someone young. It may be genetic as my skinny mom has high cholesterol too. I eat better than the average american and exercise, but total cholesterol and LDL results still often come back on the low end of high these days.
----- Moderate pain and occasional involuntary spasms, mostly on the left side of my body only, mainly near core/pelvic regions and head. Possibly from playing alot of basketball in my youth and heavy lift exercises in my 20s. Had 1 MRI that stated mild spinal stenosis (dad has severe spinal stenosis) with disc herniation at L5-S1, and another that only mentioned disc herniation at L5-S1 and no spinal stenosis. Tried PT without much success. Managed thru exercise.
----- As explained earlier, I’ve had testosterone tested multiple times that often came back on the high side of low. Not sure why it’s low as I'm muscular. Most likely genetic as my brother's is low too, but his sex life appears normal.


Medical conditions less likely related:
----- Irregular bowel movements for yrs. Powdery/loose stool 1-2x a week on avg for probably a decade. About 5 yrs ago, doctor did a colonoscopy and found nothing. He believed it to be diet related. Recently, I think I noticed that once I stop eating probiotic foods and oatmeal for awhile, the irregular bowel movements returned, so that’s how I manage.
----- Eczema flareups every few yrs. Sometimes moderate or severe. When severe, I used to resort to steroid creams or prednisone more when I was younger, but now I try my best to manage naturally.

 

[Vvs1]

It’s worth checking out a tight pelvic floor. Seems to cause a lot of the problems you mention.

 

[Nelson Vergel]

I have been part of different forums like FrankTalk.org for a while. All men report a loss of 1 inch average.

Have you tried Trimix?

When Testosterone Doesn’t Lead to Better Erections or Sex Drive

Note: There is a great booklet attached to this post (For registered members only. Register) Excerpt from the book: Testosterone: A Man's Guide Most men find that their sexual desire increases after they start testosterone replacement. Sexual dreams and nighttime/morning erections may be...

www.excelmale.com

Penile Implants- Interview with Dr Robert Cornell in Houston

Q & A with Robert J. Cornell, M.D.– Prosthetic Urology and Men’s Health Specialist Robert J. Cornell, MD specializes in the treatment of genitourinary disease in both adult men and women. Dr. Cornell's areas of expertise include treatment of post-prostatectomy urinary incontinence...

www.excelmale.com

 

[Nelson Vergel]

FrankTalk

The FrankTalk.Org website strives to advance patient education about Erectile Dysfunction

www.franktalk.org

 

[Bentiger07]

I'll look into tight pelvic floor more closely, and even though I do have pain in that area, I'm not too sure how much it would help ED in my case, as I taught myself alot about exercise and do have a balanced exercise regimen that includes pelvic exercises.

I have tried trimix and it wasn't for me.

Losing an inch would suck, but it may be a sacrifice I'd be willing to make at this point. I am familiar with franktalk.

Thanks Guys.

 

[madman]

I'll look into tight pelvic floor more closely, and even though I do have pain in that area, I'm not too sure how much it would help ED in my case, as I taught myself alot about exercise and do have a balanced exercise regimen that includes pelvic exercises.

I have tried trimix and it wasn't for me.

Losing an inch would suck, but it may be a sacrifice I'd be willing to make at this point. I am familiar with franktalk.

Thanks Guys.

This may be of interest but I just want to warn you that some of the photos are graphic.

The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

 

[madman]

Having trouble loading the pdf as the file is too big.

Hopefully, this can be fixed.

 

[Nelson Vergel]

Having trouble loading the pdf as the file is too big.

Hopefully, this can be fixed.

We are trying to fix this today

 

[Nelson Vergel]

This FB group is also helpful

https://www.********.com/groups/penileimplants/

 

[madman]

The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation


*WARNING GRAPHIC CONTENT

 

[Nelson Vergel]

@madman

Damn!! Thanks for posting.

 

[Bentiger07]

Thanks. I'll be reviewing that document more closely tonight or tomorrow. From scanning over it quickly, I already see the document made distinctions from getting the surgery done by a high volume surgeon vs an occasional low volume surgeon.

 

[Vvs1]

I'll look into tight pelvic floor more closely, and even though I do have pain in that area, I'm not too sure how much it would help ED in my case, as I taught myself alot about exercise and do have a balanced exercise regimen that includes pelvic exercises.

I have tried trimix and it wasn't for me.

Losing an inch would suck, but it may be a sacrifice I'd be willing to make at this point. I am familiar with franktalk.

Thanks Guys.

Pelvic Floor Muscle Hypertonia - Pelvic Rehabilitation Medicine

Pelvic Floor Muscle Hypertonia, blood flow is restricted which can cause an acidic environment in the area and this, in turn, can create an inflammatory cascade.

www.pelvicrehabilitation.com

 

[sctt_simone]

If you don’t want to go thru my long history that I'll share below my questions, you can skip that part, and I hope you'll at least review the questions I have at the top here:

Hope all’s well. I'm 34, from NY. I feel that after years without success with typical treatments of erectile dysfunction, penile implant may be on the table now. Any useful advice is appreciated thru here or any form of contact. In respect of your time, I’ll try to describe years of ED as shortly as I can.

1) I’ve mostly seen data of high satisfaction rates reported by mostly elders, and not much data on how satisfied a young person still is with implants 15-40 yrs later. Are you aware of such data? Is there anyone out there who got a implant while young, and can report how satisfied they are 15-40yrs later?

2) Being young, I'll likely do more revisions as I get older than elders, so the impact from multiple revisions will effect me more. Does pain, penis shrinkage, & infection chance ACCUMULATE after EACH revision? If so, how much should I worry about it?

3) How do most patients describe their pain level and how long it took before they can satisfyingly use the implant with none-moderate pain?

4) I’ve heard a mix of good/bad stories on penile prosthesis. Most forums and medical studies I’ve came across show positive data, but then I've seen some places share bad stories. There's no financial benefit to sharing bad stories, but good stories can be marketing. The bad stories makes me question if the good stories might be marketing. Any advice on that is appreciated.

5) I’m considering Dr. Francois Eid or Dr. Andrew Kramer, but am open to researching more doctors. Recommendations? Anyone regret getting penile implants, especially from these 2 docs?

6) My history of treating ED naturally and thru typical treatments have been a failure. I'm at a decent weight (180lbs, 5'11), decent diet, and some muscle from exercising moderately. There is one thing I haven't tried, more weight loss. I'm wondering if I should spend the next 2-3 months eating less to reach 155lbs to see if that resolves ED. Do you think it's worth the time to try that 1st, before trying an implant that disables my natural function forever? Genetically, I have borderline high cholesterol since young, so I was thinking more weight loss might help, as I already have a much better diet than the average american.

7) Is there any other advice you can give for someone young considering an implant who exhausted usual treatments?

Hello, I had an implant 10 months ago. To sum it up - awesome. You can reach me via email [email protected] if you’d like to talk details . Best advice I got was don’t delay

 

[Bentiger07]

Thanks. I'm currently evaluating different physiotherapists specialized in men's pelvic floor/ED. While I do feel I moved too slow, I'm going to give that a shot. Had a couple people recommend treating my pelvic pain because of the ties to ED. If that doesnt help ED (plus cialis as needed) in under 2 months, I'm going bionic between my legs. Won't wait another decade.

As the implants last on average 10yrs, that would likely mean I'll get multiple surgery revisions being on the younger side (34). I just wish I could find a guy that had an implant for at least 15yrs+ and can report how satisfied they are. I'm sure they're out there somewhere!

 

[joemorgan]

I'll look into tight pelvic floor more closely, and even though I do have pain in that area, I'm not too sure how much it would help ED in my case, as I taught myself alot about exercise and do have a balanced exercise regimen that includes pelvic exercises.

I have tried trimix and it wasn't for me.

Losing an inch would suck, but it may be a sacrifice I'd be willing to make at this point. I am familiar with franktalk.

Thanks Guys.

I want to ask more about the trimix not being for you.
It is very effective if you have the right doctor.
If you go to a urologist, you don't get the good test dose and you don't get the injector which lessens the pain of the injection by at least 50% or more. I use it myself and it is not more than a thump of the finger on the skin, nowhere near a finger stick for blood sample.

With hard to achieve and hold erection patients, the dose may need to be very high to the point you are balancing the erection you get with any pain from the large dose of meds.
We can get many cavernous patient to between 10 and 15 minutes of penetrating erection if they use the standing position on the side of the bed and their partner at the edge of the bed. Not a lot but better than nothing.

I will say that I have seen many patients with implants. Many do well for a long time. I have seen several at the end of the line with their third or fourth implant in place and its not working, and they have spent a lot of money-one patient had spent $80,000. Most patients do not have that.

Another last resort is a doctor Selfe, I think that is spelling. He's a urologist, find on You Tube. He charges about $13,000 to implant a silicone sleeve under the skin of the penis to keep the penis formed and aid stiffness with your erection or yours with some other meds.

I am not a fan of implants because it is the end of the line. You will hear about techniques which preserve the cavernous tissue but I have not actually seen any of these and do not know how it can work if implanted outside the tunica albuginea which contains the cavernous tissue.

I wish you the best of luck.

 

[jcmaxwell]

If you don’t want to go thru my long history that I'll share below my questions, you can skip that part, and I hope you'll at least review the questions I have at the top here:

Hope all’s well. I'm 34, from NY. I feel that after years without success with typical treatments of erectile dysfunction, penile implant may be on the table now. Any useful advice is appreciated thru here or any form of contact. In respect of your time, I’ll try to describe years of ED as shortly as I can.

1) I’ve mostly seen data of high satisfaction rates reported by mostly elders, and not much data on how satisfied a young person still is with implants 15-40 yrs later. Are you aware of such data? Is there anyone out there who got a implant while young, and can report how satisfied they are 15-40yrs later?

2) Being young, I'll likely do more revisions as I get older than elders, so the impact from multiple revisions will effect me more. Does pain, penis shrinkage, & infection chance ACCUMULATE after EACH revision? If so, how much should I worry about it?

3) How do most patients describe their pain level and how long it took before they can satisfyingly use the implant with none-moderate pain?

4) I’ve heard a mix of good/bad stories on penile prosthesis. Most forums and medical studies I’ve came across show positive data, but then I've seen some places share bad stories. There's no financial benefit to sharing bad stories, but good stories can be marketing. The bad stories makes me question if the good stories might be marketing. Any advice on that is appreciated.

5) I’m considering Dr. Francois Eid or Dr. Andrew Kramer, but am open to researching more doctors. Recommendations? Anyone regret getting penile implants, especially from these 2 docs?

6) My history of treating ED naturally and thru typical treatments have been a failure. I'm at a decent weight (180lbs, 5'11), decent diet, and some muscle from exercising moderately. There is one thing I haven't tried, more weight loss. I'm wondering if I should spend the next 2-3 months eating less to reach 155lbs to see if that resolves ED. Do you think it's worth the time to try that 1st, before trying an implant that disables my natural function forever? Genetically, I have borderline high cholesterol since young, so I was thinking more weight loss might help, as I already have a much better diet than the average american.

7) Is there any other advice you can give for someone young considering an implant who exhausted usual treatments?

I had my implant done by Dr. Eid in New York last year. He is an exceptional surgeon who does a thorough physical examination during the evaluation process. I am very pleased with the results. My only regret is that I didn't have the surgery ten years ago, which would have prevented atrophy and loss in size. He is an expert at interpreting Doppler ultrasound tests. He found that I had fibrosis, scarring, venous leakage, and advanced blood vessel disease. (It just doesn't get any worse.) It is generally acknowledged by top urologists that the penile arterial disease is a sensitive indicator of general cardiovascular disease - the proverbial canary in the coal mine.

I would not recommend that you undergo a 30 pound weight loss, hoping that it would lower your cholesterol, and subsequently lead to an improvement in ED. There is often a familial or genetic component to elevated cholesterol, and it's too risky to lose 30 pounds, which likely includes a significant reduction in muscle mass.

I also want to comment on the common belief that an implant leads to a one inch reduction in penile length. The one inch loss is due to the underlying diseases that necessitated the implant in the first place. Having ED for several years leads to atrophy and fibrosis, which contribute to a loss in overall size.

 

[Bentiger07]

Thanks Joe and Max.

I couldnt find a doctor Selfe on youtube. To touch on your comments with penile injections, it helped so I'm not writing it off, but I didn't like it for many reasons. Trimix ached, bimix didn't but the response wasn't predictable, I didn't like having to give myself a shot every day while young, that the treatment is far from spontaneous,, that my doc charged $10 a dose, and it has to be refrigerated where family may find it.

I mostly made up my mind on a plan of attack researching various things for where I'm at with ED.

I'm going to do pelvic floor therapy for men/ED, to see if treating that helps ED or moderate core/pelvic pain. I'm also going to do a cheaper form of shockwave therapy by getting a device made for home use. Tadalafil as needed.

If that combo doesn't work, implants it is. I was wondering if anyone knows great implant doctors in lower cost of living countries who offer better prices than what I'd get charged for in NY, $30000. I hear implants last about 10 yrs on average. While paying $30000 every 10 yrs is affordable to me for something so important, it'll definitely hurt the wallet of a middle class man.

 

[Skateboard]

I want to ask more about the trimix not being for you.
It is very effective if you have the right doctor.
If you go to a urologist, you don't get the good test dose and you don't get the injector which lessens the pain of the injection by at least 50% or more. I use it myself and it is not more than a thump of the finger on the skin, nowhere near a finger stick for blood sample.

With hard to achieve and hold erection patients, the dose may need to be very high to the point you are balancing the erection you get with any pain from the large dose of meds.
We can get many cavernous patient to between 10 and 15 minutes of penetrating erection if they use the standing position on the side of the bed and their partner at the edge of the bed. Not a lot but better than nothing.

I will say that I have seen many patients with implants. Many do well for a long time. I have seen several at the end of the line with their third or fourth implant in place and its not working, and they have spent a lot of money-one patient had spent $80,000. Most patients do not have that.

Another last resort is a doctor Selfe, I think that is spelling. He's a urologist, find on You Tube. He charges about $13,000 to implant a silicone sleeve under the skin of the penis to keep the penis formed and aid stiffness with your erection or yours with some other meds.

I am not a fan of implants because it is the end of the line. You will hear about techniques which preserve the cavernous tissue but I have not actually seen any of these and do not know how it can work if implanted outside the tunica albuginea which contains the cavernous tissue.

I wish you the best of luck.

Use a good grade of Numbing Cream (Lidocaine) For Tatto's You feel the needle/shot