You have ED if you have trouble achieving and maintaining an erection that is sufficient for satisfactory sexual intercourse. There are multiple reasons why this might be related to each of your blood flow, your hormones, your brain, et cetera. The first thing that you should do if you have ED is go discuss the issue with a doctor.
The big three factors that doctors look at are nitric oxide (related to viagra and cialis), testosterone, and dopamine. Dopamine is a neurotransmitter that makes you want things, if you're depressed you might just not want women. Nitric oxide is what dilates the blood vessels, viagra and cialis work by inhibiting PDE5 (which undermines nitric oxide), and thus their effect can be viewed as a double negative on nitric oxide. Testosterone ties into both.
ED is very much a canary in the coal mine. If anything is wrong with you, you are at risk of ED. The following is the approximate order with which many doctors will treat ED:
- When you meet a doctor to discuss this, he will likely first ask you what medications you're on. Any number of medications can trigger ED, including blood pressure medications, adderall, propecia, and so on. Other people take these medications and do not suffer these side effects. The response varies. This may or may not be the cause of your problems.
- Your doctor might perceive you as depressed, or suspect it, and then refer you to a psychiatrist. That is a reasonable course of action, and may improve your lot over a few months.
- Your doctor may worry that you have diabetes, obesity, high blood pressure, etc. These factors are associated with ED. He can test for them with a few checks. If they describe your situation, then he will suggest lifestyle modifications, and you might improve over a few months.
- The next line of defense is to test for serum hormones. The exact list will vary from doctor to doctor but will typically include testosterone, estrogen, SHBG, the thyroid hormones, prolactin, FSH, LH, etc. Low testosterone can cause ED. Thyroid problems can cause ED. High prolactin can cause ED. If a specific hormonal failure is identified, then you will get follow up in that area.
- Through this all they are likely to prescribe PDE5 inhibitors. These are viagra, cialis, and levitra. In my opinion, cialis is the best option as it has a long half life in the blood. You can just take it once a day, in the morning. Viagra only lasts a few hours so you need to plan things.
- There are other, different drugs that can be tried, that have other effects on the body.
- Your doctor may follow up with a penile doppler ultrasound, during which they give you a combination of drugs to cause an erectio, and then monitor your blood flow in both the flaccid and erect states. This can be used to assess the physical health of your veins.
"NoFap" is very famous in the last few years for example. The notion is that men's minds become desensitized to real women due to pornography, and their dicks become desensitized to real women due to excess masturbation. That is plausible. I have tried it twice, and in both cases I had the same trajectory. Difficulty in the first few days, then a "Flatline" during which my sex drive drops to zero, and then my spontaneous erections were restored after roughly ~23 days of abstention. However, it then becomes very difficult to maintain outside of a relationship, as sex drive just builds up, and up, and up. It culminates in my waking up horny and hard in the middle of the night. After masturbating, I'm not quite back at square one but close to it. This might work better in the context of a real relationship. Psychologically, this seems to be a more plausible issue for incels than for regular men.
A lot of people claim to have cured ED with very long water-only fasts. I have never fasted as long as them ... I've done 10 days. The people reporting cures have gone 20, 30, 60 days even. I am not sure what happens in that process, nor if it's reliable.
A lot of successes are claimed off of various herbs and supplements. This seems like a minefield -- way too much BS. Though I might try cycling a few at some point.
What did work for me was a combination of cialis (for blood flow) and cabergoline (for reduced prolactin and increased dopamine binding). But, my body seemed to build a tolerance quickly, and the cabergoline disrupted my sleep. I'm now off it for a while, in the hope of finding something else, and rebuilding tolerance. Since I'm taking a break from dating as well, it doesn't matter.
Are good resources for dealing ED and related issues, and include testimonials from various people who have recovered.