Originally Posted by
Eisenhower 
I struggle with sexual performance anxiety and it's really depressing. A couple low T tests (235 and 434) caused me to finally go see Dr. Mariano, who said it's actually probably my E2 causing libido issues (it was only 10 while my T was 460). He's got me on lots of nutritional supps and stuff trying to get my sleep and diet right in an effort to better regulate hormones.
Before I went to Dr. M I'd been taking supps like Argenine and Zinc and had actually started getting nocturnal and spontaneous erections again (hadn't had nocturnals in a few years and had started to use Viagra to ensure good erections when I needed them). I actually stopped using Viagra for sex - it was great. After about six months though, I thought I noticed it was taking longer to get erect for sex and the old performance anxiety started up again. That's when I went to see Dr. M who keyed me in that it was probably E2 not the T that was causing erectile issues (lack of nocturnals, slow to get hard, etc.)
I started using Viagra again recently just because I hate worrying about how fast I'll get hard. But for some reason (probably because I'm only 37) I feel really bad about myself for taking Viagra ... And the sad thing to me is that I know the anxiety limits what would probably be decent performance without Viagra. For instance, I'll get hard just hugging and kissing my girl, but if I KNOW we're about to have sex, it will take oral or direct stiulation to get hard because I'm nervous.
I don't really know what I'm trying to say, I'm just sick of being anxious about sex ... to date, I've never failed to get it up and have good sex, yet every time, I'm anxious beforehand. How can I break this cycle of negative thinking? It's a real drag? Any ideas?
Thanks,
Eisenhower
There is light at the end of the tunnel. I would recommend that you consider going to a qualified sex therapist in addition to what you are currently doing. I had a similar pattern, where I would get hard fine but then would start worrying and lose it, even masturbating. It felt like my life was over. Like you, I would use Viagra or Levitra with success but it made me feel extremely bad about myself as a guy around the same age as you are. The whole thing depressed the hell out of me, the anxiety was overwhelming, and I was constantly thinking about it.
After suffering like this for too long, I finally went to a sex therapist. Results were not quick and it was difficult at first. It took me about three months of weekly visits, but I have improved dramatically, to the extent that we recently stopped the therapy because I did not need it any more.
In my own inexpert opinion, it sounds most likely that your problem is psychogenic, and therefore amenable to sex therapy (although sex therapy can be helpful even if it is not completely psychogenic). Most men can get good erections even with lowish testosterone, and your nocturnal erections were probably there all the time even if you were not aware of them (I also thought I hadn't been having them for years and only started noticing them this year because I started paying attention to the issue during middle of the night wake-ups).
But you should have a good urologist confirm that there is not a physical problem. If there is a physical problem, you should know of some studies that suggest that ED can be *cured* by *daily* administration of lower dose Sildenafil or Tadalafil for a *limited* period, after which the patient does not need it any more. See article 17187165 on Pubmed (I'm not allowed to post links on here).
Improved spontaneous erectile function in men with mild-to-moderate arteriogenic erectile dysfunction treated with a nightly dose of sildenafil for one year: a randomized trial.
Sommer F, Klotz T, Engelmann U.
which is reviewed in the article with the name
Long-term Nightly Sildenafil Promotes Normal Erectile Function
Paula Moyer, MA
which you can google.
In this study, a group of patients maintained good erectile function for at least six months after treatment. Also, Google for a powerpoint presentation by Yoram Vardi, "Chronic PDE5 Inhibitors use for sexual indication only?",
which has some dramatic graphs from the Sommer study and suggests similar things for Tadalafil (Cialis). In these cases, the important issue was that the dosing be every day (evening in case of the shorter-acting Viagra) so that nocturnal erections would be improved, which caused rehabilitation of the endothelial tissue in the penis. On-demand usage, on the other hand, had no such "curing" effect.
Finally, be careful of L-Arginine. I was also using it for a while, and I thought it definitely helped some, but in the same way as Viagra it was a crutch. I stopped when I got scared off by this study that made me worry that it might possibly cause harm to the erectile tissue in the long run:
L-Arginine Supplementation in Peripheral Arterial Disease
No Benefit and Possible Harm
Andrew M. Wilson, MBBS, PhD; Randall Harada, MD; Nandini Nair, MD, PhD; Naras Balasubramanian, PhD; John P. Cooke, MD, PhD
