Is it possible my issues are not from pfs?

Just a warning that I do go into explicit detail in this post

Hey guys so for the past year approximately ive been assuming that my issues, which center around lowered libido and greatly lowered erections, difficulty maintaining erections, difficulty getting them. I could go into a lot more detail but I’m not sure if it would help necessarily, although I’m not shy if anyone asks me.

It basically feels like there is not enough blood that’s entering my penis because the veins feel tight and constrained. I always thought it was due to me taking saw palmetto (I believe the dosage was 240 mg twice a day) on and off for a couple months a bit over a year ago or perhaps rogain which I still take a very small amount of (couple drops per day) to this day.

However I’ve recently been thinking that perhaps my issues aren’t pfs related but rather some other cause. The reasoning behind this is first off all that saw palmetto is much much weaker than fin from what I’ve read and side effects are also much less common. Second off, my libido and erections were already on a somewhat downwards trajectory even before I started the saw palmetto (although I cannot remember if they were before I started rogain but I believe so).

I have been dealing with mental health issues to varying degrees from quite severe to moderate over the past 3.5 years approximately. I know that prolonged mental illness can perhaps affect libido and hormones? I could be wrong.

Finally there is something that perplexes me which is that I have had moments over the past year where I would get strong erections. Particularly, I’ve taken cialis prescribed by my doctor and when I do take it I’ve had times where I’ve gotten incredibly strong erections and huge libido spikes. For example, last month and a half ago, at the end of October, I had a girl over and wasn’t expecting to have sex but took some cialis before just in case and for some reason something cut through the cloud and I got extremely honey we ended up having great sex and I was able to maintain a strong erection. Even before I started taking cialis on occasion, I remember a time in a museum, a little while ago (before the pandemic but after I had taken the saw palmetto and had started dealing with erection issues) that I randomly out of nowhere got a raging erection that I had to go the bathroom to take care of because it was so bulging and I couldn’t walk around like that.

But at the same time, the majority of the time I have really bad erectioms. Or I can masterbate and get a decent erection but only while my hand is on my penis, as soon as a take my hand away my penis goes down so I’m not sure if this counts as an erection? Are you all able to do this?

Maybe someone could help shed some light on what the possibilities might be so I can try and tick all the boxes and find possible solutions. Thank you so much. Also I’m 20 about to turn 21. Thank you.

Did you check hormonal values? (All sex hormones + thyroid panel)
Is your glucose level normal?
Penile doppler?
Prostatic ultrasound?
Do you watch porn a lot?(if yes, could be pied, dopamine desensitisation in the brain erection centres)
Are your kidneys and liver ok?

I’m the same age as you and only have ed issues. Penile doppler showed venous leakage, although I need to check it again to confirm diagnosis. My veins in the prostate are very dilated, which can contribute to venous leakage like my doc said. Im currently working on this issue.

If all of these are fine then you probably have pfs. Also if you haven’t been to a urolgist/andrologist go to one. Might or might not help.
Wish you all the best

Stop rogain. It’s an anti androgen. If you don’t want to stop Rogain and all other hair regrow this methods then don’t expect your erections to get any better.