Recently, I’ve received a few requests to update my thread, so I’m logging in here today to get everyone up to speed on my present situation. Most of you probably assumed correctly that I’ve been dormant for a while because I haven’t had anything new to report; for the most part, at least in terms of my health, I’m basically still where I was at several months ago. Although there have been a few minor changes, and I’ve detailed them below.
I’ve made some changes to my medications. I am no longer consuming the bupropion or the ropinirole. The last time I posted here I believe I stated that I was using 150 mg of bupropion daily in the morning; as time went by, I cut this back to 75 mg, a dosage that I continued late into the fall of 2011, and thereafter quit using it entirely. I was up to 2 mg of ropinirole in a dosage (#3 per day) at one point, and held that dosage level until early in the spring of 2012, at which point I cut myself back down to 1 mg per dosage for a few months, and then took myself off of it entirely late in April.
I cut myself down to 75 mg of bupropion because the 150 mg dosage level was causing mild insomnia, and after months on it I came to conclude that it was not really helping my sexual function, so I made the change to improve my chances of receiving a decent night of sleep. My sleep did improve and I did not experience an increase in depression. Late last fall, for whatever reason, I started to experience issues with intense nausea; often, I would swallow my medications in the morning and head in to work or out on a bike ride or whatever, and within an hour I would be puking my guts out. I got tired of losing my breakfast all the time, so I stopped the bupropion entirely last fall. I did experience some rebound depression for a little while after quitting, but that corrected itself after several days, and the nausea went away immediately after I discontinued the medication.
Ropinirole, in my opinion, actually did begin to act to improve my libido after several months of staying on that medication. I would actually experience moments of low or moderate arousal after swallowing it. The problem was that, in addition to the bounce in my libido, there came side effects that in my opinion negated the benefits of the improved libido. I experienced extreme fatigue and also experienced some psychological effects that were uncomfortable and simply made my head feel weird; in the literature I suppose they might refer to these as “mood changes,” but in my opinion it was really more like “mental discomfort,” and its effect on my demeanor was similar to that of a headache. So essentially, I would feel a little bit aroused, but at the same time I had a headache and felt like I might pass out. The fatigue and the “headache” impacted my ability to function at work, and since the libido bounce was momentary and not really “natural” and since it wasn’t persistent enough to actually impact the way in which I interacted with women (I was too busy feeling sleepy), I made the decision to stop the use of ropinirole as well.
The application of testosterone cream to my genitals was suggested by Dr. Goldstein. There is evidence of reduced sensitivity in my penis, so I wanted to try to do something to correct that, if there was anything that could be done. According to him, there is anecdotal evidence that this has helped some men with their sensitivity, so I wanted to try it. I have been applying it regularly for several months now, and I am waiting for my one-year follow-up appointment with Dr. Goldstein (within the next month) to retest my sensitivity and to see if it has been helping me. If there has been an improvement I will continue to use it; and if there has not been improvement, I will stop using it so that I could save money on a medication that isn’t helping.
Clomiphene citrate and anastrazole are by far the two cheapest medications that I consume, and without a doubt have been the most effective in terms of helping me with the series of symptoms that I’d experienced because of Propecia. I am experiencing no side effects from them whatsoever; only positive results so far, so since these medications are cheap, I will continue to use them for as long as Dr. Goldstein permits because I am unwilling to risk a relapse back to a hypogonadal state. Perhaps I would be perfectly fine if I stopped using them, but they only cost me like $20 a month altogether, so I think it is just dumb to risk another bout with hypogonadism to save this trivial amount of money.
I don’t have as much evidence that the cabergoline and the naltrexone have helped me, but similarly, I’ve experienced no adverse side effects so I feel that there is no reason to consider removing them from my medication plan. According to my blood test data, the cabergoline was effective in reducing my prolactin levels; like the issue with testosterone and estradiol (controlled by Clomid and Arimidex), I do not know what will happen if I stop using the cabergoline, so I have just as much reason to continue taking it at this time, although it’s true that cabergoline is a bit more expensive than these other two drugs. Naltrexone, however, is pretty cheap, so given the absence of side effects I will continue to use it simply in the hope that I might gain something over long term.
My belief is that the daily before-bed usage of Viagra may be helping me, but I will have to wait to see the results of Dr. Goldstein’s testing later this month to understand if that’s actually true. I’ve noticed that there has been a mild improvement in my nocturnal erection activity, and that it is less difficult for me to achieve erections during the day and evening while I’m active (but it still requires direct contact); however, I don’t really know if this is a result of regular Viagra usage, or if it could be the result of my body repairing itself in other ways. Presumably, my brain, spinal cord, nerves, or whatever it was that was messed up by Propecia will slowly self-repair over time, so perhaps that could be the reason rather than the Viagra.
I am presently consuming these medications, at these frequencies:
Clomid (Clomiphene Citrate) 50 mg, #3 per week
Arimidex (Anastrazole) 1 mg, #3 per week
Cabergoline 0.5 mg, #2 per week
Viagra (Sildenafil) 25 mg, #1 per day (PM, just before bed)
Naltrexone 50 mg, #1 per day (PM, just before bed)
Testosterone 1% Cream, applied #1 per day to genitalia just before bed
One thing I can confirm is an improvement in the function, appearance, and feel of the tissue structure of my penis. The fleshy shades of pink are returning, although the coloration is still patchy; and, although the dents and wrinkles are still there, I think they are somewhat less pronounced, perhaps because the improved coloration may be masking them. Overall, my penis still looks relatively unhealthy compared to how it was before Propecia; it still does not look “full” or “robust” as it once did, but for sure it is much better looking now than it was right after this episode with Propecia began back in January 2010. The responsiveness of my penis to contact has also improved; for a long time after Propecia, it would require an extremely intense amount of stimulation to achieve an erection that I would lose immediately after the stimulation was discontinued, but now the amount of stimulation required is less and my response to that stimulation is more “linear” and predictable than it was before, so that now I can obtain an erection using less effort and can maintain it with a more moderate level of stimulation. But regardless of how hard I may try, I am unable to get my erection as hard or to last as long as I could in the past (before Propecia), unless I use a medication such as Viagra and/or injectables to help me. The really significant development here is that I can now achieve a certain level of erectile function without the need for direct stimulation; even though it is hard, I am now able to make my penis respond to some of the thoughts that I prompt in my head, so at least now the brain-to-penis pathway isn’t entirely broken.
The health of my body has remained stable since my last posting. By mid-summer 2011, I had hit a respectable fitness level after several months of intense training, which was mostly comprised by weight lifting (4 times per week) and running (2-3 times per week). I dramatically reduced the amount of body fat that I had, while simultaneously increasing my muscle mass and strength to levels that were comparable to where I was at before Propecia. However, since reaching that highpoint last summer, I’ve since cut back on my fitness routine, mainly because the other commitments in my life are using up a lot more of my time than they were before; I’ve gained some body fat and lost some muscle as a result, but I’m confident that I could get back to where I was last summer if I got serious about exercise again. I have slightly more significant issues with acne and increased hair loss relative to the past, but otherwise everything else with my body is the same as it was for me before Propecia.
Similarly, the function of my brain and my mental health has improved since last summer, or at the very least has remained stable. I am becoming increasingly more capable of functioning at work, as my memory is improving and my ability to think has recovered quite a bit, while I am also less likely to experience the bouts of depression that would leave me sitting around unproductive for hours at a time. One thing I do continue to struggle with to a certain extent is anxiety and related emotional problems, and these things tend to impact my ability to sleep; I cannot predict when I will be able to fall asleep on any given night, or how well or how long I will sleep that night, and hence I cannot predict when I will wake up the following morning and what I will feel like after I do wake up. Part of the sleep problem is, in my opinion, also tied to my sexual health; I’ve come to believe that the absence of sexualized dreams and the weakness of nocturnal erections impairs the quality of my sleep, since I think in healthy men these probably act as a “pacifier” to control anxiety and to keep him relaxed during the night, and this is a moderating influence that I do not have. Death anxiety is also an issue that I experience; for whatever reason it starts to kick in as soon as I shut the lights off and climb into bed, it eliminates the sense of relief that someone might otherwise experience after turning in at night after a long day, and makes the time at which I finally fall asleep that night that much more unpredictable.
In terms of my social attitudes, I am also behaving more normally now than I had been immediately after getting hurt by Propecia, and better than I was last summer as well. Now that the major time and money pit of searching for medical help, getting tested, going through the treatment program, etc. is mostly behind me, now after two years have passed I finally have time to go out and make a serious effort to try to enjoy myself. I am still somewhat inclined to avoid large gatherings of people, especially at late evening and nighttime events such as parties, but at least now I can function more appropriately whenever I do attend these events. It took me a little while to get used to interacting with people socially again, but now I can communicate more comfortably and I am less likely to be flagged as “different” by the average person that I bump into on any given night, although for sure I am identified as being more awkward than average. Unfortunately, without a doubt, I still have a tendency to bug out if a seemingly interested woman approaches me to talk. It is a shame that I blow these opportunities, but at least now I am able to tolerate remaining in the room with them and can carry a conversation; I must remember that this is an improvement over where I was before, even if I do fail to dive into the conversation and take it further. The underlying cause of this issue is the anxiety that I have about my sexual performance, the extent of the impairment of which I do not qualitatively understand, and also the relative absence of sexual attraction that I feel in general; sex does not drive my motivations to interact with women, and I worry that I could be embarrassed if my sexual performance turned out to be inadequate (without the use of Viagra and/or injectables, which I never carry with me), so it becomes uncomfortable for me if I am approached for reasons of physical attraction. Even if it is clear that sex is not an immediate prospect, the possibility that it could only be a month or two away is enough to deter me from allowing her to get any closer to me.
More than anything else, the issue that is really killing me right now is the libido dysfunction. I always enjoy the company of a decent girl and when I’m with one I want to keep her around, but I hesitate to seal the deal and proceed past that point simply because I do not have a desire to pursue a physical relationship. Sexual performance, although a concern, is not driving this problem; after a couple years of healing, I am now confident that my performance would be at least passable if I swallowed a Viagra tablet when she wasn’t looking, but there is nothing that I can do that will elevate my libido sustainably and unless that happens things won’t fall together naturally. I find a woman that I like, or bump into one that likes me, but then I waffle and hesitate to make a decision, the moment to make a move comes and goes, and then the moment gets cold and nothing happens and I am left kicking myself over the experience later. After having been through this more than once over the past couple of years, I am starting to realize that I may have to essentially fake it so that I can move past these issues to ultimately get what I want; I don’t want to be lonely forever, but if I don’t get myself past the issue of sexual attraction then that’s exactly what will happen. All this time I’ve essentially been waiting for my libido and interest to recover to “acceptable” levels before I seriously considered a relationship situation; but now, I think the best thing for me to do is to just pick a pretty girl that treats me well and to ask her out to lunch. Maybe later, after an extended period of time after I’ve entered a relationship, my sexual health will recover and then I will be able to fully enjoy that pretty girl; or, maybe it will never recover, but then at least I will be with someone that I have experience with and won’t be lonely, and perhaps I will have learned to function so that sexual experiences are at least no longer a chore.
