PFS - Cognitive, Sexual and Physical Symptoms [4 years in oral and topical Finasteride]

[Aquarius330]

Time to update the post with a mix of good and bad news.

First of all, did you check my patient story (Luis) and the other guys?
https://www.pfsnetwork.org/patient-stories

Protocol over the last 3 months

As a summary, you can find below the protocol I have been following over the last 3 months:

• Tadalafil 5mg (daily)
• Clomid 50mg (every second day)
• Bupropion 150mg (daily) - [Since the 9th of December 2020]
• Vitamin D3 1000iu (daily)
• Acetyl L-Carnitine 1000mg (3 times per day)
• L-Arginine 2000mg (3 times per day)

Additional Supplementation:

• Boron 3mg (daily)
• Magnesium 120mg (every second day)
• DHEA 25mg (daily) - [Suspended in the end of December 2020 after noticing excessive aromatisation while on Clomid]
• Sodium Butyrate 1200mg (daily)

I have now suspended Clomid, Boron, Magnesium and DHEA.

Unfortunately, I have not been able to follow the sports routine as gyms have been closed due to national lockdown (until mid-April) and the development of tendinitis in my ankle that has prevented me from running over the last 2 months. I believe this has affected my general mood and energy levels at some points. I aim to run again by the beginning of April.

Symptoms

Below the evolution of the remaining symptoms reported over the last 3 months:

• Lack of motivation / concentration. NO IMPROVEMENT . I have not noticed the effects of Bupropion and this symptom (one of the most damaging as it prevents me from working) stays pretty much the same as 3 months ago. My motivation for doing things has not increased and I keep having great trouble concentrating on minimally demanding tasks. Frequently, I feel severely limited when doing simple maths (for instance: 17 divided by 2) and it makes me quite frustrated not to be able to solve such a simple thing without a massive mental effort. Concentration on something that requires attention (solving problems, working or studying) is a hopeful dream. Recently, I was offered two job opportunities on Investment analysis and I had to value a couple of companies and write a detailed report with a recommendation. I had 20 days to perform the task. It was a great opportunity to work in what I like but I did not feel any excitement or motivation about it. Indeed, I felt it as a bother and I ended up being totally unable of sitting and complete more than 10% of the work. I could just not concentrate on it so I let the opportunity pass me by. In a normal situation, I would have been truly motivated and had written both reports to a great level of detail and hours of dedication.

• Lack of energy. IMPROVEMENT . Low energy days are less and less often. I believe that regular sport has massively helped over the last 5-6 months. Sometimes, I experience sudden “episodes” in which I feel my body lethargic and it cost an effort to stand straight and move my muscles, do tasks or even standstill and I need to sit and rest. It is little a sudden melt of physical and cognitive capacity leading to a deep state of derealisation. Fortunately, this only happens once every 20 days or so and for shorter periods of time. In the months following to quitting Finasteride, this happened much more often.

• Anxiety / Low tolerance to frustration. IMPROVEMENT . I do not have severe issues related to anxiety and sudden disproportionate anger anymore. Prior to starting Bupropion, this had already substantially improved.

• Gynecomastia. NO IMPROVEMENT . Everything remains pretty much equal.

• Disconnection feeling between brain and penis. IMPROVEMENT . This symptom was very present over the last month I took Finasteride and particularly on the 2-3 months after quitting. Since then, it has mildly but steadily improved (also during the last 3 months) and I only notice it occasionally. I believe the time is helping to heal it.

• Watery semen. IMPROVEMENT . Clearly due to Clomid, semen consistency is thicker now than before Finasteride. I guess it will normalise during the following months, hopefully to an intermediate state between both.

• Erectile Dysfunction and lack of morning wood. NO IMPROVEMENT . I do not notice a great difference between taking Tadalafil 5mg daily or every two days. Erections are generally functional but weak and not complete. Morning wood happens around 40% of days but they are mostly weak. I would say I am on the same point as 3 months ago.

• Prominent darker veins on penis and sensitivity on one of them. NO IMPROVEMENT . I am noticing more and more veins over the last 3 months, the penis looks more vascular particularly during the erections. It looks very different than pre-Finasteride status, changes in penile tissue have occurred for sure. The uncomfortable sensitivity in that vein is lower now, which is positive.

• Penis shrinkage. NO IMPROVEMENT/WORSENING . Over the last 3 months, the penis has continued degenerating, losing some additional girth (mostly) and length. I was suspecting to have fibrosis and/or venous leakage due to the tissue changes Finasteride has done on my genitals.

• Sexual dysfunction. IMPROVEMENT . Little by little, I am finding easier to get aroused from external stimulus. A few months before, sex began to be unpleasant as I could not always get excited by the touch of my partner and felt totally disconnected and I had to stop as I would feel like “abused” by the external touch. Very unpleasant. Now, this has improved considerably but I am still far from normal. I do not have a feeling of sexual urge anymore when I am aroused.

• Lack of libido. NO IMPROVEMENT . In January, 3 weeks after starting Bupropion, I had a slight spike of libido lasting for 3-4 days that I did not experience from a long time ago. However, it faded away. Overall, I continue experiencing little interest and physical attraction for the opposite sex.

Regarding general sensations about the treatment, I felt quite badly for over 2 weeks in January (waking up with lack of energy, total lack of focus, physical weakness, etc.). Once I began to reduce the dose of Clomid to 37.5mg, 25mg to stop it 2 weeks before blood tests, I experienced a general improvement in mood and erection quality (far from optimal) that faded away one week after.

New blood test / Echo Doppler Results (and doctor’s suggestions)

Here is when the bad news come up. I also had an EchoDoppler test in the Spanish Health System. My diagnosis was venous leakage as I was expecting. However, no fibrotic tissue was found, I guess this last part is positive even though the Doppler is just an indication and I may indeed have fibrosis.

The urologist (very skeptical about Finasteride creating any of my symptoms) did not suggest a solution and said that venous leakage had no treatment and may resolve for itself (rare) or in most cases stay with me forever. He said that the only option was an implant (which he totally refused at my age given that I have some functionality) and that I could try a cockring and Tadalafil to maintain erection longer.

Lastly, the endocrinologist who prescribed me Clomid and Bupropion requested new blood tests at the end of February.

Overall, LH, progesterone, 17-OH progesterone, and androgens have skyrocketed along with oestradiol. I am at supraphysiological levels. FSH went up too within the normal range. SHBG has gone down substantially (Boron effect?) and now my free testosterone is much higher than before. IGF-1 is low but I assume this is due to Clomid. Moreover, I am very deficient in Vitamins B6 (why is this deplected?) and D3 (despite supplementing it every day for 3 months it came back lower than last time). C-Reactive Protein is in the high part of the range.

The treatment proposed was:

• Tadalafil 5mg (daily) + 15mg extra (on demand)
• Bupropion 300mg (dose increased from 150mg)
• Aromasin 25mg (Aromatase Inhibitor, every second day)
• Andractim Gel 2.5% (daily applied the genital area)
• Hydroferol 0.26mg (every 10 days) + Vitamin D3 2000iu (daily)
• Vitamin B6 100mg (daily)

My main doctor suggested to keep the current protocol, add the above and follow the supplementation of the neurologist (NAC + L-Tyrosine). He was also opened to new sources of treatment when my androgens go down a bit in a few months. This includes HCG, stopping Bupropion if 300mg does not give me improvement, Buspiron for libido, sensation and concentration, etc.
Lastly, he also suggested to use a VED 15-20 minutes (3 times per week) and practice pelvic floor therapy (not kegels).

As you guys see, I have a lot of my plate right now so I am keen to reduce the number of pills per day soon. Let’s see …

[Aquarius330]

Just a quick update.

I have been following (and still on) the treatment above and, I must say, some things are improving despite not been able to be as constant as I should due to supplementation shortage and a relocation.

First, my estrogen levels were sky high and my body was looking fatty, gyno was more notorious, etc…I am taking Aromasin 12.5mg every second day and, after 4 weeks I begin to feel myself less estrogenic. Fat deposits in belly, legs and breast (which appeared after Clomid) are slightly reducing.

But the most relevant improvement is that I AM ABLE TO WORK AGAIN.
Yes, I began to work as an Investment Analyst again and I am able to concentrate. In full disclosure, I am not able to concentrate as before, but I believe I am on the way and I am much more functional than before. Indeed, I can say I am functional again and I might be at 75% of my previous concentration levels.

Why is this? Might it be the NAC and L-Tyrosine?
Might it be Bupropion 300mg?
Might it be the pressure and new situation of working?

I do not know for sure but I was feeling so well (other than frequent headaches) that I decided to decrease Bupropion back to 150mg and, if everything maintains, I will stop using Bupropion by mid-June.

So far I have not noticed improvement regarding Andractim in breast tissue nor genitals, however, each time I use it I feel the warm sensation of blood going towards those tissues and I presume that is not a bad sign.

Sexually, things are still complicated but I guess that is “normal” due to the venous leak. I would like to combine the Andractim with VED, pelvic floor theraphy and shockwave therapy. BUt this is the last part I will address.

In regards to fertility, the last spermiogram came up with lower tha 6M sperm count and motitily is low/normal, which is quite bad. Two years ago, while on Finasteride, my sperm quality was considerably higher.

I will undergo new blood tests in a couple of months and will evaluate the next steps but my objective (if possible) is to spend the following 3-4 months as clean a possible before getting into any other hormonal treatment such as HCG.

[Aquarius330]

Long time no update.

Many things have occurred in my personal life. My 10-year relationship ended abruptly (no PFS related) and my whole life project and aims in life changed from one day to another. The bad news greatly affected my symptoms and amplified my cognitive side effects, destroyed my sports routine, distorted the way I was taking my pills and gave me new concerning physical issues such as back pain, shoulder pain, and difficulties moving, particularly in my legs (all neurologically related).

Protocol over the last 12 months - Medically controlled

As a summary, you can find below the protocol I have been following (not consistently) over the last 3 months:

• Tadalafil 5mg (every second day)
• Vitamin D3 1000iu (daily)
• Acetyl L-Carnitine 1000mg (3 times per day)
• L-Arginine 2000mg (3 times per day)
• Taurine 1000mg (daily)

And for a three months period:

• Pregnenolone 50mg (first month)
• Pregnenolone 100mg (second and third month)

My endocrinologist gave me the Pregnenolone but I began to feel less and less concentrated. Brain fog was coming back and my energy levels decreased notoriously. I went even worse when I increased from 50mg to 100mg. I don’t know if it was the lack of sport or the break-up ongoing feeling, but I was feeling worse and worse each day. After quitting Pregnanolone, I began to feel slightly better in terms of energy despite I was left in a very low mood state.

Symptoms

Below is the evolution of the remaining symptoms since my last post:

• Lack of motivation / concentration / brain fog. NO IMPROVEMENT/WORSENING . While I had previously improved on this. The break-up had its toll on my mental health and I cannot concentrate for more than 2 minutes for the last 7-8 months. It reached a point that made lacing my shoes extremely difficult and it would just feel like a big struggle and would take me like 10 minutes to do so. Concentration on anything that requires attention (solving problems, working or studying) is a hopeful dream.
• Lack of energy. IMPROVEMENT . Little by little, coming back to normal levels. I would say I am at 80%. This clearly improves when I exercise regularly.
• Anxiety / Low tolerance to frustration. IMPROVEMENT . I do not have severe issues related to anxiety and sudden disproportionate anger anymore. I do have occasional anxiety by always due to external reasons.
• Gynecomastia. NO IMPROVEMENT . Everything remains equal. Considering surgery at some point.
• Disconnection feeling between brain and penis. IMPROVEMENT . Over time, this has mildly but steadily improved and I only notice it occasionally. I believe either the time is helping to heal it or I am forgetting how it was to feel “normal”. Sensitivity is sometimes intermittent during sexual activity but this may resolve if I had a full erection.
• Weak orgasm (Anorgasmia). NO IMPROVEMENT/WORSENING . My orgasms are much weaker than before and sometimes not pleasurable. Other days
• Watery semen. NO IMPROVEMENT . Semen volume and consistency is intermittent but it is still not normal.
• Erectile Dysfunction and lack of morning wood. NO IMPROVEMENT . I do not notice a great difference between taking Tadalafil 5mg daily or every two days. Erections are generally functional but weak and not complete. Sex becomes difficult in certain postures. Morning wood happens around 40% of the days but they are mostly weak. I would say I am on the same point as 1 year ago.
• Prominent darker veins on the penis and sensitivity on one of them. NO IMPROVEMENT . I am noticing more and more veins, the penis looks more vascular, particularly during the erections. It looks very different to pre-Finasteride status, changes in penile tissue have occurred for sure. The uncomfortable sensitivity in that vein is just intermittent and rarely occurs.
• Penis shrinkage. NO IMPROVEMENT . The penis has not worsened or improved. Girth (mostly) and length seem to have stabilized. It has curved slightly to the left, but it is minimal and not always noticeable.
• Sexual dysfunction. IMPROVEMENT . Little by little, I am finding it easier to get aroused by external stimuli. Despite having low libido, I do not feel totally disconnected like in the old days. I am not proactive but I can be reactive to the external touch. Now, this has improved considerably but I am still far from normal. I do not have a feeling of sexual urge anymore when I am aroused.
• Lack of libido. IMPROVEMENT . I would say my libido improved by 10%. Very little, but something. I have also noticed I have days of higher libido, particularly around days I could have sex. Overall, I continue experiencing little interest and physical attraction for the opposite sex. For instance, girls do not attract my sexual attention in public places.
• Urinary urgency. IMPROVEMENT . This has slightly improved with pelvic floor exercises but it greatly depends on the day and how much I drink.

Overall, last year has been tremendously difficult in my personal life, I lost 6kg and recovered 10kg afterwards. All my hopes and expectations went down the toilet and I had to rebuild myself (I am still on it): went back to my mother’s home, lost a greatly meaningful relationship, my health went down the hill again, and I go to work but I am unable to perform, multiple expenses, etc

And while now my life is far from “ideal” at 33 and does not look promising, I keep burning stages on my medical options as I will explain below:

New Evoked Potentials of the Pudendal Nerve Test Results (and doctor’s suggestions)

Here is when more bad news comes up. Following my endocrinologist’s advice, I visited a neurophysiologist in order to test the status of my pudendal nerve signalling.

I took this 1-hour test with needles in my head and electric impulses running up to my legs, penis, etc. It sounds worse than it is. The result was mononeuropathy in the left side of my pudendal nerve with the right also affected to a lesser degree. More thin and thick fibres. In plain words: nerve damage prevents good signalling due to the loss of myelin in the nerve. Apparently, the right part is keeping function and compensating for it.

The doctor mentioned that this damage might have had a key role in vascular deterioration, venous leakage, penis shrinkage, urination issues and, of course, sensitivity and weak orgasms.
He did not doubt the Finasteride history and indeed said that Finasteride can be neurotoxic.

Potential surgery intervention (pulsed radiofrequency of the pudendal nerve)

Following the previous doctor’s recommendation, I went to another doctor whose speciality is the pudendal nerve. He examined the evoked potentials result and suggested intervening surgically (minimally invasive) to cover the nerve with PRP and hyaluronic acid to isolate it from any pressure and stimulate myelin recovery with pulsed radiofrequency at medium temperature (40 degrees Celsius). After that, he suggested going for shockwave therapy on the penis. Moreover, he did not discard that my pelvic floor would be affected so he suggested trying pelvic floor therapy first to see how I respond as it can help with innervation too.

The surgery costs around 2,000EUR which is a considerable amount for Spanish salaries, particularly for an intervention with no warranties to mitigate my symptoms. After seeing a couple of recent interventions to fellow PFS patients that showed no improvement/worsening, I have doubt about undergoing this intervention and I may keep my money and go straight to other alternatives such as a combination of HCG, shockwave and Andractim.

Pelvic Floor Therapy

In the meantime, I also went to a male pelvic floor clinic in Madrid on a weekly basis for pelvic floor rehabilitation. In the beginning, they did not believe in PFS but, as they apparently were the best in the country, I had to cope with their incredulity. Little by little, they started to believe and ask more, particularly the younger doctor, but the treatment seemed an “experiment” to which I did not respond well.
The diagnosis was not clear to me: pelvic floor muscles too tense in relaxation, tissue degeneration on the penis but no fibrosis according to them and … they did not explain it further.
Basically, the sessions consisted in pelvic floor exercises (to do at home and on-site), diathermia (radiofrequency on the penis to heat it inside for tissue stimulation), electrostimulation (to stimulate the pelvic floor nerves and recover sensitivity and orgasm feeling) and penis pump exercises.
After six or seven sessions, plenty of exercise at home and quite a decent amount of money spent on trips to Madrid, I did not see much improvement. Maybe urination urgency slightly improved but … difficult to really tell.
My current plan is to keep doing the electrostimulation on 2-3 times per week basis for a period of a couple of months as I bought the rehabilitation device and begin regular VED therapy for at least 1 year.

Next steps

Due to subclinical depression symptoms, I began to attend frequent sessions with a psychologist and I am making little progress. I am particularly concerned about the cognitive issues that prevent me from working normally. I cannot just focus on anything, read for 5 minutes, think clearly, etc.
Wake up, getting dressed and going to work takes me no less than 2h 30min and, during some time, I began to struggle to move my body due to stiffness. I even fell down the stairs one day.

After trying for several months, she believes I should go to cognitive rehabilitation sessions in a mental hospital to prevent further deterioration and see a psychiatrist in order to get some medication to push me out of the hole. At this point, I even consider it. I would like something to cope with my cognitive issues and, to be honest, I am quite curious about Buspirone as another doctor (experienced with PFS) told me that might help both libido and general mood.

In the last few weeks, I am beginning to be able to exercise again and I am feeling a bit better but still struggling.

I have rationalized and reduced the number of pills per day. So, now I am just taking the following:

• Tadalafil 5mg (every second day)
• Vitamin D3 2000iu (daily)
• Acetyl L-Carnitine 1000mg (2 times per day)
• L-Arginine 1500mg (3 times per day)
• Taurine 1000mg (daily)

My plan is to get in shape to promote an androgenic environment, lose some 4-5 extra kg and possibly attempt a combination of shockwave therapy for the penis plus HCG (low dose for an extended period) and Andractim. But, in order to do that, I need to get in shape first to ensure my estrogen does not go sky-high again.

Lastly, I am keen to participate as a donor for both Kiel study (Hamburg) and the new genetic study from PFS Network.

[sudosudo]

Hey I’m from Spain too, in which clinic did you get your hormones checked?

[Henrique]

What did you do to regain muscle loss or stop muscle loss? Can you currently gain muscle?

[Aquarius330]

This would be better handled privately but I checked my hormones both in the national health system and Laboratorios Ruiz-Falco (Madrid).

[Aquarius330]

I exercised regularly, even when it was hard because I was weak.

Yes, I can gain muscle but slowly and I lose it quick too but this might be my body and not PFS.

[Huehueh96]

Hola amigo, que endocrino estás viendo en España? Llevo solo un mes con este problema y estoy dudando aún a que endocrino ir. Muchas gracias y espero que mejores. Un saludo, amigo. Si quieres decirlo por privado, no pasa nada. Y si no quieres revelarlo, tampoco pasa nada. Gracias!

[wdnation1]

Hey I am very curious as to if you ever completed the pudendal nerve therapies that you had mentioned? or if any of the others that you were thinking of pursuing worked to any degree for you?

[Aquarius330]

No, others did have the surgery with no improvement. Even though they never measured conductivity later.

[Aquarius330]

Well, after a year, it is time to update the story.

My life is a bit more stable (not particularly for the good) but I have not recovered from the cognition issues that were triggered again after the breakup of my long-term relationship, two years ago. I am still living with my mother again as I could not find the stability and strength to move on my own. I am (partially) functional again but I really struggle to stick with simple routines such as regular exercise, doing tasks, focusing on something demanding or not, etc.

In my daily life, I do not feel “right” as I am frequently tired or simply demotivated, my mood varies a lot towards feeling profoundly sad and I do not have the drive to achieve anything I plan, even if it is something basic as going to clean my car. As a result, my personal development as a 33-year-old grown-up man is totally stuck.

I got a new girlfriend but the relationship is challenging as I do not feel “in love” with her. I believe this was due to PFS and emotional flattening. Sex was not awful but I struggle with erectile problems (particularly on penetration), anorgasmia and sensitivity changes. Due to this “lack of feelings”, we decided to split up.

Main remaining symptoms - No relevant changes

• Lack of motivation / concentration / brain fog.
• Anxiety.
• Gynecomastia.
• Erectile dysfunction and lack of morning wood.
• Weak orgasm.
• Watery semen.
• Prominent darker veins on the penis and sensitivity on one of them.
• Low libido.
• Urinary urgency. This symptom has actually worsened.

Kiel study (Hamburg) - Scrotum sample biopsy

Last May, I travelled to Hamburg to donate a sample of my scrotum for the upcoming University of Kiel study. I hope we get some promising results to keep building on the reasons why this is happening.

New Dopler results

In June, I decided to undergo a new Doppler ultrasound test with one of the most veteran and leading penis echographer experts in Spain. The test lasted almost one hour and provided very detailed results and a new diagnosis that complemented my previous unknown “venous leakage”.

This time, they found low blood flow on a basal state, heterogeneity of the corpora cavernosa, a noticeable and located engrossment in the tunica albuginea (4mm at the thickest point when 2mm is the normal thickness) and a zone of low vascularization next to the engrossment, all of the mid-part of the penis. As a result, secondary venous leakage was detected.

The main conclusion was that poor blood flow was getting into the mid and distal part of the penis due to those zones of low vascularization so the vessels were not expanding enough to push the tunica.

This was a much more accurate diagnosis than just “venous leakage” because the leakage is a consequence of the poor blood flow and vascularization anomalies but not the cause, as thought before.

Vertica RF

Other than higher doses of Tadalafil, Avanafil or Sildenafil, one of my doctors suggested the possibility of trying a new state-of-the-art radiofrequency device called Vertica ( https://vertica-labs.com/ ) to use at home. This device promotes the regeneration of elastin and collagen to maintain and improve tunica albuginea health and, potentially, recover the veno-occlusive mechanism and improve erectile quality.

The main issue with the device is the lack of clinical research (just one study so far with great results and US approval ongoing) and its price, around 1,800€. That’s simply a lot for an experimental device. Nevertheless, I managed to get a device for less than 330€ by pooling money from 5 other patients, sharing it for 3 months each. So far, after one and a half months, the results are vastly poor and erectile quality is not improving for me. I still have another month and a half to run it but it is not promising.

Urinary urgency

This symptom has been giving me more problems lately. Sometimes I just drink 0.25L of water in the office and I will go to the toilet 5 times in a period of 4 hours. On one occasion, I went to a bar with a friend, drank one bottle of beer and had to pee 3 times in one hour. Moreover, when I was going home (35 minutes walking) I almost pee myself before reaching the toilet.

I am pretty sure this is a neurological issue as I do not pee much when I go and it does not happen every day. It has some degree of seasonality.

My andrologist gave me a compound made of Black Maca, NAC, Milk Thistle, Selenium, Vit E, Lycopene and Astaxanthin. It seems to improve a bit in severity but it still happens often.

Buspirone 5mg [3 times a day]

A couple of weeks ago, I finally started a treatment with Buspirone. I had been waiting several months for this as I wanted to regulate my sleep and life first to focus on the real effects. A doctor recommended I try this medication as a resource to improve my libido, minimise concentration issues and regulate my general mood.

Apparently, this was developed as an anti-anxiety treatment that works as a GABA modulator rather than as a benzodiazepine. Hence, it causes no addiction. The problem was that they found out that it didn’t work well as an anti-anxiety treatment because it was too mild and long-term. It began to be used off-label to treat ADHD with people who do not want to use Adderall/Ritalin compounds due to side effects or with hyperactive dogs, cats and fish.

It is still soon to tell how it is affecting me but I hope to take it for several months to evaluate whether it helps.

Current Protocol - Medically controlled

As a summary, you can find below the protocol I am currently following:

Tadalafil 10mg (every day)
Maca + NAC + Milk Thistle + Selenium + Vit E + Lycopene + Astaxanthin Combo (daily)
Tongkat Ali 1020mg (twice per day)
Acetyl L-Carnitine 1500mg (once per day)
L-Arginine 2000mg (twice per day)
Buspirone 5mg (3 times per day)

Vertica (radio-frequency device) (3 times per week)

Next steps

My main concerns now are all the subclinical depression symptoms and my lack of concentration that greatly affect my work and my life. The sessions with a psychologist did not help much in that aspect. maybe it was not the right psychologist.

Of course, all the sexual problems too … but that is secondary at this stage. I am still thinking about a combination of shockwave therapy for the penis plus HCG (low dose for an extended period) and Andractim to try to recover sexual function. But it is expensive and likely to work just temporarily on my corpus cavernosa.

First, I have to finish with both Vertica RF device and Buspirone treatment.

[gomesemog]

how u doing with the HCG?

[Aquarius330]

I am not on HCG yet. It’s just a possibility in 2024.

[LondonUK]

Hello, thanks for the comprehensive and articulate updates.
How are you getting on with the Buspirone

[Aquarius330]

It did not work, just made me dizzy.

[LondonUK]

Sorry to hear that. Are you still following the same protocol (minus Buspirone) as outlined in the Oct 23 Post?

[sg8627]

My dude

That concoction that doctor gave you (I don’t mean to freak you out) has at least 2 or 3 5ari Inhibitors in there

Lycopene and Asxatiaian
Also black tea

Be careful please

[aki]

what is your sebum secretion like?

[Aquarius330]

Time for an update in June 2026.

I have gone through many changes in my life. For instance, I live on my own now, which is still challenging given my cognitive and organisational difficulties.

I really struggle to stick to simple routines and create good habits for myself. My mind often feels scattered, and I struggle to complete even simple tasks or stay focused for short or long periods.
Indeed, I lost my job, and my cognitive issues were a major contributing factor. … but I’m OK financially by now.

Good things: I built the habit of exercising regularly. During a couple of years, I became a regular runner and finished a half-marathon, but I stopped jogging at some point. At least, I have been training for strength 2-3 times per week since the beginning of 2025 with a personal trainer, and I am starting to see results, but food-wise, I could do things much better, and I have to lose 3-4kg extra.

Day-to-day feeling: Not depressed and pretty decent mood. I am used to this situation and try not to be too harsh on myself. Brain fog is not unusual (but light compared to the past). Motivation is not there … I don’t enjoy playing music or video games as I used to. As a result, I rarely do those things anymore, and when I do, it often feels more like an obligation than genuine enjoyment. I even fix a date/time in my calendar to force me to do those things sometimes.

I do not have the drive to achieve anything I plan. My personal development as a 36-year-old man is a bit stuck. I feel pretty “slow”, and being unemployed (even though I am studying with difficulty) is not helping me maintain a sense of momentum in life. Nevertheless, I would say I am better (maybe not in terms of health, but mood) than in my last update.

I came back together with my latest girlfriend, feelings towards her have greatly improved, that’s a bonus … but sex is challenging. Not only does erectile dysfunction make things complicated, and I believe it is getting worse with time (ageing), but the orgasm is not satisfactory on most occasions, and partial erections simply do not feel normal or satisfying in terms of pressure and pleasure for me, even on Tadalafil, the venous leak is still evident in every sexual situation.

Gynecomastia reminds me every morning of the biggest mistake of my life in the mirror. Even though I am getting in shape, that always remains.

Main remaining symptoms - No relevant changes

Lack of motivation / concentration / brain fog.
Sporadic Anxiety.
Gynecomastia.
Erectile dysfunction and lack of morning wood.
Weak orgasm.
Prominent darker veins on the penis and sensitivity on one of them.
Low libido.
Urinary urgency.

Buspirone 5mg [3 times a day]

The treatment with Buspirone did not work. Instead of having benefits from it, the main effect I noticed was dizziness. It was really notorious when I was playing padel with a few members of my family, and the ball would be “slow motion” for me. My reflexes were clearly affected, and I felt quite dizzy and slow to play. It happened to me a couple of times, and I saw that as a red flag telling me to withdraw from that treatment—no benefits from it on libido, cognition or other aspects.

Psychologist

I am not currently seeing one, but I was recommended a therapist by a doctor to help with my concentration and motivation issues. In the end, I did not try it as I do not think it will help me, and it was expensive.

Vertica RF

I finished the treatment with the Vertica RF device I talked about in my last post. The results after 3 months of continuous use were disappointing. Maybe a little bit more blood flow that fades away after 2 weeks of no use. Nothing remarkable is worth continuous use.

Urinary urgency

This symptom is still out of my control and very intermittent. I am considering visiting a new urologist so he can study just the urinary problem to see if there is something to be done about it. I suspect I may not be emptying my bladder completely. Sometimes I feel like peeing a lot, and I pee very little, still with urgency. In any case, this is not my top priority now as I have many things going on in my life.

Current Protocol - Medically controlled

Mostly, I have stopped taking care of myself in terms of medication. I should be in the following:

Tadalafil 5mg (every day)
L-Arginine 2000mg (twice per day)
NAC 600mg Sustained Release (twice per day)

But what I am really doing is:

Tadalafil 5mg (some days, on demand when I remember)
L-Arginine 2000mg (occasionally)

Even something as simple as taking medication consistently remains difficult for me.
What I intend to do in the following months to improve (hopefully) or preserve my cognition and erectile functionality is the following:

HCG (250IU every second day - 750IU per week)
Tadalafil 5mg (daily)
Water Pump (4-5 days per week, 10 minutes each time)

Next steps

My main concerns now are concentration issues. I have to get a job too but with my cognitive issues is going to be challenging.

If the treatment with HCG does not improve my cognition, I will try to go for an ADHD diagnosis to be prescribed something that improves my focus.

I have wondered whether I may have had inattentive ADHD since childhood and was previously able to compensate for it because I had the tools in my mind. If that is the case, whatever changes occurred after Finasteride (possible in the dopaminergic circuit) may have reduced my ability to cope with those underlying difficulties, and I am not able to function normally anymore.

Moreover, gynecomastia remains a concern every day and after closing the hormone’s chapter (HCG + reset of the hormonal axis will be the last) I will consider undergoing surgery to remove it.

In my last post I talked about a combination of shockwave therapy for the penis plus HCG and Andractim to try to recover sexual function. But I do not really want to waste more money on expensive, unproven methods with generally poor results (shockwave) after my experience with Vertica RF. At this stage, I believe the technology to save our sexual performance is still not on the market, but I am pretty confident that something for venous leakage will come out in the following 10-20 years.

[Aquarius330]

Normal. My hair is fine and I have slight acne if that gives you a reference.