Hey I’m from Spain too, in which clinic did you get your hormones checked?
What did you do to regain muscle loss or stop muscle loss? Can you currently gain muscle?
This would be better handled privately but I checked my hormones both in the national health system and Laboratorios Ruiz-Falco (Madrid).
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.
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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!
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?
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No, others did have the surgery with no improvement. Even though they never measured conductivity later.
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.
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how u doing with the HCG?
I am not on HCG yet. It’s just a possibility in 2024.
Hello, thanks for the comprehensive and articulate updates.
How are you getting on with the Buspirone
It did not work, just made me dizzy.
Sorry to hear that. Are you still following the same protocol (minus Buspirone) as outlined in the Oct 23 Post?
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
what is your sebum secretion like?
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.
I would urge caution in playing with ADHD medication or anything affecting your brain chemistry. Just be careful not to throw any mental gains you have had and end up with worsened anhedonia or something. I wish you the best of luck with whatever you end up doing though.
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Absolutely. I am aware of the risk and do not like that pathway but … I need to be able to work and keep going with my life. So far, I am still on HCG (third month) so I will evaluate that option after HCG.
Thank you for sharing over the years. It was a great read with a lot of information you collected and documented. When I read posts that sound the same as what I’m feeling it gives me a great sense of community. I actually struggle with being able to just articulate my feelings and putting them down into words. Cognition being my worst symptoms. I have total loss of mental sharpness, creativity, wittyness, memory focus and have been trying to fix that for years and am still shocked that after all the reading and experimenting from this forum that I have yet to come across a straight answer. Very discouraging.
A few things that seems lasting is to avoid alcohol at the level of intoxication. Makes all cognition side effects worse. I can tolerate 1 or 2 a day with no issue and some benefit. Maybe a slight boost in gaba with no noticeable neuroinflammation. Save big drinking for very special occasions ot holidays.
Eat cleaner. Avoid snacking between meals, avoid garbage treats and over eating. Aim for lots of fiber and protein.
Mild exercise.
B Vitamins and a multi vitamin, every other day for mental sides brings me from 20 to 25 percent lol. Slight improvements go a long way though.
Sleep at the same time is very important. When I go to be an hour or two later I feel it.
Being 42 and living and feeling like im in my 60s. Still look my age but do not feel it.
I took Accutane in my early teens. Im one of the cases that I took a quarter pill of proscar for 3 or 4 days and felt off and discontinued Recommended to try again by gp, one pill and have been messed up badly since. Now sensitive to everything that inhibits dht and the use of retinoids for oily skin and I crash hard. Apprehensive to try anything more pharmaceutical due to sensitivities. I also have hashimotos so im like quadruple fucked lol
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