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.