Severe ED 18 months post-fin, need advice on protocols

I used finasteride 0.25mg for a total of three months in the summer of 2024. Over the course of my first year off, I had incredibly strong windows of improvement, followed by periods of worsening, but overall I was getting better. But by the one year mark, I stopped having windows entirely and I stagnated for the next four months. My erection quality also declined, and I started on 5mg daily cialis to prevent my penis vasculature from declining further

However, I developed tinnitus as a result, and one of the drugs I tried to treat it, a chemical called prednisolone, crashed me severely. Now, two months later, I am having erections again, but they are weaker even than my previous low in the autumn. I can’t get more than about 20 to 30 percent hard any more. My nocturnal erections are also noticeably softer than before when I wake up

At this stage, I am fairly sure I have a venous leak that is slowly worsening over time. I am looking into finding an endocrinologist to prescribe me HCG and some other steroid like Clomid or DHT cream in order to try and halt my long-term decline. I would like to know if any other users with steadily declining erection quality and sexual health over time managed to halt this decline using hormonal interventions. I doubt shockwave therapy or PRP will help much without addressing the underlying cause. I am not yet ready financially or psychologically for a penis implant

Any advice would be much appreciated

By taking a massive dose of synthetic cortisol, you likely suppressed your own adrenal function and further desensitized your Glucocorticoid Receptors.

Before injecting HCG, confirm if the “leak” is real. If the Peak Systolic Velocity is low, it’s an inflow problem (Arteries/Nitric Oxide). If End Diastolic Velocity is high, it’s a leak.

The only non-hormonal way to stop penile atrophy is with a Vacuum Erection Device. Use a pump for 10 minutes daily (without the constriction ring). This pulls oxygenated blood into the tissue, forcing the smooth muscle to stretch and preventing fibrosis. It is physical therapy for the pug.

Have you looked into Pentoxifylline? Unlike Cialis, Pentoxifylline is actually used to TREAT tinnitus and sudden hearing loss.It replaces the anti-fibrotic function of Cialis without the tinnitus risk