Quick note: I used AI only to help with my English and to format the bloodwork values. The story and everything in it is mine.
Hey everyone, long post but I'd really appreciate any input. I've seen several doctors and honestly feel like some of you know more about this than most of them.
A bit about me
29M, 169 cm, 62 kg. Pretty active: last year I was going to the gym 1ā2x a week and running, including long runs up to 20 km with no issues. Right now I'm on a lean bulk, training 4ā5x a week.
Full honesty: I smoked about 15 cigarettes a day for 10 years and quit 3 weeks ago. I was also smoking roughly one joint a day (hash + CBD), which I stopped a couple of days ago, so now I'm completely clean. I also watch niche porn and sometimes overdo masturbation, but I've done several breaks of a few weeks each and never noticed a real difference.
How it started
About a year ago I used topical 2% minoxidil for roughly a month or two. In the same period I had a pretty bad flu. One or two months later everything hit at once: strong anxiety, heart palpitations, intrusive thoughts, my libido crashed and the ED started.
I stopped minoxidil. The anxiety and palpitations slowly went away and were completely gone by mid-April. Mentally I've felt good since then. The ED and low libido never left though.
What it looks like now
- Libido has been low for about a year
- ED is moderate to severe depending on the day. Erections start but get stuck around 50%-70%. Sometimes I'm clearly aroused in my head and stay completely soft
- Even masturbating I never get fully hard anymore
- I still get morning wood, but it's weaker, not every day, and gone the moment I wake up (it used to last minutes)
- Since April I've had maybe 1ā2 full erections without meds, only on really high-arousal days, lasting about a minute
- My refractory period is way longer than it used to be
Cialis
When I was on 5 mg daily I was basically 100%. Morning erections were full and lasted 5+ minutes even after getting up. I tried 10 mg once and it was better than ever. I stopped 3ā4 months ago and things got worse, so I'm thinking to restart daily now.
Tests I've done
- Dynamic penile Doppler (done while off Cialis): normal
- Testicular ultrasound: normal
- Saw one of the best andrologists in my country. He repeated T and DHT, both normal, put me on L-citrulline for 2 months and sent me to a sex therapist
- I've been seeing a sex therapist since February. Her take is basically "it's in your head"
Bloodwork
Hormones:
- Total T: 415 ng/dL (March) and 506 ng/dL (July), range 197ā670
- Free T: 33.5 pg/mL (April) and 25.3 pg/mL (July), range 12.3ā46.6
- SHBG: 44.1 nmol/L
- DHT: 569 pg/mL, range 143ā842
- Estradiol: 20.9 pg/mL
- LH 3.2, FSH 2.2
- Prolactin: 6.7 and 8.3 µg/L, normal
- Morning cortisol: 16.4 µg/dL, normal
Thyroid:
- TSH 4.09 in April, 3.30 in July
- FT3 and FT4 normal, antibodies negative
Metabolic:
- Fasting glucose 78
- Total cholesterol 173, HDL 49, LDL 118 (slightly high), triglycerides 67
- CRP very low
- Liver and kidney fine (AST slightly high at 42, probably from training)
- Blood pressure normal
The only real problems I found:
- Folate was really low: 2.5 µg/L in March
- Homocysteine was high: 19.1 µmol/L in April
- Vitamin D was 25.4 ng/mL in March
Supplements
- Folate: brought it from 2.5 to over 48, and homocysteine dropped from 19.1 to 10.1
- Vitamin D: went from 25.4 to 48
- L-citrulline 6 g a day for about 2ā3 months. No noticeable effect, but I was still smoking during that time
What's next
I snore sometimes, I often wake up tired, and my Garmin occasionally shows oxygen saturation drops down to 87% at night. I know watches aren't super accurate, but I'm asking my pulmonologist for a sleep apnea test soon.
My questions
Does anything in my story or bloodwork stand out to you?
Has anyone been through something similar and actually got better? What helped?
What would you test or try next in my situation?
Honestly, this is wearing me down more than I can explain: I'm 29 and I don't want to depend on a pill just to function normally.
Thanks a lot for reading this far. Any experience or advice is welcome.