As I've gotten older, I've had to accept that I'm not the same guy I was in my twenties. And, one of the most difficult things was to acknowledge that things aren't the same as far as sex goes. I consider myself fortunate in some ways because I've never had to accept the indignity of impotence or incontinence, but there's no doubt that things aren't like the good old days. I know I bear a certain responsibility in that I've been a lifelong smoker. I've cut that down to a bare minimum, but the damage is done and I have to deal with how that's affected me. However, I'm not willing to just give up the way some guys do......I don't accept that I'm older and have to concede that sex is over or just a shadow of what it used to be. A few years back, I determined that, if I have a goal in my remaining life, it's to grimly hang on to that part of my life. It's just too important to shrug and say "Oh well".

I started out as many people do by first trying herbal supplements hoping they'd be a cure-all. It just doesn't work - at least not as the complete answer. I also talked to my doctor and tried medications as a solution. Also, not the way to deal with it....at least, by itself. This has been a learning process ad it's taken years to acquire a basic understanding of the medical aspects of it, and what needs to change. In totality, this isn't any one thing....It's a complete acceptance that first, there are costs involved and there's no way around it, second that it requires a commitment to follow a regime that means faithfully taking medications and supplements that contribute to my health, and third, being willing to adopt a lifestyle that leads to the end result I want.

There are some things that started the process - I had to have very open discussions with my doctor, setting aside any embarrassment and being willing to say things that they need to know to help me. Initially, I had to be willing to tell my nurse practitioner that my libido was slipping and I needed advice on how to deal with it. She conferred with my doctor, which led to her referring me to a specialist, an endocrinologist who took a very extensive medical history, ordering extensive tests, and eventually diagnosing me with low testosterone. I've been getting bi-weekly testosterone injections from a nurse for about fourteen years, and lab testing every three months to ensure that my testosterone levels remain within strict boundaries.

Knowing that TRT (testosterone replacement therapy) helped, but didn't solve the whole issue, I tried ordering and self-medicating with herbal remedies. I experimented with tongkat ali, horny goat weed, genseng, tribulus terrestris, maca, saw palmetto, and a whole host of herbs that are reputed to aid in male sexual issues. None of those things was adequate to deal with what I faced. (I do think that some of those herbs, such as maca, saw palmetto, pygeum, and stinging nettle have a legitimate place in male sexual health, primarily in dealing with enlarged prostate).

I talked to my doctor further, and she physically examined me and referred me to a urologist. I found him to be less than helpful.....Beyond digital prostate checking, he mumbled a lot about the paradox of using blood pressure medications to deal with hypertension while trying to find ways to improve erections, and in the end, his recommendations were giving me samples of Viagra and Cialis, and talking about penis pumps to induce hardons. I left that scene less satisfied than with any other medical help I received. A referral to a second urologist led to examining my equipment but no other recommendations other than perhaps Trimix injections to get hard when I wanted sex. He mentioned in passing that his clinic owned a low frequency acoustic shockwave machine, which excited me.....However, he basically waved it away saying it didn't work.

I did find online ads from a business located close enough (30 miles away) that did acoustic shockwave treatments. I went to have a consult with them, was told that shockwave treatments were of some value to people who weren't completely impotent but wanted something to improve on impaired performance. I ended up buying a series of six treatments, spaced two weeks apart, to see if it would help, at a cost of 1700.00. So, every two weeks, I drove thirty miles for a fifteen minute treatment. At the end of it, I wasn't sure it had helped......I wasn't any worse off, and perhaps a bit better, but I still wasn't where I wanted to be.

For a long time, I relied mainly on educating myself online, trying to absorb enough medical knowledge to figure out how to help myself. I was buying almost anything I could find mentioned online that made reference to "promoting nitric oxide production", knowing that nitric oxide was necessary for erections, and also, anything that made reference as a "Vasodilator", understanding that anything that help dilate blood vessels was helpful in getting more blood to the penis. I'm sure lots of my friends thought I was nuts, as I was taking as many as 12 - 15 different things that I thought might help, as well as multiple vitamins that seemed particularly important to male health. In a lot of ways, I was throwing things at the wall to see what would stick. It probably wasn't very scientific, but as I said, it was a learning process.

In the last year or year and a half, I've learned a lot about arteries. I know blood flow is all important to achieve erections, and it all seemed to point to getting things right there......I recognized that age, smoking, and various other factors led to plaque buildup in the arteries. That means that in the arteries, the single-cell thick wall of cells called the endothelium that line the arteries become stiff and unable to naturally relax and expand to permit improved blood flow through nitric oxide that's necessary for erection. It wasn't until I began to realize that viagra and cialis were trying to force the blood vessels to expand that I realized why PDE5 inhibitors like viagra can only work so well, and that over time, they become less effective so you need larger dosages, but finally, they don't do anything. The answer is to find ways to repair the damaged endothelium inside the arteries so it can expand properly to increase the blood volume.

This has brought me to the point I'm at now......I know that what I need is to find ways to thin the blood, as a way of improving blood flow, repairing the endothelium so it will expand to allow more blood to pass through, and adding the supplements that will promote nitric oxide production. There are lots of things being advertised online that are reputed to help, but I've settled on 24 month-aged garlic capsules, nattokinaise (Japanese soy capsules), and capsaicin/cayenne pepper softgels, as the best products to accomplish the repair and improved performance of the blood vessels that lead to better erections. These things aren't a magic bullet - They don't work overnight....It takes weeks or months to do what's needed. These problems in your arteries took years to develop, so it's reasonable to assume that it'll take time and consistent effort taking these medications and supplements for things to get back to what you want.

It's worth knowing though, that it really doesn't take too long before you begin to see the initial improvements. For me, it's only been a few weeks and already I'm discovering that I'm beginning to experience nocturnal erections when I wake up in the middle of the night, and frequently discover I have morning wood when I wake up in the morning. It's a great feeling when you start to get rewards for the effort you put in, and it can happen quicker than you might imagine when you start.

The final chapter (I think) in this whole adventure is the, what I think of as, mechanical aspect. There are a couple of things......I'm coming to the conclusion that the shockwave treatments I took a couple of years ago may still be something that potentially could be beneficial. I'm suspecting that they have to be part of the bigger picture before they'll really help. I don't have a couple of grand to put into having the treatments again, but there are a couple of more home-based answers that didn't exist when I was first aware of shockwave therapy.
One is a device that you sit on, called Vital Flow. It produces low frequency shockwaves that are designed to penetrate the interior of your body. They're targeted at two muscles at the base of the penis - pubococcygeus (PC) and bulbocavernosus (BC). Getting blood into your cock to create an erection is only half the battle......The muscles that keep it there so your hard-on doesn't fade is the other half of the equation. The low frequency shockwaves are designed to train these muscles to make sure that the blood producing the erection stays there. There are multiple brands of these devices on the market. I'm mentioning the one that I viewed as one of the best that I am purchasing. These machines are rechargeable from a computer USB. You use them 15 minutes per day.
The second device is a handheld that you attach to the genitals and again, it's battery powered and rechargeable. You use it for about 10 minutes per day. It's designed to disperse low frequency shockwaves to the penis, pubic area, and perineum. The basic premise is that the low frquency shockwaves promotes the creation of new arteries to carry more blood to the area you need it to in order to obtain an erection. Again, I think there are probably multiple versions of this on the market. The one I chose and have purchased is EnergieAlpha Vital Engine.
It's important to emphasize that these things aren't novelties or sex toys....They're intended to be a legitimate part of restoring a man's sexual function.

This is the stage I'm at now. I hope that some of this may be helpful to other people who are dealing with the same issues.