31 y.o. Here
I’ve struggled with erections, libido, and orgasm almost all of my life. Nocturnal erections correlate with my other sexual functioning parameters, so it’s not (primarily) psychogenic.
Unfortunately the only thing that seems to work for me is very high levels of testosterone, and low-normal estradiol.
I’m currently on 420mg test-e per week, and 1.135mg letrozole per day. My sexual functioning is better than ever. Measurably so, according to my symptom diary.
Due to health concerns, I’m not happy taking 420mg of testosterone per week, and I’ll titrate it down at some point (and then back up) and reassess symptoms along the way.
But if needed, I’ll stick at 420mg per week indefinitely.
Pro-erectile drugs such as PDE5is, MCRas, and A1-blockers have all helped my sexual functioning, but they tend to work “multiplicatively” on my sexual functioning, rather than additively. Meaning if my sexual functioning is poor, then adding those ancillary drugs makes a relatively big difference, but in absolute terms it’s nothing.
Going from a 20 second erection to a 40 second erection is a 100% improvement. But that pales when compared to going from a 10 minute erection to a 20 minute erection.