Lisinopril and ed

Symptoms: constant muscle weakness, constant muscle fatigue, low appetite, low sex drive, heart area weakness, ED, lethargy
A1C 4.4
Male 22, type 1 diabetic of 13 years. African American. 6’4 225LB. For the last 5-6 years I have intense heartburn experienced constant extreme muscle fatigue. Not only in functionality, but the inside of my muscles constantly feel weak as well. The only way I can best describe the sensation I feel in my muscles at nearly all times would be high blood sugar. It feels as if something is constantly eating away at my muscles. When this all started I felt intense heartburn and fatigue. I assumed that my insulin was no longer working, because my body would feel as though I was at least in the 300-400s. Unfortunately every time I checked my glucose it would never be high. If it was high it would be low 200s. Definitely nothing to warrant the way I was feeling. I was a high school senior when this began in 2018. I was an athlete back then, in quite good shape. I loved running and lifting, however I never pushed myself too far. Now it’s as if every time I attempt lift weight or gain muscle in my arms I experience the unpleasant sensation mentioned above only stronger. I feel it all hours of the day, even when I attempt to flex my arms. It’s like something “eats” away at my progress. if I was instructed to do 10 pushups, I could do them (with a little difficulty considering I’m not as spry as I once was haha). Within the next few minutes the sensation intensifies in mainly my biceps and upper arms, numb and trembling. it doesn’t seem to affect my deltoid strangely. After only 10 pushups, it feels like I’ve tried to do 60 pushups in a row. Same concept with any arm exercise. My legs don’t feel nearly as bad as my arms, but they still feel weak as well. I am able to walk, run, and jump. However I’ve noticed that anytime I do workout my legs, not only do they feel somewhat like my arms but I never get sore like I used to. No matter the exercise, it’s like I never even worked out. Frequent need to urinate. I’m quite tired all the time. I’m exhausted no matter how much sleep I get. I could sleep through an entire day if I tried. In early 2020 I was given a Transthoracic echocardiogram the to summarize these are the results posted on MYMERCY: “There is mild concentric left ventricular hypertrophy, most likely athlete's heart. No significant valvular dysfunction.”
They just assumed it was mild Cardiomyopathy. At first I was relieved to finally receive a diagnosis, but even after being prescribed 2 medications (carvedilol and lisinopril) my symptoms did not improve. I still felt the constant muscle fatigue, the heart burn, and the chest weakness. In January of this year I was asked to do another echocardiogram. Keep in mind, none of my symptoms have improved in any way. These are the results: “Mitral Valve: Normal Leaflets. Trace regurgitation. No stenosis. Tricuspid Valve: Normal. No regurgitation. No stenosis. Pulmonic Valve: Normal. No regurgitation. No stenosis. No findings consistent with cardiomyopathy or athlete's heart.”
I won’t lie, seeing that bummed me out. I just want to know why I feel like this all the time. I’ve tried everything. Altering my diet, taking a truck load of vitamins, I’ve tried positive thinking…but nothing works. I feel terrible no matter how good my glucose is. I lost my scholarship because of this and not to sound dramatic, but I can’t enjoy life feeling like this. I just want to feel good again….or as good as you can feel with Diabetes… you know what I mean. I don’t even care what illness I have. I just want to know so I can get treated and be free of the pain. Thank you all for your help.
Medical procedures done in the last 3 years.
Multiple Metabolic: panels all levels within normal range.
Emg: no signs of Delayed nerve response
Gastric emptying: Normal gastric imaging time
Upper endoscopy: no signs of damage of any kind
Checked for parasites as well, stool samples proved negative.
2x Muscle biopsy 1 in each thigh
Genetic blood testing, negative for ALS and MS.
Urinalysis: PH UA= 8.5 WBC UA= 6-10
Negative for Rhabdomyolysis
Negative for Addisons disease
Negative for any thyroid disorders.
Negative for Sickle Cell
Not sexual active (….unfortunately)
Suspected diabetic ED (…equally unfortunate)
Duodenal biopsy Gastric biopsy Esophagus biopsy
CTA CHEST ABD PELVIS

Like many of you, I hate that this takes so damn long, and I've also wondered why some people can restore much faster than others. Recently, while researching these issues, I chanced upon some information which led me to what seems to be a new discovery that may help speed up the glacial pace of restoring progress.
Short version:
There is a group of substances, known as vasodilators, which act upon the vascular smooth muscle cells in the Dartos Fascia (the bottom layer of the penile shaft skin and mucosa) in a way that appears to speed up the process of growing a foreskin.
Method of action:
Vasodilators are commonly used to control blood pressure. They act in various ways to relax the walls of arteries, increasing the diameter of the artery and letting more blood flow, thereby lowering blood pressure.
Now here's the connection: the tissue in the artery walls that vasodilators act on is the same vascular smooth muscle cells (VSMC) that are in the Dartos Fascia. Vasodilators appear to act the same on both tissues. It's this relaxation of the VSMC that provides the benefit for foreskin restoration.
How this was discovered:
A guy wandered into our little oasis with the most over-the-top restoration story possible. Amazingly enough, his story checked out, as much as it could be. That got me looking into how Cialis could have affected his progress, and then I had the 'Aha!' moment when I made the vasodilator-VSMC-Dartos Fascia connection. In short order I found several other restorers with similar experiences, then realized my own much-better-than-average restoring results were likely aided by the prescription vasodilator I take for blood pressure. I've collected 10+ case histories of restorers with similar journeys. The pattern is clear enough that I feel confident it's time to put this out to our community.
Here are some of our members who have given me information and have graciously consented to being identified"
u/Disastrous_Cost3980 has experienced far better than average foreskin growth while using several vasodilator supplements.
u/uneeknesss is a relatively new restorer who has also achieved well-above-average results while using a prescription vasodilator, losartan and a nitrous oxide supplement.
u/AllAboutTime2 restored from a painfully tight CI-0 to CI-2 in 20 months without even knowing foreskin restoration was possible. He was treating another condition with a traction rig and a prescription vasodilator.
u/Prepucious10 has achieved far better than average results in his first 6 months while using several vasodilator supplements.
What are these vasodilators?
Many substances readily available as supplements are known to be vasodilators, including:
Omega-3 fatty acids, L-Arginine, L-Citrulline, Creatine, Taurine, Horny Goat Weed, Pomegranate and Pipirine are among the ones that restorers have mentioned to me. Here is a paper with a lot more. These supplements are known to be safe when taken in moderate amounts, however you must do your own research and determine which is right for you and how much to take.
There are also prescription vasodilators, including: daily Cialis, ACE II inhibitors like Lisinopril, ARBs like Losartan and CCBs like Amlodipine. While they seem to be more potent than supplements, they are prescription drugs for a reason, and must only be used with a doctor's prescription.
How can vasodilators help us restore faster?
The foreskin has 3 layers: epidermis, dermis and Dartos Fascia. In the common medical procedure of tissue expansion, doctors can double the area of skin - epidermis and dermis only - in 3 to 4 months, while it takes us up to 36 months to do the same. There are several reasons for the speed difference, including the presence of the VSMC in the Dartos Fascia, which has always seemed like the most difficult of the 3 tissues to grow.
The VSMC of the Dartos Fascia will always resist being stretched - it's job is to keep the shaft skin and mucosa snug to the interior erectile structure of the penis - so helping it relax may do 2 things: 1) allow more tension to be felt by the dermis and 2) increase the rate of growth of the VSMC itself.
There is plenty of scientific evidence proving how vasodilators affect VSMC, and I will be happy to provide details if asked. I'll also put up a post with more on the scientific information.
How to use this information:
If you're interested in vasodilators, you must do your own research. There's plenty available. Google 'Is L-Arginine a vasodilator?', then 'Is L-Arginine safe?', and go from there. WebMD has been a reliable source of information for me. The supplements I listed above are widely regarded as safe, and are readily available from reputable sources, like drug stores and Amazon.
I think the easiest and best way to start using vasodilators is with Omega-3 fatty acids. Aside from how they can help your restoration progress, they are arguably the best dietary supplement you can take. So you get multiple benefits.
L-Arginine and L-Citrulline are common amino acids (they are related, and you probably don't have to take them both), and WebMD has info on safe dosages for these and other supplements.
We obviously know little about effective dosages of any of these supplements, so it's up to us to experiment (starting slowly) and share knowledge. One of the restorers I talked to used 3 to 5 grams of L-Arginine daily with excellent results.
Part of the reason I'm putting out this information is so that we can collect data on how well vasodilators assist restoration progress. If you do decide to experiment with one or more of these substances, please keep data on your tugging progress. If you've been using a vasodilator during your restoration journey (without knowing it would help, of course), please let me know how you have progressed.
For those using prescription meds for blood pressure, BPH or ED:
Some BP meds are vasodilators, others, like diuretics, aren't. If you're restoring and taking a non-vasodilator for BP, you may have the option to switch to a medication that is - but only at a doctor's direction, of course.
Viagra and Cialis are potent vasodilators, but when taken occasionally, are probably of little to no use for restoration. Daily-use Cialis, however, has been used by 4 different restorers who have had outstandingly fast results, including the accidental restorer linked above.
Again, these are prescription medications for good reasons. Do not mess around with them. Talk to your doctor, and only use them with a legitimate prescription.
One last note - vasoconstrictors:
Just as there are vasodilators, there are vasoconstrictors - substances that cause blood vessels to narrow. just as they have the opposite effect on blood pressure, vasoconstrictors likely have a negative effect on restoration progress. I don't have any data - yet - to back this up, but the logic is sound.
Nicotine is a vasoconstrictor, so if you smoke, you should quit, and if foreskin restoration is your motive, that's fine. Pseudoephedrine, the active ingredient in Sudafed and other OTC meds, is also a vasoconstrictive, especially in extended-release form.
Brand new discovery: many OTC allergy meds contain both fexofenadine, an antihistamine, and pseudoephedrine, a decongestant. Allegra-D has both, Allegra has no pseudoephedrine. Restorers who are taking Allegra-D but who can get adequate relief from Allegra may find their restoration progress improved.
Finally:
If I was a scientist, I'd be setting up some trials and studies to figure this out, but I'm not. Thanks to the lack of interest in foreskin restoration from the medical and scientific communities, we have to rely on ad-hoc, crowd-sourced research to make advancements.
Don't use these substances if you haven't satisfied yourself that they are safe - don't rely on my word, do your own research. And if you do use them, please let us know how well they work, and at what dosage. That's how we can determine whether vasodilators are as useful as I believe they are.
Oh, one more thing: if you don't know for sure that your blood pressure is in the normal range for your age, PLEASE get it checked, even if you're young. It might not only save your life, but if you do have high blood pressure (or if it's marginal), you may need a prescription drug to help control it... and if so, make sure (if possible) that it's a vasodilator, so you can help your restoration progress as well.
Thanks for reading and Keep on Tugging!
Cheers.

I recently have had a major drop in my heart rate and am quite concerned about it. It would have made sense if it happened while I was changing meds, but it happened while I was on stable medication and didn't change when I switched heart meds recently. My heart rate went from being 110 resting and higher while moving, it is now 80 completely resting, and I've been experiencing chest pain especially on my right side. I have no clue what's up with this and it has made me feel very out of breath- and ofc any professional I talk to is glad my heart rate lowered because it's in normal range now, but it is quite painful, and how tf is a 30 bpm change that happened in a day something to be glad for! I've also noticed my skin is a lot lighter and almost translucent, my feet are constantly purple and cold, my skin stays white for longer than typical when released from pressure, my brain fog has been bad and my sense of touch/feel has been lowered. Has anyone else had this happen? If so, do you know what it couldve been caused by?
For some info on me: along with my dysautonomia, I have stage 2 hypertension, hEDS, likely MCAS, EoE, celiac disease, FND (seizures and paralysis forms), a history of varying degrees of hormonal disregulation, chronic daily migraines, CFS, partial lower gastric paralysis (like gastroparesis, but it's in my bowels), and a plethora of other things that would be less relevant to this post. I recently went off of lisinopril which is known for causing circulation issues and possibly kidney/liver damage, but I was on a very low dose for less than 2 months, and I'd be mad confused if something happened that fast. My renal levels were fine when I first started the medication. I went off of lisinopril around 2 weeks ago and went back on atenolol, and my blood pressure is much more stable (120/80 again), but the issues I was having on lisinopril did not go away, and I'm concerned what I thought were side effects are an actual issue.

I’ve been on lisinopril + HCTZ for over a year now and I definitely noticed a massive decrease in my libido, but didn’t chalk it up to the medications. Recently met a girl and have been having issues with ED and lack of sex drive.
A couple months ago, my lisinopril ran out and I forgot to re up for a while as I went on vacation. During that vacation, it was like a switch had flipped and my libido was back. I thought I was just enjoying myself, maybe coming out of a minor depression or something. I was horned up again and not suffering from ED symptoms at all. Then I met this girl online, and right before we finally met up, I had gotten my BP script filled, and it was like everything had shut off down there. No drive. Could not get or keep an erection.
I read that HCTZ can cause ED, but in higher doses. Mine is 12.5 tho. But I’m really starting to suspect this is the culprit of my problems. Anyone ever deal with this? On top of that, the BP meds don’t seem to be working unless I maintain the strict lifestyle changes like diet and exercise. Is it possible my doc would drop the HCTZ part? Or switch me to something different. Calling tomorrow but wanted to see what I can find out beforehand.

(37m) I’ve been on blood pressure medication for over a year now, lisinopril + HCTZ. For a while I was having a hard time getting it up to JO, but I chalked it up to being bored and lonely.
Then a couple weeks ago I went on vacation and forgot my BP meds. Half way thru the trip I was hornier than I ever even remember being before. I had full hard erections all the time and was just ready to go.
When I got back, I kinda forgot that I was taking BP medication, and didn’t go pick up my script for a while. It was so weird it was like my sex drive had fired back up and I was on the dating apps and talking to girls again. I was masturbting with full erections like twice a day, maybe more. I met a really amazing girl and we hit it off over messages. I got back on the BP meds right before meeting up with her, and it was like everything had shut down. I wasn’t horned up. When we went to have sex, no dice. I wanted to have sex, but like, could not feel myself at. Now im terrified im going to lose her if I can’t get my dick figured out.
Now I’m reading that HCTZ can cause a a decrease in libido and cause ED. Anyone else have experience with this? Any solutions?

Hi all, I don’t know if this is the right place but I’m running out of ideas. This will be extremely long. Any advice that would be helpful is greatly appreciated. I’m 27F nonbinary afab, 350lbs, 5’6”, previous smoker, I take dual advil, lisinopril 10mg, omeprazole 40mg as needed and skyrizi every 3 months. The only chronic conditions I’ve ever had consistently in my life is Psoriasis, mildly elevated high blood pressure and evidence of EDS. As of 2017, I’ve become chronically sick with a mystery illness. The symptoms I have everyday are fever (99 to 102F), extreme fatigue, torso pain (from my intestines to my stomach) that feels like there is a blender going through me. It’s better some days, or it’s more localized to the left side of my stomach into my bladder region. I also have a cyst on my ovary that developed after getting the previous one removed. Only on the left side. A cyst has also developed on my cervix. I had a month and a half where moving felt like agony and nothing made me feel comfortable, I peed blood one day and saw a urologist as a result. We did a CT and found that my left kidney was fine but the right has a lot of cysts in it as well as kidney stones. He asked if I have had a lot of UTI’s growing up and I’ve never had one, ever. He said my kidney looks very scarred and was being pulled inwards. My latest CT scan said something about my kidney as well but I can’t remember what exactly, essentially just to keep an eye on it. That same CT showed thickening in my colon as well. As of recently (September) my lymph nodes in my armpits have started to swell and become extremely tender. It started with the lymph nodes in my left armpit closest to my breast becoming enlarged. The pain gets worse with any pressure and with eating. Sometimes the pain is so bad that it makes my arm have this incredible numbing pain. This also travels to my collarbone and sometimes to the side of my neck. My lymph node behind my jaw on my left side also became so swollen that I thought it was going to burst if I moved a certain direction. It’s gone down but it’s not back to normal. The same situation is happening on the right armpit now, exact same lymph node. However the pain only goes to my back on that side, not down my arm. The lymph node on the back of my jaw on that side has also become swollen, but is not as painful as the left side was. I also deal with chronic dry eyes/eye irritation, constantly high WBC, pain that goes from the left side of my stomach to the right side of my rib cage. I don’t have a gallbladder bladder. Also no periods and low vitamin D. I see my PCP, rheumatologist, OBGYN, and gastro. Now a breast care specialist as well. I am due for a lymph node biopsy coming up, but she is not convinced it’s anything malignant. I have had two endoscopy/colonoscopies, a pill capsule endoscopy, cystoscopy, genetic testing, all the blood work checking my CBC, vitamins, cholesterol, thyroid.. everything normal except my ESCRP and platelet count being high sometimes , plus WBC’s being high most of the time. My a1c is also normal. I move around, I dont over eat, I drink water and eat balanced meals, I sleep as best as I can (I get night sweats. For my lymph nodes I’ve tried ice, heat, voltaren gel, massages (doctors suggestion). I also take 2-3 dual Advils everyday or else functioning is a nightmare. I’ve seen an allergist, been gluten free, did the elimination diet.
I don’t know what else to do. If my biopsy comes back normal I then go to an orthopedic dr again. Thanks for reading.

Clinical picture and angioedema both points at C1 esterase inhibitor deficiency. But for something as serious as that, should we not confirm the diagnosis?? (Check C4 level)
Correct answer is E
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A 52-year-old man comes to the ED for swelling of his lips for 5 hours. He has not had difficulty breathing or any other symptoms. Six hours ago, he consumed a meal that included turkey, gravy, stuffing, cranberries, sweet potatoes, pearl onions, and pumpkin pie. Before dinner, he ate salmon hors d'oeuvres. He has hypertension and hyperlipidemia. Current medications include 81-mg aspirin, atorvastatin, and lisinopril. On arrival, he is not in distress. Vital signs are within normal limits. Examination shows edema of the lips. There is no stridor or wheezes. Results of initial laboratory studies are within the reference range. In addition to the administration of an antihistamine, which of the following is the most appropriate next step in management?
A) Measurement of serum 3 and C4 concentrations B) Radioallergosorbent test (RAST) C) Discontinuation of aspirin D) Discontinuation of atorvastatin E) Discontinuation of lisinopril

I’ve talked my new Dr into prescribing me Lisinopril 20 mg again to try.. Seems like when I was on it before it was controlling my blood pressure quite well but had a dry cough ever so often. When I got changed over to Valsartan just seemed like it never controlled my blood pressure as well as lisinopril and that lead on for to take combinations with my Valsartan which most of the other combinations wasn’t working much either.. I did well with Nebivolol with my Valsartan but can’t take the tiredness and lack of libido and ED. I took my first pill last night and today I’m checking out at 142/91 my question is usually how long does it take to really see a difference in numbers?

I know that there are tons of articles about how Bup increases libido, but for me it's the exact opposite. I get ED on days when I take it and if I can get the general to rise I rarely get him to shoot. If I don't take it the next day then it's no issues at all.
My girlfriend and I have tested this several times. She can be giving me her "A Game" and I barely stiffen up and if I do it's a LOT of work to pop. She can't do it on her own, I need to lend a helping hand.
For the record, I'm 48 and the only other meds I take regularly is Lisinopril and Atorvastatin, which I've taken for years.
Even if I take Tadalafil or Sildenafil I have an issue doing the deed when I've dosed on Bup.
Why is it so difficult to find any other studies that support what I experience? I told my doc and he said it's all in my head but now after numerous tests I know that to not be the case.

I am 34M and took Bystolic in addition to amlodipine (5mg) for nearly 4 years as I have resistant high blood pressure. I recently heard that bystolic may cause ED and asked my PCP and he recommended Lisinopril. I started taking it for 3 weeks and noticed that my blood pressure was higher averaging around 140/88. Did anyone experience this?

I don't feel like I'm going to survive this.
The arguments are off the charts. Our children have completely lost faith in us ever having a somewhat happy home again. And I'm so tired. I've now moved from listening to Neko Case's Wish I Were the Moon Tonight to Alison krauss' Ghost in this House. And I feel it in every single fiber of my being.
I have ptsd, pmdd, pcos, lost now about 70 pounds rapidly from being seriously ill for almost two years. I still have very high blood pressure and am on 40mg lisinopril, 30 mg fluoxeteine, 30 vyvanse (i was diagnosed with adhd at 50), cholesterol meds and metformin for the pcos, not insulin resistance. I have a serious malabsorption issue now. I watched my mom die from a parkinsons with dementia, she passed in June and I feel like i havent been able to grieve with all the arguing. I realize now I've been going through peri for about 8 years now, because that cold shoulder thing that took me two years to recover from was not taken seriously by a female gp when my youngest was 3 (had her at 41)and she stuck me on cymbalta which made me incontinent. In both ways. If you're detecting rage bubbling under the surface you would be correct. I also am now anemic because of lack of care I received.
I've lost a brother and step mother to political crap. I also have an older brother who drags that line of leapords eating his own face, but I can tell he honestly can't see it and he does try to be a good person. My father's relationship has changed drastically with me after issues with his wife. She is a Ramtha (cult) follower and qanon member. I was absolutely a daddy's girl. Now I've lost him too...and he's alive with parkinsons and amd, but things are differentnow when i talk to him, so it feels i've already lost him.(Both my parents separately sustained serious head injuries)
I have two children. One is 17 and the other is 11. I homeschool the 11 yo. They both have ASD and ADHD. So does my husband. They are all very intelligent, but lack emotional intelligence. I also lack a lot of emotional intelligence due to childhood and marital trauma. Though I can improve and had been improving doing some serious work on codependency (Micelle Farris).
I got in an argument with my husband yesterday. Even though it is incredibly hard to ask him for the help I needed, I tried to be vulnerable and brave and do so. With his ASD, I assume, telling him repeatedly in the past that I need to hear enthusiasm and encouragement from him if he's willing to help, otherwise it just looks the same as all the other times he said he was willing to help but did not. But he didn't do that outwardly. In his mind he was. Yet...as a somewhat more neurotypical person with a SHIT TON OF EMOTIONS I saw zero enthusiasm nor heard any real encouragement either. And I did absolutely start out telling him I was kind of afraid to ask because this always ends badly for me. And so here I am. It is going badly. It is bad.
I sent him an article about a guy who tried to het his wife help with her perimenopause. She killed herself anyway. 6 GPS and none even bothered ro mention hrt and denied her perimenopause. Very typical. I sent it 20 times. Im not kidding. I spoke up, i told, i communicated, I ASKED FOR HELP and was completely ignored. And it continues today. My husband knows I have pmdd and peri. He knows everything about mu health including the mass by my ovary that I need to get another ultrasound on from the gynecological oncologist. There is even more going on, but just usual stuff, two job loses in a year (him), completely broke, down to one car that's limping along, our house is in taters from lack of care because of his adhd or asd...who knows. I can tell you I can't install French doors and put drywall and woodwork around it. I can sand and paint and make look pretty, and I also can't solve the issue of the gray water tank for our washer that has been left opened exposed in our backyard, I can't do shit about the lead paint lacking off our house from the wood that is under the vinyl that we removed to fix our sink drain. There is a hole in the back of my house now. At least if the drain breaks we can just fix it quickly, right? Everything is broken.
I am now getting high all day. I didn't start using cannabis until I was 45 for fibromyalgia. Now it's my survival mechanism. I just want the person who said he loved me to be kind and understanding, especially after all the REALLY BAD SHIT he's put me through. I haven't worked in 17 years, but I was the bread winner before kids. Now he is and I will never even approach what he makes. I only have my two year degree and basically a lot of administrative type work, which is where I feel most demeaned honestly. I'd do okay with a wok from home job but there are so many scams out there now and seeing what my husband now goes through to fund a job is horrifying. Even an ex coworker of his almost got scammed...and they're both older men in cyber security with lots and lots of experience. I do not trust I can find a legitimate work from home job. And I still need to homeschool my younger child. We're in Florida so it's pretty hopeless getting any real help with education here. It falls on me to provide my kid with the education they need so now I'm having to learn to be a special Ed homeschooler with a child that does not want to go to school (the other one is extroverted so she started at 15 in an arts high school and is at least very happy there...but even she worries for her sister at home in this tense environment).
All I can think is that I just have to stop thinking he'll ever be there for me.
My 53rd birthday is tomorrow.
Edited for clarity, lol.

Anybody else experience this side effect? I am also on Tadalafil for ED and before I took Losartan, my erections were much firmer and I actually could get it up more easily. Anybody else experience the same? I was on Lisinopril for awhile but got off of that due to the extreme dizziness I felt on it.

I feel like attendings always correct me or even if they don't correct, they just throw in comments, which make me feel like it's personal. Maybe it's the medical knowledge part, but I don't think I'm stupid or anything compared to my co-residents.
1) A patient comes in for uncontrolled HTN. He is already maxed on Lisinopril and amlodipine. He is also on clonidine. He tried HCTZ in the past but stopped due to side effects of ED... And he states he was on spironolactone but I couldn't find anything. So anyways I said let's discontinue clonidine and restart/start on spironolactone. And the attending is like nowadays I've seen cardiologist using carvedilol more than spironolactone for HTN. This guy doesn't have any cardiac history, not tachy, I didn't think carvedilol would lower BP as much as spironolactone. So she looked on up-to-date and didn't see much that says carvedilol was better than spironolactone for BP control, but was like switch spironolactone to carvedilol at the next visit..
2) A patient comes in with headache that is more consistent with tension headache than migraine. I typically start on amitriptyline (CGRP not covered well in my area), but then the attending says amitrptyline is off-label and it should be topamax. I looked up on uptodate and they are both off-label, but it looked like uptodate says amitriptyline is most frequently used than topamax for prevention? The attending then goes "oh well but still we use topamax".
3) A 65+ patient comes in for COPD exacerbation. No risk factor for Pseudomonas. Followed uptodate algorithm and prescribed augmentin. And was told that is not the right antibiotics and should be doxycycline (if not azithro or cephalosporin). Again, I showed uptodate, and was brushed off.
I understand that maybe I followed uptodate straight up, but I don't think my medication choices were wrong. So was this attending being an asshole or was there something that I'm missing in terms of knowledge?
Edit: 1) got deleted and some spelling for typing over the phone

Thanks so much for any information that could help me. I recently turned 50, and as they say, it seems things are falling apart.
Well over a month ago , I came down with a blood pressure "attack". Even though I consider myself in decent shape and work(ed) out regularly, I now appear to have high blood pressure needing treatment. My doctor started me off on Amlodopine 10mg. I recall having side effects from it, and worse it didn't seem to bring my BP down.
I then wound up on Olmesartin, which I've taken the longest. This drug is rated well, and it seemed to do very well at keeping my BP low - however the side effects were absolutely horrendous. I guess because I'm tough enough, and I read they would eventually fade, I kept going. I don't think it will ever fade, and in some ways had gotten worse. I was also taking low amounts ~ 5mg 2x a day. However, that was with cutting pills into quarters, which I've learned may be too inaccurate - even with a good cutter. I also wound up in the ER twice, and they prescribed other meds. None of which were good, and one that could have been very bad with my pulse.
The never ending "dizziness" along with crazy back pain, and a very upsetting tight throat/belching urge, and much more, I finally got back with my doctor desperate for relief. Wound up getting on lisinopril in lieu of the olmesartin. This was prompted by my memory of many years ago, when I took lisinopril. I did remember side effects of dizzing but I *think* they weren't that bad.
I guess I'm about to switch over from Olmesartin to lisinopril (which is also confusing). I'm praying I will be able to tolerate it, but if I can't , things will likely be even worse for me. I haven't been able to drive for nearly 2 months (due to side effects), and so ironically can't get to the gym to workout. I have a referral to see a cardiologist, but the appt may be awhile away. Thanks so much for any ideas here, and I'm also wondering about hoping lisinopril won't "hit" me as hard as olmesartan seemed to do.
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I will try to keep this condensed, but also provide details enough from the process so far. I am looking for a secondary opinion as my Endo, PCP and Cardiologist seem to be stunned. My goal is to actually find the issue so that it can be corrected so that I no longer have to be on TRT AT ALL.
When this first started I was feeling lethargic, low libido, ED, Depression, Panic Attacks and hypertension.
39 YO Male, 5'10", 215 lbs
Two years ago I started to feel horrible. After various test from my PCP, I was placed on 50mg Test C every other week and referred to urology. Urology told me there is nothing they can do and scolded me for allowing my doc to place me on Testosterone. I was referred to Endocrinology who did a years worth of tests before placing me now on 100mg Test C weekly, with lingering issues that have still remained.
Endo initially changed my Test C to 75 mg weekly and within 4 days my libido was through the roof. ED was no more and all issues slowly went away (except for hypertension). After 4 weeks of that dose, the benefits started to wear off. ED, depression, panic attacks and low libido returned (panic attacks and depression aren't as bad as before) . I then contacted my Endo, who upped my dose to 100mg weekly. Since then, my ED is hit or miss. More specifically, during initial TRT my wife and I were able to have intercourse 3-4 times daily, but now it is limited to 1 interaction a day as ED seems to kick in after that. Libido isn't the best, but also not the worst its been. Wife isn't complaining, but agrees the quality of the erections during initial TRT treatment are very different then before/now. At start of TRT they were rock solid and 10 minutes after intercourse would be back at it, just as hard. Now the first erection of the day seems to be at around 90% blood flow and second is 65% maybe. All other symptoms fluctuate throughout the week. Two to three days after my injection I feel better and then slowly start to feel worse again.
Side Note: Between late 2021 and Endo in 2023, there was a 6 month period where I used a private HRT clinic who had me on 200mg Test C (twice weekly 100mg), Anastrozole 0.5 mg twice weekly and Clomiphene 25mg 3x week. I went to the private clinic due to my PCP's 50mg every other week didn't do a thing and I was tired of feeling like garbage. I felt AMAZING at the private clinic and had zero side effects for the first 6 months, until they offered to up my Test C to 300mg Weekly and add Nandrolone Decanoate 300mg weekly w/o Anastrozole/Clomiphene for $99 more/month. Being that I was previously competing as a natural bodybuilder and no longer qualified due to TRT, I gave in and agreed. A week after starting I felt like I could lift a car and my old lifting limitations were expanded greatly, but by end of week 1 I felt sick and by week 2 was in the ER with 201/116 BP. Here I stopped taking EVERYTHING other than BP meds I was now given, went back to feeling like before (Panic attacks, ED, Low Libido, etc). They had me wait 4 months before the Endo performed his blood tests to ensure nothing was in my system still from private clinic.
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Current medications:
Lisinopril 40mg daily
Hydrochlorothiazide 25mg daily
Buspar 20mg / 2x Daily
Testosterone Cypionate 100mg weekly
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Current diagnosis:
PTSD
Major Depressive disorder
General Anxiety Disorder
Secondary Male Hypogonadism
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Blood Work Results: (Only including out of range results, or results more involved in Endocrinology as I understand. More results available upon request. I have done plenty of bloodwork)
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Pre Endocrinology referral/Pre TRT (when I started to feel bad). Oct 2021-
Weight 192lbs
Vitamin D - 16 ng/mL
Testosterone total - 357 ng/dL
Test Total - 55.3 pg/mL
FSH - 1.0 mIU/mL
LH - 1.4 mIU/mL
T4 - 1.3 ng/dL
TSH - 1.99 mIU/L
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Endo tests from Feb 2023 (this is 4 months post canceling private HRT Clinic subscription):
Weight 185lbs
SHBG - 35 nmoI/L
Albumin - 4.4 g/dL
Test Free - 41.4 pg/mL
Test Bio - 83.4 ng/dL
Test Total - 337 ng/dL
Igf 1 - 155 ng/mL
Z Score - 0.2 SD
Aldosterone, LC/MS - 4 ng/dL
Renin, Plasma - 18.32 ng/mL/h
Aldo/Pra Ratio - 0.2 Ratio
LH - 1.9 mIU/mL
FSH - 0.8 mIU/mL
Cortisol - 12.5 mcg/dL
ACTH - 11 pg/mL
Prolactin - 8.7 ng/mL
Metanephrine 28 pg/mL, Normetanephrine 102 pg/mL, total Meta 130 pg/mL
MRI Brain w/and w/o contrast - Normal
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Current blood test when I was on 75 mg test C weekly (right before it was upped to 100mg). Taken at end of weekly injection cycle. October 2023 - 8 months of being on 75mg (from Feb 2023-Oct 2023)
Weight 215 lbs
SHBG - 24
Albumin - 4.6
Test Free - 64.4, Test Bio - 135.3, Test Total - 388 ng/dL
CBC - Hemoglobin - 16.2, Hematocrit - 46%
Additional side note- One blood test is available 6 weeks post being increased to 100mg weekly. Only CBC panel that showed after being increased, my Hemoglobin lowered to 14.6 and Hematocrit also lowered to 43.9%. (Dec 2023)
​

Hey all. Curious if any of you are on BP meds? I was on Lisinopril for awhile but stopped taking it due to feeling dizzy all of the time from it. I’ve heard good stuff about Losartan having 0 side effects so I’m gonna see if I can do that.
I was curious if you feel Tadalafil works better when you’re on those meds vs off? I feel like tadalafil isn’t working as well now that I’m off of those meds..
Also, I’ve noticed that I lose my erection if I’m standing up at times. Is there any way to help that? I hear that has to do with a tight pelvic floor most likely?
I’m not 100% sure where my ED stems from 100% other than a multitude of things -

• diagnosed with sleep apnea, on CPAP and that changed my life. Somewhat increased my libido too, but erections seem to be the same
• high blood pressure since I was 18, 28 now turning 29 in a month
• possible trauma from masturbating too aggressively at a young age
• death grip potentially when I first started jerking it

The meds work for the most part, but I haven’t been able to test it out on a lady yet due to shame and anxiety. Been thinking about trying out viagra to see if that helps.
Sorry for the rambling, just looking for potential insight and suggestions!

Pre warning: I kind of run on in this post…
I’m in my mid 20’s and I have been married for 2+ years. In the time I was dating my now wife to present day I’ve had issues with keeping an erection off and on usually it’s not too bad. But currently it’s been 3+ weeks since I’ve “Worked” properly to completion, which is the worst it’s ever been.
Earlier this year we found out I have hypertension, and I am currently on Lisinopril (10mg/day). I thought this would help and it seemed to for a few months but then it was back to every now and then I just don’t work. Until this last 3 weeks where I haven’t been able to at all.
I’m posting because we tried to be intimate again today but I didn’t work and my wife broke down about how she feels like she can’t get me to work. I’m frustrated with my body and I can’t help but feel a little anxiety every time we are intimate now.
I’m looking for general advice or guidance with some things to try that people with similar situations.
I don’t have health insurance due to a job switch causing me to not have health insurance until January 2024, once I’m back on health insurance I plan to see a doctor because it’s never been this bad.
Until then is this possibly ED? Psychological or otherwise? I really want to know what others have found that helps them to be at the very least consistent?
Thanks to anyone that provides helpful input/experience/information!

Hello everyone, former user as of 10 days ago. I stopped for several reasons. One, I noticed the 3 mg (would go through a can in 2 days) caused my raynauds to flare here (cold clammy hands) as well as would make me feel like my hands and feet would swell with chronic use. Additionally, it would peak my anxiety which hasn't been treated until Welbutrin which I started a week ago.
Additionally, the integrity of my erections have been low as well as little to no libido, also stemming from anxiety. This started when I had covid earlier this year and we attempted sexual intercouse. She made a comment one day asking if it was an attraction issue. I think because of my chronic zyn use as well as this new factor, it would cause anxiety pretty much in the moment of not wanting to let her down.
As an RN, I'm aware that the vasoconstriction can also figure into causing ED. I was taking bystolic, but have now transitioned to lisinopril as it doesn't cause ED side effects as well as ceased Zyn (weaned off by doing actual skoal pouches that I don't keep in all day, only doing 2-3 a day). I now have no life stress other than the ED issue and changing of medication along with zyn cessation. Has anyone else had issues or experience here with being on a BP med, doing zyn, and having subsequent ED and/or anxiety from their habits?

Age: 27 Sex: Male Race: White/Caucasian Location: USA PMH: None (prior to these issues), now Hypertension, Hearing loss in left ear Current Medications: Amlodipine 10mg, Losartan 25mg Duration of Complaint: 10 months Symptoms: Many, see description. Family History: Heart disease (paternal grandfather, paternal uncle), dementia (maternal grandmother), migraines (mother).
Hey all,
I am a previously healthy 27 year old male, who has been having a strange collection of symptoms since the end of August 2022. I have seen numerous doctors without much success. Prior to the onset of these symptoms, I considered myself perfectly healthy beyond the occasional seasonal illness and stuff like that.
On 26 August 2022, I had an episode of vertigo. This felt very similar to a previous incident of vertigo that I experienced in September of 2019: all of a sudden, I felt like I was falling to the left. There was nothing preceding either of these events, in both cases I was sitting in a chair, reading / on the computer. For the incident in 2019 I went to the hospital, where the ED doc told me I had benign paroxysmal positional vertigo (BPPV), and gave me some exercises to help relieve the symptoms. In both cases, I did the exercises and took a nap, and the acute symptoms went away by the next morning. Also in both cases, I felt kind of off/unbalanced for a few weeks afterwards. Not to the point where it impacted my motor skills, but I just felt ever so slightly off balance, especially in the dark. This feeling faded back to normal over the course of a couple of weeks.
This is where things changed between the 2019 incident and the incident from last year. Although the acute "spinning" sensation subsided as normal, a number of other symptoms appeared after the vertigo symptoms began to fade. Over the next few weeks, I began to experience a "fuzzy" feeling, as though my head had been stuffed full of cotton, like a moderate brain fog. I felt off balance, my vision seemed blurry, my eyes were constantly either watery or too dry. I had constant itchiness and dull pain in my left ear. Occasionally, I would have a brief (30-60 second) stabbing pain in one ear that would gradually fade back to normal. I started having headaches, especially the feeling that the top of my head was being squeezed, or a stabbing pain behind the eyes. It was hard for me to focus on objects, especially in the middle distance. My eyes felt tight or streched. I would see halos around lights at night. I felt a constant pressure in my ears (especially the left one), to the point where I would clear my ears by equalizing pressure 5-6 times per day, each time would be accompanied by an audible squeal of releasing pressure from the left ear. Perhaps most distinctly, when I would lay down and close my eyes I would have the feeling of falling: a sudden jerk (usually to the left or backwards), before I would immediately feel normal again. This would repeat randomly until I would fall asleep. I would have a "television static" across my vision all the time, when in low light I would sometimes see objects or patterns vibrating.
I went to an ophthalmologist in the middle of September 2022, who noted my eyes looked fine, with some mild signs of hypertensive retinopathy. They also noted that my blood pressure was quite high: around 150/110 when resting, up to 170/120 when not-relaxed. I went to my PCP and was prescribed lisinopril/HCTZ 20mg/25mg. This seemed to help my blood pressure somewhat, but caused me to have constant waves of nausea and gastroparesis such that I went back in November and asked to be moved to a different medication, at which point they started me on Amlodipine 5mg. This did not control my blood pressure, and in December I was moved to Amlodipine 10mg, and then recently Amlodipine 10mg and Losartan 25mg. I have not been on the most recent medication long enough to see any long term changes in BP.
I saw an ENT at the beginning of the year who noted that my ears looked fine, were not infected, and that sometimes pressure in the ear accompanies one sided hearing loss like I have. He recommended that I see a neurologist.
Over the recent months, my symptoms have settled somewhat. I no longer feel brain fog or motion when laying down. However, the following symptoms are still present:
Lots of eye gunk, eyes feel either dry or watery and tired all the time, I am constantly rubbing them. I see astigmatism beams around bright lights, even during the daytime, halos around lights and globes of color around colored lights at night. I have constant floaters across my vision, both small round clear ones and large darker linear or triangular ones. There is a constant "heat haze" or static effect across my whole vision. I have extremely noticeable diplopia (sometimes minor, sometimes severe where the words are 95% offset from the originals), but mostly with light colored writing on dark backgrounds. There is a constant tinnitus, which is fairly loud, and pressure in one or both ears, requiring me to clear them as mentioned before. I still see the vibration when looking at straight lines or patterns in low light. I have random headaches, usually behind my temple or on top of my head, but these tend to go away quickly.
None of this is debilitating, but it sure is very annoying and has tanked my quality of life. No One I have talked to has had any answers for me, even after a number of tests and blood work.
Here is what I have had done and the results:

• Basic Metabolic Panel and CBC with differential (9 September): All Normal
  
• EKG (9 September): Normal
  
• Eye Exam (19 September): Normal, signs of slight hypertensive retinopathy.
  
• Basic Metabolic Panel (22 November): All normal
  
• Urinalysis (23 December): Normal
  
• EKG (23 December): Normal, "t-waves more upright"
  
• Comprehensive Hearing Test (13 January): Moderate Hearing Loss Left Ear, no significant changes from baseline June 2018
  
• Head CT (temporal bone) without Contrast (1 February): Bilateral thinning of the tegmen tympani, otherwise normal.
  
• Basic Metabolic Panel (6 April): Normal
  
• Plasma Renin Activity (6 April) : Normal
  
• Aldosterone (6 April): Normal
  
• Brain MRI with and without Contrast (14 April): Normal except for trace right mastoid effusion and minimal mucosal disease in left sphenoid sinus
  
• Renal Ultrasound (26 April): Normal, renal arteries < 60% stenosis, everything within normal limits.
  

I'm kind of at the end of my rope here. Since I'm an American this has basically bankrupted me, even with my insurance. I'm moving to a new state in 2 weeks, so I haven't been able to make any appointments for anything else, and I don't know what my insurance will be with me changing jobs. The only other thing I have to go on is the ENT recommendation to see a neurologist, particularly one specializing in migraines.
Any thoughts or suggestions would be greatly appreciated.

24m 6’2” 205lbs. Wondering if you guys have any ideas a out why my systolic is so much higher than diastolic 1405-150/65-75. Currently prescribed 20mg ed lisinopril and 80mg telmistartan ed. lisinopril dosed morning. Telmisartan dosed at night. I would like to bring my systolic lower but im go hypotensive if i add in other meds. Frequent gym goer 4x/wk and consume 90oz-120oz water per day. Relatively clean diet been slacking lately and enjoying myself more