I’m disclosing some personal medical information because I think it is important that the Over 60 board appreciate the medical choices available to seniors.  (I am now 69.) There is so much inaccurate information that circulates on Viagra and its substitutes that I thought I would offer up a candid alternate view. This post is about my recent experience self-administering trimix shots.  It is semi clinical and contradicts some of the negative comments often posted on the internet.

Last summer I went through a series of prostate difficulties that included visiting the ER three times in five nights.  Not a good experience.  Ultimately the outcome was to undertake laser prostate surgery to significantly reduce the size of my prostate.  My prostate was larger than 90+ cubic centimeters.  Senior prostates are typically 60.  The surgeon was top notch with excellent credentials.  He did his thing.  His 450th procedure. My urinary tract is now unobstructed.  

However sexual responsiveness was significantly curtailed.  Neither 20 mg of Levitra or 100 mg of Cialis were no longer effective.  Six months after my surgery I leveled with my surgeon.  He said the next step was trimix shots and in their academic medical center practice, that was handled by another “Men’s Sexual Health” specialist board certified urologist.  He wrote the necessary referral and I contacted the new guy next down the chain.  Took a month to get the appointment but the actual appointment was very easy and comfortable.  That urologist wrote a prescription for the trimix solution with a local compounding pharmacy.  Trimix comes as a liquid that is a custom blending of three chemicals and has to remain refrigerated. If kept cool it has a shelf life of 2 to 6 months.  It took a week to get the prescription filled and then another week to make an appointment with a male nurse practitioner who specializes in the teaching the giving the trimix shot.
   
Here comes the part that puts off everybody at first.  Trimix is administered by hypodermic needle directly into the shaft of the penis.  Sounds awful but it isn’t.  It is a very small insulin size needle.  The NP gave me guidance but I did the first shot in the office under his supervision without a problem.  The initial dose was 35 units.  With trimix there is a titration process whereby the best dosage of trimix is determined.  The major risk of trimix is priapism (look it up) and a trip to the ER.  You don’t want to overdose on the injection. I had a distinct positive reaction but not a raging boner.  This first test was just to make sure I would respond to the drug.
   
I went home with my kit and embarked on a process of discovering the right dosage.  Every two days I administered a shot and increased the dosage by 5 units.  Kept getting a better and better reaction.  50 units was good.  55 units is very good.  I’ve decided to stop there and get comfortable with the whole process.  I have a follow up appointment with my medical team in 4 weeks.  Trimix seems like Levitra etc. in that I get a medium erection with just the shot but get a very solid erection with further arousal and stimulation.  I am easily hard for at least 30 minutes and have no problem reaching orgasm.  It is a very natural and comfortable reaction.  I then go through a refractory period just like normal
.  
With practice, the shots pose no problem.  Alternately goes in at the 10 or 2 o’clock position half way down the body of the penis.  Have to alternate sides.  Easy, even left handed.  The needle is so small there is no pain of any sort.  Just slides right into the sweet zone.  As to cost, at the dosage I am on, it is about $12 a dose. Well cheaper than U.S. Viagra brand pills.
   
So there is life after prostate surgery and the sex can be very good.  Trimix shots seem to have become a standard part of post surgery prostate cancer therapy around 2002.  Thank God my life span has extended into the 21st Century.  No need for us to fear the grim reaper, at least for a while.  


-- Modified on 4/3/2016 6:34:12 PM

Which works great for me...More info here in a post of mine from a few months ago, see link below...

I agree with most of what phi68psi above says. But it works different with everybody. I am 75 years old so it may work a little different on me.
 I had almost the same problem, in 06 I had laser surgery and it worked well but by 2014 I had to have it over again, this time I opted for the old fashioned kind done with a knife blade. To this point it is working fine. I didn't start this hobby till 2011 and my sex life was zero up till then. Viagra was not working anymore so the next step is Tri-mix, as my UR suggested. I went in and he did my first injection and it worked fine 10 units but my erection lasted 4 hours so the next time I went in he supervised me doing the injection and it worked fine, lasted 4 hours again which is to long. I called and he told me to keep lowering the dose till I achieved what I wanted. So at this point I am down to 2 units and it is lasting long enough to finish all my activity's that I came to do.  As to the pain, I do have some pain, I would compare it to a flu shot in the arm.  
But it is worth it for what I get. The Dr. told me as well as what I have read that anywhere on the side of the penis at around 9:00 o'clock on either side will work. Well on me it only works on the left side at exactly 9:00 o'clock, and an area about a half inch  long, anywhere else and it will miss the target. I still miss about 25% of the time and I been injecting for almost a year now. I have talked to my UR about this and he says that is in the normal range. I only inject once a week now and the chance of hitting the same hole is almost impossible. You have to hit the same spot many times to do any damage.
 I have to pay mim. charge in my area $110 for 5 mille liters. It gets outdated long before I can use it up.  6 months but my pharmacist that mixes it for me says I can use it till it quits working.  So much less than any of the pills.  Good luck.

Thanks for these useful comments.  One of my questions:  how long after injectiion is erection achieved?  In other words, how important is timing?

Response to the shot is almost instantaneous.  For me 2 to 6 minutes.  So you need a partner who is a ready participant.  I do foreplay with my ATF, get her ready, then she helps with the shot, and then we get down.  It is very effective.  The hard on is better than I have had for years.  Lots of blood infusion.  Good for the penile tissue.  Also kegels are better too.  With hard kegels I can feel blood coursing through the penis and into the head.  Nice sensation. I don't want to seem like I'm giving TMI,  I just want you guys to understand that this is a very effective approach for older men.  When or if you get limp dick, this is a legitimate medical treatment. I am so glad I went down this path.  Nine years ago when I first tried levitra, it was very effective but has lost its boost especially after my most recent surgery.  Now this is the next stage.  Men should be aware of it

Mine takes from  five to ten minuets to get hard enough to use.  But I also found that I have to be sexually stimulated before it will work. I tried to inject several times before I went in and had no luck with that at all.  The ladies don't seem to mind, I just tell them right away what I have to do.  I'm afraid if I don't tell them and just slip away to the rest room they will think I'm injecting some kind of illegal drug so I just do it in front of them.  So far I have not found anyone who objects, anyway they would rather play with a hard dick  rather than a soft one.

END OF MESSAGE

I don’t know, Rancher, if I was having a 25% failure rate and couldn’t consistently find the sweet spot, I’d be worried.  I’d think you would be a lot happier if you could figure out why you’re having failures.  From what I know, it shouldn’t be happening.  My urologist expert says there is no doubt about the efficacy of the drug.  Put it in the right place at the right amount and it works almost every time.  You might want to get a second opinion on your shooting technique and your whole regimen.

The problem is in the non-standardization of the trimix mixes.  And in the needles.  My mix is PGE 8.3, Phentolamine .083, and Papaverine 22.5.  My compounding pharmacy calls it their “standard” mix and it is what my urologist starts most guys out on.  But I don’t think the healthcare industry recognizes that formulation as necessarily standard.  I have seen internet posts of very different formulations.  But even my pharmacy lists a total of 7 different “trimix” formulas on their standard order form.  The proportions of the 7 different versions differ significantly.  Some are much stronger and more concentrated than what I use.  They also provide one straight PGE offering, two bimix offerings, and two quadmix offerings.  Quadmix adds atropine to two of the higher end optional trimix mixtures. Apparently heavy duty stuff. I wonder if englishguy could comment on why his doctor chose a quadmix option. I have no idea what version Rancher uses and what his doctor’s intent is.  Doctors in general may have to adjust the choice of formulation to get individualized successful results.  My doctor said if I wasn’t getting a good reaction at 60 units he would move to another formulation.  But I kicked in at 55 units.
   
Now to needles.  I use an insulin syringe that has a 1.0 milliliter total capacity.  Remember that number.  On the syringe a single marked unit is .01 milliliters. The needle itself is 1/2 inch long and 30 gauge in diameter.   Both short and thin.  When I shoot 55 units, I am shooting .55 milliliters or a little more than half a syringe worth.  The idea is to get enough liquid into the corpora cavernos tissues of the penis to affect the tissue there.  The corpora caverna are two areas of soft tissue along each side of the penis that fill with blood during an erection.  That is their primary biological function.  Just so you guys know, the clitoris is made of similar tissue.  The two sweet spots are along the sides half way down about the size of a dime.  You just want to miss any visible arteries, veins or blood vessels, and key nerves, and the urethra.  Those are all along the top and the bottom.  If you get the needle into the right locality, put it all the way in up to the hub, and inject the whole amount without any withdrawal, you will get an erection. Side note, I had to cut back the thicket so I could see what I was doing.  
 
Rancher, if you are getting a straight erection then I would think both of your corpora caverna are intact, are interconnected, and are reachable.  Something is wrong if you are only able to inject to one side.  You need a doctor who can evaluate that.  If you are using small needles calibrated like mine are, then your mix is apparently much more concentrated than mine.  If you started at 10 and went down to 2 (that’s hardly anything), and I started at 35 and went up to 55, and these are all .01 milliliter units, you and I are using two very different concentrations of trimix.  You are using just a thick glob and it may not be fully circulating.  That may need to be adjusted too.  The higher concentrations aren’t always the best.  A better, less concentrated solution may be better.  I have read that you should ease the dosage in over 8 to 10 seconds to get good distribution.  I would think it would be hard to ease in 2 units. You may be rushing it sometimes and not getting good absorption.  
 
I didn’t mean for this to be too preachy.  I appreciate your contribution.  I started this thread because the whole topic is so complicated and I wanted dialogue to help everybody.  You are a good example of how tricky this stuff can be.  It is amazing that you have stuck with it.  But you also know it can work.  Best of luck to all of us.
   
Listed below is some information from the Sloan Kettering Cancer Center in NYC website.  It gives some very good, medically sound information on the whole subject. It made me feel better that trimix is a legitimate therapy

Here are the various formulations my compounding pharmacy mixes.  This is one reason the subject is so complicated.  Look how different they are.  I may have transposed some numbers but the point is how many possibilities exist out there.  Only your urologist and pharmacist knows for sure (maybe).

Basic PGE in 10, 20, and 30 mcg/ml strengths
Bimix 0.5-30: Phentolamine 0.5mg/ml Papaverine 30mg/ml
Bimix 1-30: Phentolamine 1mg/ml Papaverine 30mg/ml
Trimix 5-.5-15: PGE 5mcg/Phentolamine 0.5 mg/ Papaverine 15mg/ml
Trimix (Standard) 8-.8-22: PGE 8mcg/Phentolamine 0.8 mg/ Papaverine 22.5mg/ml
Trimix 10-1-30: PGE 10mcg/Phentolamine 1 mg/ Papaverine 30mg/ml
Trimix 20-2-30: PGE 20mcg/Phentolamine 2 mg/ Papaverine 30mg/ml
Trimix 40-2-30: PGE 40mcg/Phentolamine 2 mg/ Papaverine 30mg/ml
Trimix 60-3-26: PGE 60mcg/Phentolamine 3 mg/ Papaverine 26mg/ml
Trimix 80-3-25: PGE 80mcg/Phentolamine 3 mg/ Papaverine 25mg/ml
Quadmix 10-1-30-.15: PGE 10mcg/Phentolamine 1 mg/ Papaverine 30mg/Atropine .15mg/ml
Quadmix 20-2-30-.15: PGE 20mcg/Phentolamine 2mg/ Papaverine 30mg/Atropine .15 mg/m

I had terrible luck. More times than not I got a hematoma. Nothing like a bent bruised item to really spoil the mood. I'm in a health profession who injects folks all the time. So I know my way around a needle and anatomy just fine. Just my luck...

Viagra for quite a few years. Lately I've noticed a diminished reaction to the drug, I sometimes lose a firm erection during party time too.  Nothing drastic yet, but unnerving.  I've never read up on the whole trimix subject since it seemed so creepy to me.  But having just read through this whole thread I feel much better educated and calm about it.  It's good to know there are other options should I ever need them.  So, major props to you for posting and to the others who have shared their experience.

My challenge is storage of a refrigerated product.  I am happily married and do NOT want to jeopardize that, so I can not/will not store it in my home fridge.  I do not have a local ATF who would store it for me.  I would appreciate ANY suggestions about how I might solve this storage dilemma.
Is it necessary for ALL of the ingredients be refrigerated?  Might it be possible to make a bimix by leaving out the one ingredient requiring refrigeration?  I know, I know - ask my urologist and/or pharmacist.
VERY informative thread - Thanks, guys.

No but it certainly works for me ! Only recently heard of Tri-Mix...

All that said, for me, the best name is "Happy Shot", which I've heard is what the nurses call it - lol...

I can only speak about Quad-mix (no Tri-mix experience)...

Quad-mix for me is made at a compounding pharmacy, with a prescription order, and is premixed. The shelf life is supposedly 60-90 days and should be refrigerated at all times. The only way to extend the shelf life is to freeze it shortly after delivery and then carefully thaw / chill it when a previous batch has been used. All that said I have had no problems with a batch that was 180+ days old that was kept in the fridge at all times...

As each prescription order costs me $200, I am very careful with the care of the product. When travelling you need to use ice packs and hopefully the hotel has a fridge in the room.

Not sure what to suggest for off-site storage options. Maybe I should start a company that provides freezer storage options for hobbyists that have a SO...?

-- Modified on 4/6/2016 6:59:45 PM

furthermore how do you transport the stuff?  Igloo full of ice or what?

you can find online discrete insulated medical zippered pouches that accommodate ice packs.

But I have had it overnight-ed to me from the compounding pharmacy in a 6"x6" igloo that has ice pack inside...

was a pain to use. But that was several years ago and I'm sure there's been some improvement since,
But best luck I hah was using 20 mg Cialis the day before and then A 100 mg Viagra as I was knocking on the door. worked pretty well for me but since OCT 2014 I've had 4 heart attack, Radiation treatment for a soot on my lung and of cause some respiratory issues due to go along with all the cigarettes I smokes for 60 years. I'm 73 now and lucky to be alive lots of people die on there first heart attack. I'm now getting ready to get back in the hobby but I can't take any enhancement pills  because if I need Nitro my BP may sky rocket. I'll see if all these heat pills and blood thinners are doing me any good/ But I also think if you pick the right lady with lots of TLC makes all the difference in the world. We'll see.

I have a couple of questions:

1. Do you know if this injection is effective for Peyronie's Disease?  I can feel the hard scar tissue on the top of the shaft.  When I get hard, I bend at least 60 degrees upwards.  

2. Have you (or anyone who does injections) ever experienced bleeding at the injection site as you get an erection?  I would think that would be a big deterrent for the ladies as well.

1.  Semi detailed questions.  I have read a few items that mentioned Peyronie's Disease and the shots.  Didn't really understand the treatment or the connection.  No personal experience.  Really should contact a medical specialist.

2.  FAQs mention the remote possibility of some blood from the injection site.  Seems rare.  I have had no such experience.  

I have a question for you guys, since I'm a little younger than you: what kind of general physical condition are you in?
Not trying to be rude but outside the prostate surgery were there other factors that added to viagra not working?
As just for general knowledge, levitra has never worked well, Cialis doesn't produce the same erection that viagra does...I've worked in medicine a long time and a friend sells viagra and her company does a chart comparing all three.  
But I'm only interested for my own knowledge
Thanks

Rancherjim, so wonderful to see a friend here!  The shot seemed to work just fine for our fun  I like that you were open about what was working for you while not hiding the injection.   I had a gentleman use some kind of topical treatment without telling me.   He went into the bathroom upon arriving I realized later only because he left the tube hidden between the liner and the rubbish can.  I don't think it really matters to most providers that you need a little something but I was uncomfortable feeling I had possibly been exposed without being informed

Just wondering, I know that injections are commonplace for male talent in porn.  I wonder if they use the same combinations of what you were just alluding to?  If they do, I am surprised no one has come up with a specific formula that they would endorse?

Ally, I think our sensitivities to our clients' needs and being able to accommodate their needs is enhanced by being aware of their situation. I certainly am more comfortable being informed of what to expect rather than having to guess as I go through the encounter. I think we are probably all very receptive to having an understanding and helpful attitude - it makes us what we are, true service!