I’ve been dealing with similar circulation issues for a couple years, and after some urologist-guided tweaks, here’s what moved the needle for me-backed by what I’ve read in studies from places like the Journal of Sexual Medicine.
On nitrates and timing: L-citrulline at 1.5-3g daily (not arginine, as it doesn’t absorb as well) built up over 2-4 weeks for steady NO production. I time beetroot juice (about 500mg nitrates) 2-3 hours pre-activity; it spikes blood flow without GI upset if sipped slowly. Stacking with 200mg cocoa flavanols (dark chocolate extract) amplified it mildly-no bathroom drama for me.
Pelvic floor: Standard Kegels helped control, but reverse Kegels (gentle push-outs like starting urination, 10 reps of 5-10 sec holds, 3x/day) fixed my over-tightness and reduced what felt like venous leak. Took 4-6 weeks to notice firmer sustains.
Shockwave: For my mild vasculogenic case (confirmed via duplex ultrasound), 6 sessions of low-intensity ESWT improved IIEF scores by 5-7 points at 3 months-worth it over pills for me, but pricey without insurance.
CPAP for apnea: If that’s in play, erections often rebound in 1-3 months with consistent use; my buddy saw NPT return by week 6.
Oddball win: Looser underwear (no compression) cut numbness during the day-subtle but real for baseline flow. Avoid blood donation if ferritin’s low; it tanked mine temporarily.
Track NPT with a simple morning journal or Oura ring’s HRV trends-easier than rigs. Consult your doc before stacking supps, especially with meds. What’s your baseline like?