Try using MUSE again. It comes (pun not intended) in different strengths as well, so see if you can get the strongest (another pun not intended). I'll say this about alprostadil, with viagra if I get ahead of my wife I got to not think about sex but there is a risk of loosing the erection. With the injection, I can turn sex off and stay the hardest I've ever experienced. Zero pressure sex. So obviously I like this med. I've had ED my whole life. But only at 57 was I diagnosed with venous leak. Its a mild one but its been a thorn in the side. Venous leaks can be repaired but usually return within a couple years. TRT can fix a third of them. If one doesn't respond to alprostadil, then one can get an implant. Read one case of a guy that could only get erection while standing. So leaks can be positional. Its all weird and docs admit that little is actually known. But there are options. YOU have options. Pursue this med, talk with a good urologist, and also do the shrink thing. Since trazadone worked at times, I suspect a touchy neurological thing as well.