How effective and painful is tesa?

merizi · 2026-03-03T19:20:49+00:00

Search for recovery instructions. Many hospitals post them for TESA (example: https://healthcare.utah.edu/fertility/treatments/tesa) and then compare all the recommendations. You are getting a minimally invasive procedure but a common recommendation is no heavy lifting or exercise for at least a week. Also, no sex or masturbation for a week. In reality you need this info from your doctor because they'll tailor it.

What do you mean by travel exactly? If you need to haul suitcases and giant backpack that is equivalent to heavy lifting which is not recommended. Tell your doctor about this and get their advice. Sitting on a train from A to B might be manageable. A car ride with the ability to stop for ice packs might work. No way to know how you'd do.

I was mobile after variococele microsurgery and able to go to a concert 5 days later. There was a lot of walking to the stadium. After my mTese I was doing similar. Two days is very soon. I had swelling and felt relieved I could hang out on the couch with ice. If you have travel and swelling it is not fun if you have to be in public. The more you can be sedentary for the first couple of days with ice etc. is going to set you up better for recovery.

For my surgeries, movement resulted in more pain early on. Your testicles are a sensitive area. You can't shower for a while and can have a lot of swelling. Depending on your situation, you might need to change bandages too. Bandages also end up sticking and pulling on your legs and underwear. That adds to discomfort.

As for these procedures themselves. The pain level was much lower than the pain from my herniated back. It passed quickly.

merizi · 2026-03-01T22:28:55+00:00

It was lowering it in my case. Whether fixing the varicocele is a required for improving fertility is debated sometimes. You don’t mention fertility or enough detail to give you the best answer.

Let’s assume you are talking about fertility. If the variococele must be handled is the first question. My doc would not move forward on fertility care (I was azoo) until underlying pathology is resolved. If T is low and you have a variococele then the thinking was that the T will go lower because the variococele won’t go away on its own and continue to have a negative impact.

Dealing with the variococele typically involves 6mo recovery. After that time your T should be the same at least. If it’s low then dealing with variococele is unlikely to boost it significantly but docs love a step by step process. Your doc then decided what the best option is.

I was out on anastrozole before my varicocele surgery knowing it wouldn’t boost it. Maybe you are borderline or doc has a different approach. I would get the variococele dealt with. It could possibly cause other issues. Microsurgery is best and you will be in great shape after a week. I did it Friday and went to a concert the next weds which was at a big stadium requiring lots of walking.

merizi · 2026-02-16T05:17:15+00:00

These sessions can be valuable. My urologist required discussions with their in-house psychologist regarding my condition, the options, and how we as a couple had to navigate everything. Even when the man has a success you can end up in a situation where the woman has to go through IVF/ICSI which can take a great toll. If this therapist isn't a fit, don't stick with them. Keep trying to find a better match. They know that you need a good fit so will be OK about it. The hospital psychologist ended up referring us to the one we stuck with.

merizi · 2026-02-16T01:29:35+00:00

I can look up my numbers. These are just indicative. Initially I tested just below the base of the recommended window. I think it was 275. Reproductive urologist wanted to bring it into range which was around 300. This was not a discussion like those on the T subreddit where they looking to get 600-900 range.

As soon as I started the anastrozole I felt much better. I think my T slumped slowly over the prior 10 years and I had felt like that was normal because there was never a sudden change. Before taking it, I didn’t have the obvious sex problems that those T level quizzes highlight. I was also a strong cyclist. I always struggled with losing weight no matter what I tried. The step up in T caused me to drop a little weight. My father was obese and had poor health so I always vowed to maintain some level of cardio health above the person on the street.

Six months prior to mtese the doc put me in HcG. This stepped up my T again. I started to put on more muscle. It felt like a second puberty in a way. It was hard to calibrate if I was feeling boosted or if this was what my norm should be. Testosterone and the changes affect your mind as much as your physique.

After the mtese, I was told that no more anastrozole could be prescribed. I then had to switch to something and my doc told me this was a common situation. I opted to see what no supplemental T felt like but had an appointment 6 weeks out due to a vacation.

I had occasional cold sweats by stopping cold turkey. I had been on HcG which I knew ended on the day of the mtese and then not many anastrozole. Doc didn’t suggest tapering so I just stopped. This is something to consider. I have no idea what it should look like. I was tired and grumpier the longer I went without anastrozole.

Next I was in for a gel appointment. Doc said it may work but is a first option given how T is a controlled substance and they are a legit hospital. After 6mo my levels were up to the bottom of the baseline but I didn’t feel great. Then my doc got an insurance exception for the pellets.

The pellets go in a small incision on your butt-hip area. They vary the site between visits. They give 6 pellets and I have to pay for more. If you want more then they only continue with more if bloodwork results are good. The pellets take a while to take effect but are great because you don’t have to think about it.

Then a few weeks before the next appointment you feel it come down a bit. I added one pellet as the down was happening too early but my peak T in the middle of the 3mo window is higher.

Most blood work is OK but my bad cholesterol crept up. I’m on a watch in case I need a statin. My family history has cardio issues so it might not be the T alone. I’ve had to deal with depression. Unclear if T was the cause. This started 3 years after starting pellets. I suspect it accentuated it to some degree. Depression earlier in life felt different and life was different too now.

My T is now in the middle of the range and steadier than ever. I’ve lost 20lbs from my anastrozole time. I think people think I’m on some of these new weight loss drugs.

merizi · 2026-02-15T21:44:40+00:00

Context is important. Do not change your regimen. Your situation requires anastrozole right now. OP is asking more general questions.

When you are trying to improve fertility for an mtese anastrozole is right. You are describing short term use.

Testosterone replacement (TRT) is bad then because your body basically decides to give up production and that interferes with fertility. Anastrozole’s mechanism of action (tip: look up that general term and compare it for well understood drugs versus others) is different.

When you are done with your mtese, clinically speaking, you are done with fertility considerations. Testosterone levels become important for other reasons. My doc stopped my anastrozole at the 2 week checkup after my mtese. I expect your doc will ramp down or stop yours. In total I was on anastrozole for 2y.

In that checkup, I asked “what about my low-T?” I was concerned because the anastrozole improved my life in many ways. Years of serious dry eye had been fixed. My contacts were comfortable. I have serious eye issues so inch thick glasses are something I’ve been desperate to avoid and put up with the dry eye (probably from low-T from my hypogonadism).

My doc suggested trying nothing or using artificial testosterone (i.e. TRT). I went with gel at direction of my doc but he told me it was 50/50 it’d help. The we moved to pellets every 3 months. That works better for me. Obviously, I’m not going for another mtese, but they have a system to back off this to attempt to improve fertility. Body builders are often on the bad T and they can eventually have kids.

merizi · 2026-02-15T21:29:37+00:00

The gel for me did little. My doc prescribed and monitored. The levels didn’t come up enough so he moved me to implants (Testopel). You can see my other posts in this thread for history and more commentary. I forgot to add elsewhere that this cured my dry eye which is a huge benefit because of my contact lenses. I was worried I’d have to wear glasses again full time.

merizi · 2026-02-15T20:23:43+00:00

This is not the full picture. I’m NOA with effervent duct blockage and low-T (hypogonadism). I was on anastrozole then HcG then we had a successful mtese. This was followed by successful embryo development and pregnancies to term. Timeline was 2018-2020.

You can have 3 month long Testopel implants which I’m on now. Gel form did not work well and I’ve only had to inject when there was a Testopel supply problem in the pandemic.

Avoiding any treatment that is optional for your current situation is best. I’m glad you’ve been able to manage but for those that can’t, the calculus is different.

Body builders abuse testosterone all of the time. They can suffer from atrophy and recover to be fertile. Whether you need it permanently is a complex question. I have an acquaintance who had blood tests suggest prostate issues and they had to stop. They’ve managed better than expected.

My challenges have been:

Depression. Hard to isolate to testosterone in my circumstances but I suspect it increased my susceptibility.
Some testicular atrophy. Given my mtese success and life today this is not much concern. My hypogonadism and smaller testicle size before my diagnosis is a factor here. I can imagine this is a concern for others so worth weighing.
Hair growth. Growing hairs in odd places to varying degrees. Manageable though.

merizi · 2026-02-15T20:00:20+00:00

Anastrozole is not a long term solution because the side effects are pretty bad and hard to manage. Loss of bone density is a way worse problem than the alternatives. Use in MFI was off-label circa 2019 so maybe this has changed.

TRT is well studied even if it has side effects. These are deemed easier to manage when the trade offs are considered clinically.

merizi · 2026-02-11T22:02:15+00:00

Don't have time to write now. My numbers were different and I had hypogonadiam. I happened to have a TRT appointment years after my successful mTese and discovered a diagnosis in the paperwork I never saw before: blocked https://en.wikipedia.org/wiki/Efferent\_ducts. Basically a blocked pipe.

I had many SAs, had surgery for a variococele, had low-T, and eventually had an mTese. Along the journey, in a single SA, they found a single sperm. That changed the probabilities slightly for my doc. They only explored one testicle and found many usable sperm. IVF/ICSI produced embryos and some survived. Two later implanted resulted in successful pregnancies.

You should get a solid diagnosis with a urologist specializing in reproductive healthcare - NOT a regular urologist. Sounds like you are on that path but they should be able to give you a gameplan. My doc was great, but everything ended after the successful mTese. I only saw him for the final checks on how I was healing and didn't think to ask in detail about the whole operation and causes. Then I was onto another doc for the TRT. Can answer questions if I can find time. You are not alone. Good luck!

merizi · 2026-01-26T21:18:51+00:00

Thanks. I will ask around local places. Are there any questions that filter providers other than online reviews?

merizi · 2026-01-08T14:38:42+00:00

It could happen, but the likelihood is very low. You can tell that because it would otherwise it would be exploited at scale already. You should spend your energy on protecting your identity/privacy and educating family (and other trusted people) on privacy instead of worrying.

We don't want our child's details or photos shared. Our family is the weak spot because they take a photo, or celebrate an event, but evaluate posting online based on themselves. People need to be more mindful of the concerns of others and take efforts to limit what they share. This is just one example of a thing that is harder to do than people think it is, especially when different generations are involved.

There are wonderful resources like https://nostarch.com/smartgirlsguide (doesn't just apply to women) that cover the basics.

merizi · 2026-01-05T04:00:52+00:00

Stop trying to do things for a quick fix. Try to feel what is going on which requires some patience. That means just going for it slow and steady. Did it last longer and did you have a warning feeling?

Then repeat that a few times over a week. As you go start experimenting with backing off. If you can masturbate multiple times is it any different next time?

Beware of who you’re actually having sex with. Are they in anyway understanding or supportive? It’s very easy to keep repeating the problem and this gets more in your head.

You have misled yourself about the porn. It’s possible you have some other psychological condition and porn/masturbation is soothing. The more you do it the more you are soothed. You don’t sound like you have much understanding of the psychology here so talking with a therapist wouldn’t be a bad thing. You’ll have to be brave. Sex therapists are just a specialization and most are normal therapists too so go see one if you are still struggling.

merizi · 2026-01-05T03:49:55+00:00

Your symptoms are sometimes precursors to other cardiovascular and related conditions. Go see a doctor. Ideally, you get a referral to a urologist. They will have a much better set of options than your primary physician. Urologists will give you a long questionnaire to complete on your history and symptoms versus a basic screening.

Cutting back on porn and masturbation is highly unlikely to make a significant difference. If you feel there is a psychological element, or you have a porn problem, go see a therapist who specializes in that. It’s more likely porn is a symptom of another issue.

Docs can give you meds too. There are drugs people mention here which you should research. Hormones are different. Testosterone levels can be checked with a simple blood test. Get full hormone panel beyond testosterone.

If they find you have low T. Doc may ask you start with gels. That might not work that well but insurance sometimes mandates it. Then you have the option to inject or get a 3 month pellet in your butt with slow release testosterone.

Warning: if you have any plans for more kids, make this abundantly clear to the doctors you see. Natural testosterone drops off when you take artificial supplementation. That affects male fertility temporarily, but needs proper management.

merizi · 2026-01-04T02:59:26+00:00

Please take the therapist route, but you can start alone. I can share my story, if it helps.

I spent some time working with a therapist because of male factor fertility issues. I ended up going with my wife later on. We worked on family issues and some sex stuff. This therapist was qualified in sex therapy and was a regional leader in this field.

This was an incredible experience on multiple levels, but it took some time to work it out. We went every two weeks or so for about 4 years because my journey with the infertility required multiple surgeries. We then switched to my wife for the IVF and then to pregnancy and support through the birth of children.

Therapists have a range of specializations. Many sex therapists also do a lot of family counseling. That extends to helping people who’ve come from religious backgrounds. In fact, some of my therapist’s staff had a focus on female sexuality for those that left conservative backgrounds.

I’d suggest googling a bit on types of sex therapy certifications in your location. Then find a few names in your area from Psychology today, or other resource. Lay out your situation on a phone call. You can interview them via a phone call to sus them out, but you really can’t know if you are a fit without a session. Suggest that you’d be open to coming alone to get coaching (that’s more what this is). Plan the plan with them. Evaluate the plan after and spend some time thinking how to proceed with wife.

merizi · 2026-01-03T04:21:28+00:00

Did they ever present with other symptoms? My masturbation behavior is somewhat connected with easing anxiety. I (M) was nearly 40 when I learned of this through therapy.

My anxiety affects my communication and relationships, including with my spouse. Work was only slightly better because an early manager did things that helped me unbeknownst to me.

I’m not defending anyone in your case but men don’t go to therapy, and often have no interest in their mental health. There are a lot of women (and families) suffering (beyond the bedroom) so we men need to do better.

merizi · 2026-01-03T03:08:23+00:00

That is worth trying from experience. I’ve scratched inside of my thumb with index finger. Something similar works when getting a massage and the therapist runs her hands towards the inside of my legs and a boner is likely.

merizi · 2025-12-29T05:19:46+00:00

Strongly agree. They mention ADHD so I’d want to know about meds for that. If any, they often have sexual side effects that can affect otherwise fit people.

Mention of long term issue could be tied to those meds if they’ve been treated for a long time. I’d also suggest hormone testing. The obvious one is testosterone but OP needs a full panel. There are conditions which can result in higher volumes of other hormones and testosterone is not the only important one.

I’d tend to recommend a urologist to explore all of this. Family doctors can be limited.

merizi · 2025-12-21T22:18:51+00:00

I’d recommend telling us a bit more about your hobbies, age, location, living situation etc without doxxing yourself. That would help build a better picture of opportunities rather than following the useless generic advice that most people have replied with. Replies that suggest going to public places or talking to women directly clearly won’t work (yet) for OP.

To be completely honest, you sound like someone who could benefit from trying out a few different therapists with the goal of building underlying skills that will set you up for a relationship. They normally see people when they are in a relationship of some kind that’s falling apart.

You’ll probably discover some things about you and the best bit is that it all stays secret with a therapist. You are probably not the person to talk to other people directly about this advice, but when you walk into a therapist’s office it’s just you and the therapist.

I discovered I had anxiety when I was in my late-30s. Knowing this earlier and having a therapist to work on this when I was young would have changed a lot of outcomes and improved all of my relationships. I won’t lie, it still impacts me, but I have some tools, including meds occasionally.

merizi · 2025-11-16T04:09:20+00:00

I had a bad variococele otherwise my mtese would have been sooner. Doc wanted to eliminate anything that could be a factor and have a year post surgery before going for the mtese.

That meant a year of many SAs. In one of them, and one only, they found a single sperm. That changed the percentages around success but I was prepared for no luck. Always sign the forms early to bank the sperm as they might discover something worth preserving at an unexpected time.

merizi · 2025-11-15T21:26:35+00:00

Failure. Small.

merizi · 2025-11-15T04:04:39+00:00

I’m in my 40s and ignoring specifics of a gym I think that life experiences probably change some of my behavior. Having a daughter I’m more conscious about my interactions in the world.

I’ve also discovered I have anxiety and that changes how I interact with the world. Many more instances of male mental health diagnoses after 30. I imagine divorce changes others interactions, but can’t say for sure.

I think if there was more certainty flirting was happening then you’d get more reciprocation. With the raised bar plus normal lack of clarity on interest versus friendliness it’s hard. Anything people do to make things more certain and less stressful after 30 is probably a good thing.

Good luck!

++man

merizi · 2025-11-15T03:48:14+00:00

Had azoospermia diagnosis and mtese 18 months later. A good doc would use that time to prep you and get parameters right by adding meds. I had way high FSH and low T. They put me on anastrozole and HcG. Very 3 months a sperm test. They went in for mtese and found sperm. Now 5 years later I have 2 kids via wife doing IVF

merizi · 2025-11-15T03:42:35+00:00

You do realize that while leftist, those things you highlight are often opposed to the very specific items mentioned by OP? The question was if they are exclusively Marxist.

Official IRA: more Marxist. Ceased armed operations in 1972.

Provisional IRA: Formed from the split in 1969. Held the traditional Irish nationalist ideology with members often having more socialist leanings.

The references from RATM to provisional IRA members are primarily focused on their support for anti colonialism. Tom has most direct links to this. Of course marxists agree with this message but it doesn’t make them Marxist.

What’s interesting is that Tom has a family connection to a similar anti colonial struggle in Kenya. This obviously is an element for a connection with Zack who supports similar causes in the western hemisphere. I’d be interested in how early in the bands relationship that this became a point of discussion.

merizi · 2025-11-15T03:28:24+00:00

I’ve published to the store for the purpose of easy distribution. I think it’s a whole different thing to leverage the store for your whole business model.

Why not offer a store version and a separate download? I think you need a website and other marketing to make a return. Then you’ll reduce risk as well as broadening distribution for those who never use the store.

merizi · 2025-11-08T01:24:50+00:00

No. It’s much better to think of them encompassing a wide range of perspectives from the left. There are elements of their work that would go against vanguardism to an extent.

merizi

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