I’m a 49 year old man who has had erection and libido issues ever since stopping accutane 3 years ago.  I had started testosterone replacement therapy prior to accutane and due to the horrible cystic acne it was giving me my dermatologist put me on accutane for seven months.  I’ve had horrible libido and erections since.  I’m currently on trt, dhea and pregnenolone.  My numbers are all good but I do have very high free testosterone compared to my total.  My IGF-1 was also very high even though I take nothing for it.  I’ve had a penile ultrasound and it showed excellent blood flow.  My urologist went ahead and recommended I do 6 sessions of Gainswave.  I did nothing.  I get not improvement from Viagra or Cialis.  I have no nocturnal erections to speak of either.  I recently added ALCAR at 2 grams per day to see if it helps.  It’s been a bout 4 days and maybe minimal improvement but nothing great.  I ordered some DHT cream from overseas and i’m on day 3 of it.  Can anyone suggest anything else?  i’m really struggling.  The only way I can achieve a quality erection is with trimix.  Obviously that’s not a great solution.  I’m open to any help.  Thank you!