Prologue

I’ve never liked bikes. Something about not being on my own two feet has always made me nervous. And even in the best-case scenario, the bike seat always seems to ride up in that weird area right behind my balls.

But I was riding a bike in the Netherlands when my life changed. It was a perfect summer day—cool with a clear sky, a nice breeze,

as sunny as it was ever going to get up there. It was 2017, and I was twenty-three years old, had just graduated college, and was ending a multi-continent study abroad turned backpacking trip that I knew was the end of the road before full-time employment.

While I would have told everyone I was still having a great time, as the trip wore on, I was struggling with anxiety more than usual. I was determined to make the trip a success. And to me success meant doing as much as I could as quickly as I could. So it only took me a day and a half to do what the tourist websites recommended doing over four days. After I saw or did something cool, I would spend about five minutes appreciating whatever it was . . . and then it was right back to the next item on the agenda.

Moving so fast made it impossible to stay in a routine. Never a good sleeper, I insisted on staying in the grungiest and most crowded hostels to try to save money. I’d also lost enough weight from my already thin frame that I had to buy new clothes.

By the time I got to the Netherlands, I was so exhausted that I thought about leaving early. But I only had four days left before I had to be in London to then fly to California for a friend’s wed- ding. I knew that if I left Europe now, I’d be mad at myself for quitting. That was the lens through which I saw everything: not so much about leaning into what felt good but instead doing everything I could to avoid feeling bad, whether in the present moment or in an imagined future.

I had planned to stay in Amsterdam, but it was packed. Everyone in the hostel seemed to be there to do drugs. So after a last-minute recommendation by a fellow backpacker, I decided on Texel, an island in the north that had some cool-looking sand dunes and seemed like it could help me relax and that I’d heard was best explored by bike.

I hustled to catch the ferry and got to Texel late in the evening. The next morning, there were almost no bikes available to rent. When I was finally able to find one, the seat was too far back for me to ride comfortably. I’d always felt more at peace in motion and was in a hurry to get going. I tried to fix the seat, but I couldn’t figure it out and was too stubborn to ask someone for help. So after a couple minutes of cussing under my breath, I gave up and just started riding, stretching myself out and arching my back forward as far as I could.

Despite being uncomfortable, I rode that bike around the whole island.

There wasn’t one moment when I knew something was wrong, but when I hopped off the bike seat late that afternoon, something felt different—like I had clipped somewhere in my pelvic region, between my scrotum and my butt, the very danger zone I’d always worried about. It felt the same as when I hit my funny bone, an odd feeling, but it didn’t really hurt, so I wasn’t concerned. I went to bed assuming it would be gone by the morning.

It wasn’t. I still felt sort of a tingling sensation, and I decided I wasn’t going to get on a bike again. Not really feeling the Netherlands anymore, I headed to England early.

After a couple days of walking around, the tingling had not disappeared at all—if anything, it seemed to have gotten worse. I also noticed I started having to take a piss more than usual. I had no idea what the problem was, but I decided I should try to find a doctor before my flight.

I had never seen a doctor in a foreign country before. I ended up in a sketchy, cash-only walk-in clinic on the fringe of the city. The doctor, with his thick English accent, was cool but seemed to think I was crazy.

“You’ll be fine,” he said with a smile, putting his right hand under his pants inseam for effect. “Those seats can really ride up on ya.” He gave me some muscle relaxants, patted me on the shoulder, and sent me on my way.

I flew to San Francisco the next day before heading to wine country, where I got to hang out with a bunch of people I had not seen in ages. I stopped worrying about whatever was going on “down there” for a couple of days. But I couldn’t help but notice as the reception got underway that I was still a little uncomfortable. I kinda felt like I had to take a piss, almost like my bladder couldn’t quite decide. And I didn’t have all the usual feeling of sensations when I did urinate, like I couldn’t quite tell if I had finished.

Luckily, most people there—including me—were pretty buzzed. Between the singing and the back slapping, no one noticed I was spending a little extra time in the bathroom.

That wedding was the last event where I felt quasi-normal.

I had no idea it was the canary in the coal mine for what was to come.

The Day My Dick Stopped Working

Shortly after I get back from the wedding, I move to Salt Lake City, Utah, from northern Virginia, where I grew up, to start my new job.

It now feels like I’m sitting on a golf ball that has somehow been lobbed into my rectum. I think it could be bacteria or some other kind of infection. On the drive across the country, I start feeling a tightness in my lower abdomen and a now urgent feeling like I need to piss. I am also at times experiencing what seems to be a spasmic burning somewhere inside my asshole that takes all my willpower not to try to scratch away.

Driving across the country is also the first time I wake up in the middle of the night desperately needing to urinate. Even after I go it feels incomplete, that I somehow still have to go again, when only the smallest of trickles is leaking out.

I find another doctor as soon as I get to Utah. He agrees I probably picked up some sort of infection on my travels and writes me a prescription for antibiotics. “God knows what goes on in some of these places,” he says.

Work starts. In addition to having to piss all the time, I am now having trouble shitting. Everything is backed up like a traffic jam.

I have to arch my back forward and strain my muscles to try to push it all out, which only seems to make things worse. I have to look down to get any sense of what is coming out of me—tiny lumpy pellets that look more like pebbles in an ocean painting than something that belongs in a toilet.

At the same time, masturbating has started not to feel great. I can still get an erection, but actually jacking off is tighter and less enjoyable, like I am forcing something, in much the same way as shitting. And afterward, there is sometimes a burning sensation in my shaft that makes me put my hands up and want to back away.

I come up with all sorts of shame-related reasons why this could be happening. Maybe I’ve been jacking off too hard or too much? Whatever it is, I am freaked the fuck out. I spend hours surfing the web, self-diagnosing myself with everything under the sun: a hernia, a pinched nerve, an infected bicycle.

I start bringing an empty water bottle to bed with me so I don’t wake my roommates on my many trips back and forth to the bath- room. I decide I can’t live with people right now and get my own place. I also find a new doctor. We take turns using a stool to simulate my position on the bike. He says in order to assess the situation, he needs to inspect “down there.” I put my hands on the exam table, pull my pants down, and face away from him, already grossed out as I hear him snap on the latex glove.

When he goes in, I can feel my muscles clench up in a way that he agrees seems strong. He’s not sure what is wrong but recommends staying on antibiotics and sends me to pelvic floor physical therapy.

The physical therapist goes in with the idea that using her hand to massage different “trigger points” will help them relax. As she is massaging, she says, “Wow.”

It is not the good “Wow.”

At certain spots, I yell loud enough that she has to reassure her suite neighbors that everything is okay. The closer she gets to my asshole, the worse things seem to be.

I decide to keep seeing her every week because I don’t know what else to do.

Amid all this, I am lonely. I have a work connection in Utah but don’t know anyone there my age. I have never been on a formal date in my life, but I start downloading dating apps and compulsively swiping, even on girls I know are not a good fit for me—like some part of me knows this could be it for my dick.

One Friday, bored after work, I match with a girl who suggests drinks that night. She invites me to her place. Right as we are taking things to the next level, I look down and realize my dick isn’t moving. I’ve never had a problem getting it up before, but now it’s lights out. My dick has died! Panicked, I start performing oral sex on her to try to stall. After a while, there’s still no sign of movement.

“What’s wrong?” she asks, lying on her bed, naked, in the dark. “Uh, I’ve been taking some antibiotics, and, uh, I think I took too many and, uh, with the drink we had, I’m just not . . . I think I’ve gotta go,” I say, fumbling with my keys on the way out.

I go to bed in shock, hoping that when I wake up tomorrow things will be different.

They aren’t.

I have to stroke for several minutes to get something that is still so flaccid it cannot really be called an erection. I mostly stop waking up with morning wood, but on the rare days I do, it is shriveled and shrunken looking. At times I feel plenty of libido, but my dick won’t move, like wires are getting crossed. Other times, I feel no sex drive at all.

The spasmic pain every time I do try to jack off and afterward doesn’t help. Nor does the extra urine that has started trickling out every time I piss, sometimes as late as when I am washing my hands getting ready to go back to work.

I decide I have a deep infection similar to Lyme disease. I take months of the strongest antibiotics possible until I start getting skin rashes from a fungal infection and my mom has to almost force me to stop.

Day to day, I’m not in agony, but I feel nonstop discomfort. Some days are worse than others, but the tightness never ever goes away, like a clenched fist in my pelvic region, with excruciating pain after shitting, jacking off, and sometimes even urinating.

It becomes clear that everything is related. The weaker the erection, the more extra piss comes out, the worse it hurts to shit. And occasionally comes the burning, the throbbing, the stabbing radiating from somewhere deep inside my asshole. I have no control.

I start taking Advil every day because it makes me feel slightly better. Hot baths help a little, but the second I get out the relaxation disappears like I never even took one. I need a prescription-grade muscle relaxant to fall asleep at night.

Even with drugs, I always seem to wake up with an urgency to piss at about the four-hour mark. I am anxious, alert, and my pelvis tight enough that when I do wake up it is hard to calm down enough to go back to sleep. I don’t sleep more than five or so hours at a time over the next several years.

One night, I wake up suddenly because it feels like fire is radiating from my pelvis. I can barely breathe, sit still, or formulate a thought it hurts so much. I am still half asleep and in shock, so I immediately take my muscle relaxant and Advil and start a bath. By the time I’m in the bath and have woken up a bit, the pain is completely gone.

This happens several times over the next couple of years. Each time it goes away almost immediately after I wake up, and each time seems just as strange as the last.

Over time, the rest of my body starts to feel off kilter. Everything from my glutes to my back to my shoulders to my neck to my jaw starts to feel tight. I can tell my posture is off. I find myself feeling like I’m going to fall over every time I run. I am being held together by string, having turned into an old man overnight.

I’m also living like an old man. I am in bed before nine o’clock, both because I’m exhausted and because I know I’ll wake up in the middle of the night. I have almost entirely cut out alcohol because it makes me feel like I have to piss even more than I already do. In some ways I’m grateful to be away from all my friends because I don’t have to justify why I’ve turned into a recluse.

I try pot a couple of times, but if anything it makes my anxiety about my symptoms worse.

I wonder if it could be a diet issue, but after a month of eating the blandest food possible, there is no change.

Life is much less exciting being impotent. Why am I wearing nice clothes to work? I wonder one morning. Why bother staying in shape? What’s the point of even going to a bar or on a date right now—what’s the best that can happen?

I continue seeing doctor after doctor and one physical therapist after another.

They all ask me about stress, so I try mediating, vacationing, swimming, journaling, yoga, saunas, weight lifting (I fall over trying to deadlift), and reading deep philosophical shit. There is no improvement.

I struggle to pass the time, especially on weekends. I start making lists of things I need to be doing—even things as simple as reminding myself to read a book—because if I sit still for too long, I have to ponder my situation.

Because my erectile dysfunction is what I’m most worried about, my mom suggests an ED specialist.

Within the initial ninety seconds, the first guy announces that it’s a confidence issue and he can get anyone an erection. He gestures toward my junk and adds, “He just needs to remember what he’s supposed to be doing.”

He prescribes a large dose of daily Viagra. I am now a walking erection—except I have to look down to be able to tell I have one. There is no connection between me and my dick. The “erection,” if you can call it that, is still kind of flaccid and unnatural looking. And even on Viagra, jacking off is the same level of unpleasant.

I switch doctors. We start with a penile injection to see “what’s going on,” despite me telling him I have already tried Viagra. My dick gets much larger but is still clearly flaccid. He inspects it from every angle and announces, “Something is wrong here.”

“I know,” I tell him with frustration in my voice. “What do you think the problem is?”

“I’m not sure,” he says. “But I mostly do implants.”

“You mean like on my dick?”

“Well,” he says, “I’ve never put one on someone so young before.” He’s almost leering at me when he says this. I’m standing in front of him, naked from the waist down, with half a hard-on. My eyebrows raise, and he mumbles something about being concerned about the liability.

We do not schedule a follow-up appointment. The right side of my dick remains blue at the injection site for weeks. I stop seeing ED guys.

I find an infectious disease specialist and do extensive bloodwork. I am ruled out for rheumatoid arthritis, viruses, parasites, and many other diseases. The MRI shows some inflammation but no structural damage of any kind.

Another doctor is convinced I have an STD. He seems to almost not hear me when I tell him I’ve already been tested.

“There’s no shame in it,” he says. “I did some pretty wild stuff when I was young too.” He then goes into graphic detail about a youthful sexual encounter he had, seeming to think that if he confides in me, I will confide in him. I again test negative for all STDs. He prescribes valium suppositories, tiny packets that I insert rectally. They are the first thing I try that I see any sort of improvement. I have slightly less urgency and slightly better bowel movements, libido, and sleep. I still do not feel anywhere even resembling normal, but the suppositories make it so I can at least occasionally think about other things.

I start taking valium like they are candy and carry them with me everywhere. It takes all my willpower to not take one all the time, every day.

I don’t talk to anyone about this, other than my mom, somewhat out of embarrassment but mostly out of alarm. When I go back home to Virginia to visit friends, I drink a little bit to keep up appearances and then get uncomfortable enough that I have to go to the bar bathroom to shove valium up my ass.

Amid all this, I endlessly swipe through dating apps, trying to find validation for my shrinking self-esteem. Occasionally, I go on dates because I don’t have anything else to do and I want to feel normal.

One night, I match with a girl and meet her at a dive bar. She is very forward in what she wants us to do later. I know that won’t go well, so I pretend not to understand and make up an excuse about why I am busy in a way that visibly perplexes and later offends her. Another time, I match with Ashley. She invites me on a date, and for some reason I decide to go. I take valium right before and try to forget how uncomfortable I am. Ashley has a cute smile, and the date is, oddly enough, a great distraction. We discover we are both Utah transplants who like hiking, documentaries, and Indian food.

Intimacy is an issue from the beginning. She is touchy-feely, and even before my pelvic problems, I was very much not. She often wants to kiss or hang out more, and I push back. Sex is obviously a problem—mainly that we never have it. I have to take multiple valiums to get hard enough just to get a painful blowjob. Often my dick doesn’t work well enough to even do that. I tell her I’m having back issues and while she doesn’t seem super concerned, I am frustrated.

In the beginning, she seems to really like me. I start getting suspicious of why that is and accuse her of only wanting to hang out because I pay for everything.

As time goes on and as my dick continues not to work, I tell her that the only reason we’re together is because we live in Utah and not a bigger, more fun state. I am so mired in myself that I genuinely don’t see how this is mean.

One day she has had enough and says we are done, telling me, “You make me feel so bad about myself.”

After that, I mostly stop going on dates.

The longer this goes on, the harder time I have imagining a scenario where it will ever go away. The tension feels like a part of me now. The first thing I do when I go anywhere is scan where the bathrooms are, often without even realizing it. And even when I have just gone to the bathroom, I always feel like I need to go.

I still believe doctors can heal me from this chronic, long-term health issue. When I don’t go see doctors, I think that I am not doing anything to help myself fix this.

After a couple of failed visits, my whole body starts tensing up every time I sit on the antiseptic examination table in a gown, explaining my situation to a new urologist.

They all seem to congregate around two extremes: “This will go away soon,” or “This may be a chronic condition that you will have to live with forever.”

I am twenty-four years old when, five minutes into meeting me, an overweight MD with bad skin declares me permanently erectile deficient. My fists clench as soon as I can tell they have no idea and are just making shit up.

“How could I possibly have permanent erectile dysfunction?” I yell.

“It’s been over a year. Why would my dick just start working again?” I snap to others.

Most of them quickly revert to “I am a doctor and you are not” logic.

Several of them ask a version of “What do you think is wrong with you?”

Another asks, “Have you tried relaxing?”

There are almost never any follow-up appointments. I end several of them by informing the doctor in question that he (they are almost all men) is “a fucking idiot” and slamming the door behind me.

I go under and get a Botox injection in my ass. It does not help. One guy claims to do pelvic floor surgery. The reviews are so traumatizing I have to go outside and get some air after reading them. My physical therapist suggests talk therapy. The idea that this burning physical health issue could have an emotional component, or that it could be solved by talking about it for sixty minutes a week on a couch, is crazy to me.

I go to therapy sporadically anyway. I do not look hard for a good therapist. I downplay the problem the second I get in there. My tone of voice stays flat the entire time. I never cry.

I seem to know exactly what to say for them to tell me I am going to be fine. I try to convince myself of this too. We sit on couches with our eyes closed and practice mindfulness exercises together. After a couple of sessions with each of several different therapists, I stop going.

My physical therapist also recommends acupuncture. The acupuncturist is sure she can help me. She sticks needles right in my asshole, starts cupping different parts of my body, and prescribes a detailed herb regimen. Acupuncture does relax me, and occasionally I fall asleep in there. It doesn’t do anything for my symptoms, though.

After a couple of sessions, the acupuncturist notes that my pelvis seems just as tight as when we started. This happens a lot. The practitioners are all confident they can help me at the beginning, but not so much later. Just like the doctors, they ask me, “Why do you think you are still here or have not gotten better?” Their tone always makes me feel like I am failing them and myself.

And then, one day while I’m trying to forget how much I have to go to the bathroom, I stumble on a post by the writer Tucker Max talking about his experience with MDMA-assisted psychotherapy. While I have never communicated with Tucker, I’ve followed his therapeutic journey on social media for years.

Before his piece, I associated psychedelics like mushrooms or LSD with strange hippies in the woods who weren’t doing anything with their lives. But that impression came from others. I hadn’t actually given the psychedelics themselves much thought at all. I’d never taken or even been offered them. I didn’t know many people who had taken them and never in any kind of therapeutic setting.

MDMA, or ecstasy (which is not technically a hallucinogenic/ psychedelic), didn’t weird me out as much. I had actually done it a couple of times at parties in college, but this seemed different.

Tucker wrote about wearing an eyeshade, with a guide and zen music, in a way that at first almost seemed like satire.

Except he was 100 percent serious talking about how impactful even two MDMA sessions had been for him in working through childhood trauma—and that he would be taking more psychedelics soon. Tucker’s piece is so in your face that psychedelics can help heal trauma that I never forget the association.

I read it several times in the following days because it seems interesting. After that, I’m not dismissive of MDMA therapy and decide it could be a real game changer for veterans, rape survivors, and other people with trauma.

But I don’t have any of those issues; I just have a strange physical health problem.

I don’t discuss Tucker’s piece or MDMA therapy with anyone and, after a couple of days, stop consciously thinking about it.

“It’s more an art than a science,” the physical therapist says as he hands me lubricant and latex to make entry smoother.

At a five-day clinic in California, marketed for those who have failed all other pelvic floor treatments, I am given a curved wooden cargo hook known as “the wand.” It is not so different from a backscratcher—except I insert the wand rectally. The idea is that, after the clinic is over, patients can use the wand to massage their own trigger points without help from a physical therapist.

Lying down in the hotel bedroom with a sheet over me, I am steering the wand from side to side like a joystick, letting it linger on different points. It is horrifically painful, even worse than physical therapy. I feel like I am going to die rubbing this wooden object all around my inner anus.

And then physical therapy is over for the day and it’s time to go to “Relaxation.” About twenty-five men and women of all ages sit in a circle in a converted yoga studio, and I try to avoid eye contact with all of them. The founder tells us that he started this clinic to solve his own pelvic floor issues and that pelvic floor problems have both a physical and emotional component.

After a quick patient Q&A in which butt plugs are mentioned, he clasps his hands and says it is time to get started.

“We are going to use these five days to learn how to relax our- selves,” he says. Everyone is handed a yoga mat. His assistant comes around with eye masks. The founder sits in a chair in the middle of our circle. The lights dim.

“It’s all going to be okay. It is all going to be fine.” He repeats variations of these phrases over and over in a soft, melodic voice. It dawns on me that we are going to do this strange exercise the entire time I am not in physical therapy. This can’t be real, I think. How has my life come to this?

Five days later, the wand is tagged in the airport security line, and I have to explain that it is not a weapon.

I try using it for months. Not only is it painful enough that I have to get in the bath after, but it is also clearly not working, so I give up.

I start having noticeable hip pain, and an MRI shows that I have several labral tears, and both my hips are impinged. The doctor recommends surgery on both hips. My pelvic floor therapist at the time is sure it is related to all my pelvic issues. I am hopeful maybe having the surgeries will somehow change something. It does not.

As my body continues to decline, I become more and more consumed by my career. I decide I want a new job and join a startup in a hot industry that makes me feel important. But from the second I get there, I realize I have made a big mistake. They are dysfunctional enough and it is stressful enough amid all my other problems that I decide to just quit.

When I am unemployed and can’t find a new job, I feel adrift with a limp dick. When I stop achieving externally—when that source of self-esteem, of validation, of identity isn’t there anymore—I really start to sink. I move back in with my parents.

As the months, even years, go on, it feels as though life is passing me by. I notice people I grew up with and follow on social media have met someone, gotten married, and started families all in the time my dick has not worked.

It is now July 2020, three years after the bike accident. I have found a remote job that I am embarrassed by, but it’s better than being unemployed. I have also started seeing a new doctor for pelvic injections that help a little, at least temporarily. He is surprisingly empathetic and genuine. He seems to listen when I speak. He both gets how much of a problem this is and says he is willing to do whatever it takes to help me get better.

I have been meeting with him periodically at his office in New York City, but now he says that I do not seem to be improving and that the best treatment options are here in the city. He doesn’t say he won’t treat me if I don’t move here, but he makes it clear that is what he thinks I should be doing. New York City is the last place I want to be amid COVID-19, but I am desperate and trust him, so I decide to make the move.

At this point I have seen more than twenty doctors, twelve pelvic floor physical therapists, and six acupuncturists around the country. This has proven to be both expensive and useless so far.

Other than my twice-weekly pelvic floor therapy and acupuncture appointments, I have no idea what to do every day or how long I am going to be in New York. But I have put my foot down—I won’t be leaving until I get this fixed.

It is a rough time to be in the city. Everyone I know has left, and everyone still there looks miserable. I try to avoid explaining to anyone why I am up there.

Most indoor activities are closed, and in the winter it starts getting dark at 4:45 p.m. I never totally melt down, but over the years it is a slow decline.

My mom comes to visit me one weekend and observes that I “don’t seem to have a great setup here.”

“Do you have a better idea?” I snap back.

One day, working in my cramped studio sublet, I come across a podcast from the entrepreneur Tim Ferriss, talking about how MDMA and psilocybin helped him after being serially sexually abused as a young child.

A fan of Tim’s, I feel the saddest I have felt in a long time while listening to him talk about his abuse. I attribute it to his story being so horrible. I listen to the podcast and read the transcript several times but don’t talk about it with anyone.

In February of 2021, at one of my regularly scheduled doctor’s appointments, I tell him that I still have not seen much improvement and want to do more injections.

“The first rule of medicine is to do no harm,” he says. “I am 99 percent sure that you are eventually going to be fine. I am going to discharge you as a patient, but I think it would be a good idea to find a talk therapist moving forward.”

“What?” I scream at him in shock. “You’re quitting? You can’t do that!”

He walks out of the exam room, and I find myself almost chasing him down the hallway. He never looks back, and I leave in a huff. After that, I am stuck. I’m twenty-seven years old. I have been in New York for eight months, and I want to leave and maybe move to Austin, Texas. But I don’t think I can go without some sort of plan. My physical symptoms haven’t gotten worse in a long time, but they also have not gotten much better. I know I’m not going to die from this, but I have no idea how it is ever going to get resolved. And then, walking around Manhattan with my headphones in, I hear him.