A year into TRT ED worse than ever

[StepbyStep]

So long story short, I've been on HRT for over a year now. First just Testosterone Cypionate then HCG Monotherapy. I've been with Defy since August, and have been really happy with the results. We've made one protocol change so far and this is my current protocol:

-30mg Test Cyp EOD
-500iu HCG EOD
-35mcg T3 ED

I'm finally getting to the point where I feel mostly normal. Energy is good, no more random crushing fatigue, mood is decent, my body seems a lot more robust and heals quickly, good orgasms. The one problem I've had since I was 18(currently 27), and has been worse since starting TRT, would by my ED. I am basically incapable of having sex without cialis, viagra or trimix. Trimix is my go to because I response poorly to PDE-5 inhibitors. Before TRT I definitely had ED, but could still have sex naturally for 10-15 minutes most of the time, and my libido was much higher. I'm considering getting off of TRT after another 6 months just to get back to this level of functionality.

I'm getting to the point where I'm laying out a plan to move on to exploring organic issues, and have two Urologist appointments scheduled. I'm open to all options at this point, whether it be venous ligation, ganeswave therapy, priapus shot, and stem cell therapy. I'll work my way down the list and am willing to spend every penny I have, and sell everything I own to get where I want to be.

Now these are my most recent labs on my old protocol:
(note SHBG is usually around 25)

-40mg Test Cyp EOD
-500iu HCG EOD
-20mcg T3 ED

Just looking for any advice, opinions really. I think I'm on the right track, but I'm open to suggestions.

One side note, I mentioned this to Dr. Saya, but since starting TRT/HRT it feels as if my dopamine reward system is blunted. I no longer feel a lot of excitement, or feel a sense of accomplishment like when I get a big paycheck or complete a project. It's almost as if my emotions are flat-lined. This is not something that I've ever experienced before TRT.

 

[BigBamBoo]

I too feel very...linear...on TRT. And that is part of the “byproduct” of TRT.

Normal hormones fluctuate. You have highs and lows normally.

TRT take away...or at least lessens...those ups and down. So many it seems become “flat”.

Now some folks seem to like the flatness vs being moody or having such emotional swings.

I would imagine most get use to it after being in TRT for awhile.

 

[Checkdis]

I think 40mg EOD is excessive.... I would do 50mg every 3.5D. And 500iu EOD HCG is crazy. You really only need 1000iu a week, so 350iu three times a week is best practice. I suspect there is an estrogen and prolactin issue related to your ED suffering. I would add .125 once a week for 3-6 weeks then get bloods done to dose properly towards your estrogen.

Are you on any other medication?

Also anxiety can greatly impact ED. Please don’t take this the wrong way, I am just saying this in my honest opinion, but you are on a forum looking for answers as many of us are... I believe you are obsessing over your issue which amplifies ED. Try not caring and go on with your day, who cares type of attitude. It is tough but remapping your brain will help.

I’m putting my money on this is all in your head, but it is a good idea to re-evaluate your medication. I am certain veterans on this forum would agree that 40mg EOD is wayyyy heavy of a dose. As well as your HCG. The amount of HCG you are taking i’m surprises your estrogen isn’t through the roof. I’m curious what your prolactin is at.

I have had the same issue with ED and it took about a year to retrain my way of thinking to fix it. I pretty much stopped masterbating, no more internet porn, found what turned me on and tried new things. It really comes down to the way you view things. Would you rather live with ED, or urinate every 15 minutes for the rest of your life.

 

[Systemlord]

I also believe your dosage and levels are just too high, after I decreased my levels from 1053 down to the 450-500 range it was as if testosterone and estrogen became more potent. I have a theory that the extremely high levels were just too much for my receptors to process, so my receptors blunted the androgens while my levels were very high.

It kind of sounds like that's what's happening to you.

 

[Vince Carter]

Your SHBG @ 17 and E2 is 37...E2 is way too high, should possibly be much closer to your SHBG value.

See how high your Free T is? Way over the lab range. You likewise quite likely have a large amount of Free Estrogen to go along with. Need to reduce your Cyp dose such that your Free T meets the lab range and not exceed that. As Systemlord says your numbers are way too high, for your SHBG. This will not work for you. This could reduce your Estrogen. May need an AI if that doesn't get E to come down.
Its good to see that there's some by way of your provider working with your SHBG with EOD shots but it's woefully inadequate.

I'd cut to 25mg EOD. HCG is EXCESSIVE at 500iu EOD, probably contributes to your Estrogen problem.

 

[SpeedJunky]

Whats is your height weight? BMI?

Anxiety and depression is also a bitch, know that feeling.

 

[StepbyStep]

Thank you all for the replies, I plan to respond in detail as best I can once I get home! There are a lot of great points being made and I am very thankful for that.

Kiko, I am sorry that you're also struggling in a similar way. I understand your pain and frustration. I mean no disrespect, but could you please remove your posts and start your own thread as to not confuse people and convolute the data. This will be beneficial for the both of us.

 

[Vince Carter]

I’ve tried it all, thousands of dollars spent without any improvement!! And Normal U/S.. at least before Cialis worked..

61 y/o
5 8
160

Lets limit the discussion to what stepbystep is going thru.

 

[SpeedJunky]

Lets limit the discussion to what stepbystep is going thru.

Oops. Completely didn't notice he wasn't the OP. My fault.

 

[Donovan P]

One side note, I mentioned this to Dr. Saya, but since starting TRT/HRT it feels as if my dopamine reward system is blunted. I no longer feel a lot of excitement, or feel a sense of accomplishment like when I get a big paycheck or complete a project. It's almost as if my emotions are flat-lined. This is not something that I've ever experienced before TRT.

Have you previously used, or do you currently use, SSRIs?

What about a 5-alpha reductase inhibitor such as finasteride (Propecia)?

 

[StepbyStep]

I'm going to do my best to cover all the questions.

-Current height is 5'11"
-Weight is 180lbs
-Prolactin usually hovers between 10-12 ng/mL
-No other medications, no SSRIs, no 5ar inhibitors ever.
-I haven't watched porn for about 5 months now, and I've gone 7 months before without watching porn a few years ago. Never saw any improvements, my erection quality was still frequently poor while watching porn.

With regards to a psychological component contributing to my ED, at this point yes it's possible. With that said, I was with my previous partner for nearly 8 years, and while I had ED, I could still perform for about 10-15 minutes usually which would satisfy her. She was a one and done type of woman. The real problem I had then was I would lose my erection while laying on my back, because gravity was working against my erection. She never made me feel bad about my problem, and for the most part I never really thought about my ED because although it was present, things were manageable. My current partner, whom I've been with for about 5 months has been incredibly supportive and patient with me. Thank god for Trimix though, I never really realized what I was missing out on. I'm in tune with my body at this point, and unfortunately I know that there is a psychical and hormonal problem going on. I have been making an effort over the past several months to stay off these forums and stop thinking about my problems. The fact that I have been feeling good on Defy's protocol has really helped me focus on other things. I'm getting to a point where I need make sure I'm on the right path, and save myself from making anymore decisions that waste time and money.

I agree, I thought the starting dosage was too high. However I figured it was worth a shot to get to the top of the range or higher, just to see at that point. I've hovered between 400-600 ng/dL on my other protocols before defy without success. I could simply be feeling better because of the T3 only therapy, and the TRT has had little to do with it, who knows?

On the topic of HCG, I was on HCG Monotherapy for about 5 months, and know how my body handles it. I would consider myself a low level responder to HCG, but I agree that it would be worth a shot to the dosage to 350iu EOD to help lower my E2.

I think you guys are right, I'll have to do a small set of labs through Defy halfway through this protocol and make some adjustments. Perhaps this for my next protocol after labs:

25mg Test Cyp EOD
350iu HCG EOD
35mcg T3 ED

Thank you all again!

 

[Checkdis]

I would also consider adding a very low dose of AI taken once a week like .125mg. And get blood work done in 4-6 weeks. But HCG EOD at 350 is still very high man.

 

[StepbyStep]

I could try this for a period, as I have some .125s on hand, but I really want to see what my body converts naturally. On all of my previous protocols I have never been a huge E2 converter. So I hope it's possible to bring E2 down with protocol tweaks.

What do you recommend for HCG dosing? That in itself could be an easy experiment.

 

[StepbyStep]

I too feel very...linear...on TRT. And that is part of the “byproduct” of TRT.

Normal hormones fluctuate. You have highs and lows normally.

TRT take away...or at least lessens...those ups and down. So many it seems become “flat”.

Now some folks seem to like the flatness vs being moody or having such emotional swings.

I would imagine most get use to it after being in TRT for awhile.

It has had it's advantages, I really don't get nervous or worked up about things anymore. I would like to resolve this to some degree if possible. Defy recommend L-Tyrosine which I may give a try. I've found that EOD dosing is really needed for me to feel good without ups and downs. I've pondered possible ways to increase hormonal variation without having a massive impact on my protocol. Ideas such as skipping an injection occasionally, injecting HCG every other injection, switching to an E2D protocol to allow for some ups and downs. Once I get dialed in and my ED improves I'll have to experiment with this. The unfortunate nature of TRT though is only making small adjustments every six weeks with labs to avoid sabatoging oneself. This makes for a lengthy process.

 

[S1W]

StepbyStep,

Sorry to hear that you are dealing with this. A few thoughts:

- Do you know whether or not you have nocturnal erections? If as you say you won't spare any expense to get to the bottom of this, you might want to consider medical testing for nocturnal penile tumescence (night erections/morning wood). As mentioned above, there is a often a psychological component to ED and this might help to point you in the right direction as to whether or not the ED is purely physiological.

- Have you considered simply not using HCG at all? I removed it completely from my protocol almost a year ago and seem to do better without it.

- My $0.02 is that your E2 is not really that high given your TT/FT levels and if it were me I would not introduce an AI before doing quite a bit of experimenting with a slightly lower overall dosage of T and trying more frequent injections, too.

- Regarding the lack of ups and downs with injections and slow adjustment process - I hear ya there. Have you ever tried transdermal compounded cream? With your SHBG you might have to apply 2x per day anyway so maybe the natural cycle argument is a moot point, but the process of dialing in is a lot quicker than the 6-8 week limbo period with injections. I started out on a cream protocol (on injections now) and think about going back to cream sometimes - it was a decent protocol. I was using 1x per day application with an SHBG of 28 (injections lowered SHBG about 5 points).

Good luck with this.

 

[DragonBits]

I think for people that feel emotionally flat, don't sleep well, feel sluggish, nervous AND their hormone levels look OK on paper to do a Neurotransmitter Panel.

Neurotransmitters can cause a lot of problems people complain about.

Neurotransmitter Basic Panel | Urine Test | Life Extension

This panel contains the following 9 neurotransmitters:

Neurotransmitter
High levels in urine
Low levels in urine
Serotonin is an inhibitory neurotransmitter and contributes to feelings of happiness and well-being
May contribute to anxiety, high blood pressure, irritability, and low libido
Associated with depression, worry, obsessive thoughts, carbohydrate cravings, PMS, difficulty with pain control, sleep disturbances, and IBS
GABA functions as the brain's major inhibitory neurotransmitter
Associated with sluggish energy, feelings of sedation, and foggy thinking
Implicated in feeling stressed, overwhelmed and/or irritable, impulsivity, anxiety, ADHD, and seizure disorders
Dopamine regulates the pleasure/reward pathway, memory, and motor control
May contribute to hyperactivity, anxiety and schizophrenia. May also be related to autism, mood swings, psychosis, and attention disorders
Associated with memory issues, loss of motor control, cravings, compulsions, loss of satisfaction, and addictive behaviors
Norepinephrine (noradrenaline) Involved in a wide variety of actions including attention, focus, regulating heart rate, affecting blood flow, and suppressing inflammation
Linked to anxiety, stress, elevated blood pressure, and hyperactivity
Associated with lack of energy, focus, and motivation
Epinephrine (Adrenaline) is heavily involved in the acute stress response and helps regulate muscle contraction, heart rate, glycogen breakdown, and blood pressure
Associated with ADHD, hyperactivity, anxiety, sleep issues, and acute stress response
Leads to difficulty concentrating, fatigue, depression, insufficient cortisol production, chronic stress, poor recovery from illness, and dizziness
Glutamate functions as the brain's major excitatory neurotransmitter
Can cause excitotoxicity, a process that damages nerve cells through excessive stimulation. Associated with panic attacks, anxiety, difficulty concentrating, OCD, and depression
May result in agitation, memory loss, sleeplessness, low energy levels, and depression
Glycine is inhibitory and plays a dual role as both a NT and an amino acid. Glycine improves sleep quality, calms aggression and serves as an anti-inflammatory agent
May be associated with compromised cognitive processing
May contribute to poor sleep, poor cognitive function and issues with memory
Histamine is an excitatory neurotransmitter involved in the sleep/wake cycle and inflammatory response
May be associated with allergy-like symptoms, gastro-intestinal concerns and inflammation
May affect digestion and appetite control, learning, memory and mood and may result in drowsiness
PEA (Phenylethlyamine) promotes energy, elevates mood, regulates attention and aggression, and serves as a biomarker for ADHD
May contribute to anxiety with very high levels having amphetamine-life effects. May be associated with higher cortisol levels
May be associated with ADHD, depression, Parkinson’s disease and bipolar disorder


I am sure other labs offer this as well as life extension, LEF was easy to access the info.

But I think it's likely to show information you won't get just looking at blood tests and hormone levels.

I have never done one, but I think I will come next year when LEF has a sale on their labs. Current price is $199, but it's likely to be cheaper next Q.

 

[StepbyStep]

StepbyStep,

Sorry to hear that you are dealing with this. A few thoughts:

- Do you know whether or not you have nocturnal erections? If as you say you won't spare any expense to get to the bottom of this, you might want to consider medical testing for nocturnal penile tumescence (night erections/morning wood). As mentioned above, there is a often a psychological component to ED and this might help to point you in the right direction as to whether or not the ED is purely physiological.

- Have you considered simply not using HCG at all? I removed it completely from my protocol almost a year ago and seem to do better without it.

- My $0.02 is that your E2 is not really that high given your TT/FT levels and if it were me I would not introduce an AI before doing quite a bit of experimenting with a slightly lower overall dosage of T and trying more frequent injections, too.

- Regarding the lack of ups and downs with injections and slow adjustment process - I hear ya there. Have you ever tried transdermal compounded cream? With your SHBG you might have to apply 2x per day anyway so maybe the natural cycle argument is a moot point, but the process of dialing in is a lot quicker than the 6-8 week limbo period with injections. I started out on a cream protocol (on injections now) and think about going back to cream sometimes - it was a decent protocol. I was using 1x per day application with an SHBG of 28 (injections lowered SHBG about 5 points).

Good luck with this.

-Overall no, if I do have nocturnal or morning wood, it is weak and doesn't last long. I have had a couple of very short periods where I woke up with decent MW. These periods last only a few days. I have recently learned though that 10mg of Cialis and 50mg of Viagra taken before bed guarantees that I'll wake up with a 100% erection that lasts for 5 minutes or so after waking. I just ordered a bunch more PDE-5 inhibitors so that I can do this more frequently. I hope that at least one of the two urologists that I see will request a nocturnal tumescense test.

-Ive found that when on Testosterone only, my balls would ride so high and tight that it was uncomfortable and I experienced a lot of shrinkage. Orgasms and ejaculate volume we're poor. I was on test alone for 5 months and would never go back. HCG fixed all of those problems.

-That's what Dr. Says said, there are so many opinions on this it's hard to tell which direction to take. I'd rather not take an AI personally.

-Thank you for the suggestion, I'll give it some consideration down the road.

 

[StepbyStep]

DragonBits,

I was looking into that a while ago, have you ever done this panel or have any knowledge of interpreting the results? The research I did a while ago seemed to indicate that measuring the metabolites of nurotransmitters as this panel does, will not provide an accurate picture of actual nurotransmitters activity within the brain or nervous systems. In addition, nurotransmitters are an area of science that is so quantum in nature that we know so little about.

With that said, I would like to do the test, possibly in a few months when funds permit. I wish that these topics came up more often. I feel as if a thread could be dedicated to this topic alone. Thank you!

 

[Checkdis]

DragonBits,

I was looking into that a while ago, have you ever done this panel or have any knowledge of interpreting the results? The research I did a while ago seemed to indicate that measuring the metabolites of nurotransmitters as this panel does, will not provide an accurate picture of actual nurotransmitters activity within the brain or nervous systems. In addition, nurotransmitters are an area of science that is so quantum in nature that we know so little about.

With that said, I would like to do the test, possibly in a few months when funds permit. I wish that these topics came up more often. I feel as if a thread could be dedicated to this topic alone. Thank you!

Let me know what blood panels are ran if you end up looking into this. I am also curious for myself. Would like to see what a Neurologist tests to make sure everything is balanced?

 

[StepbyStep]

Small update,

My appointment with the first Urologist went extremely well. He's younger, energetic, and even offered to prescribe me any medications I need HCG, Test, Trimix, Cialis, ect. Just to give him a call. He also gave me a referral to a well renowned Urologist that has a great deal of experience, and has every piece of testing equipment possible when it comes to testing for ED. He spoke very highly of this guy, so I'm quite excited to say the least.

Also pleasantly surprised to find that my insurance covers daily 5mg Cialis, where previously I could only get x18 10mg every 75 days.

Will keep you this thread updated in the months to come.