Basic erection questions

I wanted to crowdsource some thoughts on erection issues I'm having.

Background
  • I am 33 years old, generally healthy
  • Started TRT at age 28 - after symptoms, discovered a pituitary tumor and T levels in the 100s. Ruled out primary hypogonadism.
  • TRT has done wonders for my physical appearance and state of mind, but has not helped much with sexual issues
  • Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
  • PDE5is are not very effective
  • PT-141 is the most reliable in giving a firm erection, but I hate the GI side effects
  • I am low SHBG
Questions
  • Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
  • If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
  • Could E2 be a factor here? Or thyroid?
Latest Labs
  • T - 749 (300-1080) - 22mg T ED
  • FT - 245 (47-244)
  • SHBG - 16 (16.5-55.9)
  • E2 - 24.8 (10-42) - 0.1mg anastrozole EOD
  • FT3 - 3.6 (2.2 - 4.2) - on 60mcg Armour ED - these labs were taken prior to my daily dose
  • FT4 - 0.85 (0.80-1.90)
  • TSH - 1.83 (0.40-4.1)
  • Prolactin - 10 (4-26)
 

DixieWrecked

Active Member
I wanted to crowdsource some thoughts on erection issues I'm having.

Background
  • I am 33 years old, generally healthy
  • Started TRT at age 28 - after symptoms, discovered a pituitary tumor and T levels in the 100s. Ruled out primary hypogonadism.
  • TRT has done wonders for my physical appearance and state of mind, but has not helped much with sexual issues
  • Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
  • PDE5is are not very effective
  • PT-141 is the most reliable in giving a firm erection, but I hate the GI side effects
  • I am low SHBG
Questions
  • Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
  • If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
  • Could E2 be a factor here? Or thyroid?
Latest Labs
  • T - 749 (300-1080) - 22mg T ED
  • FT - 245 (47-244)
  • SHBG - 16 (16.5-55.9)
  • E2 - 24.8 (10-42) - 0.1mg anastrozole EOD
  • FT3 - 3.6 (2.2 - 4.2) - on 60mcg Armour ED - these labs were taken prior to my daily dose
  • FT4 - 0.85 (0.80-1.90)
  • TSH - 1.83 (0.40-4.1)
  • Prolactin - 10 (4-26)
Great question and great post. I am sure stopping the ai will help things but I don't know how much of an effect it will have on your erections. According to your blood work you are really healthy. For me, TRT has hurt my erections/libido and helped in every other department. Not sure what the solution is at this point but continue to try new things.

How do you dose the PT141. Just when you need it or a couple times week? Where do you get it from?
 
Great question and great post. I am sure stopping the ai will help things but I don't know how much of an effect it will have on your erections. According to your blood work you are really healthy. For me, TRT has hurt my erections/libido and helped in every other department. Not sure what the solution is at this point but continue to try new things.

How do you dose the PT141. Just when you need it or a couple times week? Where do you get it from?

It is prescribed by Defy and I get it from Empower. I take 0.15 ml and it gives me rock hard erections for hours, but I can‘t stand the nausea. I’m more curious in why that works vs. PDE5s or anything else I’ve tried. It doesn’t increase libido as it is documented to; it just gives me raging erections that need to be satisfied lol.

Why do I not have morning erections? What should I do to rule things out there or potentially improve - I think it’s all related.
 

Cataceous

Well-Known Member
In addition to dropping the AI I would experiment with lower doses of testosterone. With lowish SHBG you likely don't need so much. I think you could reduce the cypionate to as little as 12 mg daily without becoming hypogonadal. There's a decent chance you'd feel better dosing somewhere between this and your current 22 mg. Just give things lots of time to settle between changes.

For further perspective: If you had average SHBG then with your current free testosterone your total testosterone would be over 900 ng/dL, according to the Vermeulen calculator. And if the average guy your age had your SHBG of 16 nMol/L then his total testosterone would be about 500 ng/dL. You're sitting 50% higher than that. What if this level is unnatural for your body? This and the loss of upstream hormones are two of the most common reasons why guys have problems with TRT.

Regarding nocturnal erections, they do seem to be an indicator of when things are working right. They can also be surprisingly sensitive to minor perturbations. I recently tried adding a mere 1 mg nandrolone (NPP) to my daily protocol and was surprised at the disruption caused by such a seemingly minor change, including a major reduction in nocturnal erections. This makes the whole system more sensitive than I would have suspected. The takeaway is that trial and error are necessary components of TRT dosing.
 
In addition to dropping the AI I would experiment with lower doses of testosterone. With lowish SHBG you likely don't need so much. I think you could reduce the cypionate to as little as 12 mg daily without becoming hypogonadal. There's a decent chance you'd feel better dosing somewhere between this and your current 22 mg. Just give things lots of time to settle between changes.

For further perspective: If you had average SHBG then with your current free testosterone your total testosterone would be over 900 ng/dL, according to the Vermeulen calculator. And if the average guy your age had your SHBG of 16 nMol/L then his total testosterone would be about 500 ng/dL. You're sitting 50% higher than that. What if this level is unnatural for your body? This and the loss of upstream hormones are two of the most common reasons why guys have problems with TRT.

Regarding nocturnal erections, they do seem to be an indicator of when things are working right. They can also be surprisingly sensitive to minor perturbations. I recently tried adding a mere 1 mg nandrolone (NPP) to my daily protocol and was surprised at the disruption caused by such a seemingly minor change, including a major reduction in nocturnal erections. This makes the whole system more sensitive than I would have suspected. The takeaway is that trial and error are necessary components of TRT dosing.
Great points, and yes, am planning to first experiment with removing AI, then lowering T.
 

DixieWrecked

Active Member
It is prescribed by Defy and I get it from Empower. I take 0.15 ml and it gives me rock hard erections for hours, but I can‘t stand the nausea. I’m more curious in why that works vs. PDE5s or anything else I’ve tried. It doesn’t increase libido as it is documented to; it just gives me raging erections that need to be satisfied lol.

Why do I not have morning erections? What should I do to rule things out there or potentially improve - I think it’s all related.
How often do you take it? Once a week?
 

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