Chronic erectile dysfunction - Blood test results

Zibernet

Active Member
The original point stands. Esterified testosterone is considered bioidentical. When it hits the bloodstream the ester is rapidly detached and the testosterone is then indistinguishable from topically-absorbed testosterone. What matters for HPTA suppression is the serum concentration and the length of time at levels higher than the natural set point. Thus far the only form of exogenous testosterone proven to allow continued HPTA function is the nasal gel.

Did you measure LH and FSH after being on this high dose for some months? If so and they showed normal levels then you would be quite unique, one among thousands or more. If not then the anecdote suggests a fairly rapid recovery of natural production following discontinuation of exogenous testosterone. Topical testosterone would clear the body more rapidly than esterified forms.

Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.
 

Cataceous

Super Moderator
Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.
So you were shut down by bioidentical testosterone, as expected. After stopping, you recovered your natural production, as would most men, including those who had been using esterified testosterone.

Your statement about esters is false. Daily injections of testosterone propionate create peaks and valleys that are more pronounced than natural variations, yet still cause HPTA suppression.

Recall that the doctor's claim is "... bioidentical hormones ... don’t shut down your own production". This is not qualified in any way, so it is false. At therapeutic doses, transdermal testosterone, injections and pellets all result in HPTA shutdown, even though they all use bioidentical testosterone.
 

madman

Super Moderator
Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.

* All formulations, with the exception of the short-acting ones, have a target of long-term maintenance of SUSTAINED STEADY_STATE TESTOSTERONE LEVELS IN THE MID_NORMAL RANGE, which leads to suppression of the endogenous activity of the HPG axis.



post #78/79/80/81



 

madman

Super Moderator
Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.

This is key: long-term maintenance of sustained steady-state testosterone levels in the mid-normal range, which leads to suppression of the endogenous activity of the HPG axis.

Topical gel formulations achieve a sustained mid-normal T level with a once-daily application (8). While the topical gel results in less fluctuation of T levels between dosing intervals when compared to IM T, the sustained T levels result in inhibition of HPG axis activity (9).
The inhibition of HPG axis activity is evidenced by the nearly full suppression of gonadotropin levels following treatment with either IM injectable testosterone (10) or topical gel administration (9).








Even once daily scrotal application (cream) can easily maintain steady-state mid-normal let alone high-normal physiological T levels.


RESULTS

*Figure 1 shows the concentration profile in blood serum after administration of a 200-mg dose of testosterone via Topi-Pump and VersaBase


As shown in Figure 1, therapeutic levels were reached at 116 minutes and remained maintained to beyond 346 minutes. Further evidence (unpublished internal data) suggests therapeutic concentrations (>1100 ng/dL) at up to 24 hours. More research is needed to confirm these concentrations. Most importantly, the patient’s low testosterone symptoms resolved without adverse effects from the therapy.
 

madman

Super Moderator
Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.


Abstract

Transdermal testosterone has been used for years to treat patients with low testosterone symptoms. Clinically, we have monitored patients to evaluate results of testosterone absorption via blood serum concentrations. The data on multiple time points to determine trough and peak concentrations is lacking in the literature. In this case study, we demonstrate the absorption of testosterone cream via scrotal delivery. The data suggests that after application therapeutic levels are reached with concentrations of (1204.7 ng/dL) within two hours. Additionally, consistent concentrations (1320.6 ng/dL) remain beyond six hours. To our knowledge, this is the first study to collect and measure multiple time points for testosterone via transdermal delivery. The research indicates that testosterone via transdermal delivery is an excellent method to achieve therapeutic concentrations of testosterone. Most importantly, the patient's symptoms resolved without side effects.
 

madman

Super Moderator
Why would I need to test for LH and FSH?
My original levels having returned is proof enough that HPTA function has recovered.

I didn't equate "bio identical" to "esterless", I was precise enough to make the distinction. It's precisely the presence of an ester that causes the shutdown as it doesn't allow for peak and valleys throughout 24h periods. It makes hormone levels so constant that the HPTA senses sufficient hormone levels and shuts down over time.

post #37/38/43

Screenshot (5534).png

Figure 1 Serum testosterone following three doses (12.5, 25, 50 mg) of testosterone cream applied to the scrotal skin at time zero with sequential blood sampling at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14 and 16 h. Each participant underwent scheduled blood sampling after administration of each of the three doses with at least 2 days between the administration and sampling periods. S1 and S2 are two screening blood samples taken prior to the study and P1 and P2 are two blood samples taken 15 and 5 min prior to the application of the testosterone cream. Data are plotted as the mean and standard error of the mean. Biexponential curves are fitted to all the data for each dose. For further details see the text. Note conversion factors: to ng/dL multiple ng/mL by 100; to SI units multiply ng/mL by 3.47. [Colour figure can be viewed at wileyonlinelibrary.com].




DISCUSSION


This study provides a pharmacokinetic profile of three doses of testosterone administered to the scrotal skin in a cream formulation. Application of the testosterone cream produced a rapid rise in serum testosterone peaking around 2 h after administration with a dose-dependent peak concentration, but not any consistent relationship between time of peak and testosterone dose. At the lowest dose (12.5 mg), the serum testosterone concentrations were maintained in the physiological range for at least 12 h and with the 25 mg dose maintained serum testosterone concentrations within the physiological range for nearly 24 h concentration.




Take-home point: maintained serum testosterone concentrations within the physiological range for at least 12 h and for nearly 24 h.
 

madman

Super Moderator
Thanks a lot. That’s what I thought, it was too good to be true. The question still remains: should I give it a try? I don’t know. My testosterone is okay, and my progesterone is a little low, but overall my levels are fine. I still have to make up my mind about it.

Think deeply on this one before you jump in head first!

Sure there is a good chance that during the short-term honeymoon phase that you will experience a strong increase in libido/erections which is common as you are driving up T levels/increasing dopamine but it will most likely be short-lived and temporary.

Once the body adjusts you may very well end up with improvements in libido/erectile function but it is not a given especially seeing as you have healthy T levels (TT 600s and normal SHBG) let alone a functional HPG axis.

Only time would tell and again much more involved when it comes to libido/ED than just having healthy T levels.

Shut down of the HPG axis most likely has a big impact.

There is so much more involved when it comes to libido/erectile function.

Having healthy testosterone levels is one piece of the puzzle.

Even then when it comes to trt and libido many tend to get caught up in thinking that it will be through the roof once they hop on trt and get to the point of so-called dialed in let alone cure any ED issues they may have.

When you find that happy place you should have a healthy libido not raging, savage, insane.

There are many men who will see an improvement in libido, others will continue to struggle, some may even end up worse off than before trt and some of the lucky ones will see a drastic improvement.

I think too many get caught up in expecting to feel great 24/7 once on trt as if testosterone is going to cure all that ails them.




Seems as though you have already made up your mind:

So I finally talked with the anti-aging doctor, and she gave me a prescription. It’s a cream that I will have to apply to my arms. I’ll have to take it 6 days a week (she wants me to have one break from the treatment every week). Here’s what’s in it:

Testosterone 80mg
Progesterone 15mg

She said, though, that she doesn’t think my ED is caused by a problem with my hormones since my levels are not bad.
She still thinks that it’s worth giving it a shot and that I’ll probably have other benefits from the treatment. She also prescribed vitamin D.
 

madman

Super Moderator
So I finally talked with the anti-aging doctor, and she gave me a prescription. It’s a cream that I will have to apply on my arms. I’ll have to take it 6 days a week (she wants me to have one break from the treatment every week). Here’s what’s in it:

Testosterone 80mg
Progesterone 15mg

She said, though, that she doesn’t think my ED is caused by a problem with my hormones, since my levels are not bad. She still thinks that it’s worth giving it a shot, and that I’ll probably have other benefits from the treatment. She also prescribed vitamin D.

I haven’t decided if I’m going to try it or not. Before trying hormones, I’ll try something else, a little supplement kit that seems to be helpful for guys with mild ED (as recommended by someone on this forum). I’ll start this next week and will try it for one month: L-Arginine, L-Citrulline and Pycnogenol. If anybody is curious, here are the links to the studies that showed the benefits of these supplements for ED:

Treatment of erectile dysfunction with pycnogenol and L-arginine - PubMed

Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction - PubMed

That’s about it. There’s only one thing that confused me when I met with the doctor: she told me that bioidentical hormones (which she prescribed me) don’t shut down your own production. I was surprised to hear that, because I haven’t read any reference to this on the forum. Does that make any sense?

Once again, thanks everyone for your input. I’ve learned a lot in the last weeks.

Not trying to deter you in any way but shutting down a healthy functioning HPG axis is
a big move!

Do what you feel is best for you.

Even then if you decide to hop on trt then I would at the very least look into trying Natesto.
 
Not trying to deter you in any way but shutting down a healthy functioning HPG axis is
a big move!

Do what you feel is best for you.

Even then if you decide to hop on trt then I would at the very least look into trying Natesto.
Thanks a lot for your input. I haven’t made up my mind yet, but I’m leaning towards not taking the treatment. I find the risks are much higher than the chances the treatment helps me in regards to ED. It seems to be the opinion of most guys who wrote in my thread as well.

I’ll start with my supplements kit for 30 days (L-arginine, L-citrulline and Pycnogenol), and then I’ll go on daily Cialis. If I can have a decent erection during sex with daily Cialis, then I’ll be very happy with that option. I don’t want to feel horny 24/7, that’s not what I’m looking for. I just want to be able to make love to my girlfriend when I go to bed with her, and be able to take my time and do different positions without losing my erection.

I’m still staying away from porn and masturbation, so hopefully things will improve during the next year, like it did for thousands of other Nofapers. If I’m still dealing with ED in 6 or 12 months and can’t rely on daily Cialis to have decent boners, then I might try TRT, but if I do, it will be for a brief period, just to see if it has any impact on my libido and erection quality.
 

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