ED issues - 2 years & counting trying to get to root cause

[bc0116]

Hey guys,

First, love this forum and all the great content on here. My wife and I have been dealing with a very personal issue (like a lot of men) of trying to tackle ED/mental impotence and we are really trying to get to the root cause and work through it. Symptoms pre-TRT were initially low libido, and no matter what I do/my wife does, the gear just wasn't working. I have faced the issue where I get it up, but then in mid-sex session I just lose the erection.

I'm now 37, got on TRT amongst other recommended supplements by my Doc in Feb 2018. Symptoms now are at high libido, but there is that dreaded mental block of being able to perform and maintain erection. It's to the point where when we have time together, we just "try." Sometimes gear will work, sometimes it won't. It's to the point where my wife just says if I'm up, let her know, and it's completely humiliating if gear doesn't work on-demand.

I've tried sildenafil and like most, it'll work with good planning, but to me that's just a band-aid and is never guaranteed with life's daily tasks. I have not tried Cialis or any other PDE-5 inhibitor. I've been open to those, but I don't like having to rely on one particular extreme drug for "just incase". I wake up often with raging/very hard morning woods and can usually get it up mid-day. Weird thing is, I'll have it, then if I initiate sex, there's no telling if it'll go limp at any point which increases my anxiety for not wanting to create emotional turmoil between us.

Feb 2018 initial blood results with no medications:

Aug 2019 Blood results (I also got recent blood work done as a bi-annual but no changes in Rx at all).

My Doc currently has me on:
1.2mg (240mg) of Test-cyp -- injecting 1x per week
100mg DHEA
100mg Pregnenolone
120mg Thyroid (60mg 2x per day) but lately I've been doing 60mg 1x per day to see if that has any effect
5,000 mcg Vitamin B-12

I've noticed my libido is up (I want sex all the time), but still have issues getting it up on-demand. I normally am roughly 195-200 lbs, 10-12% body fat prior to TRT and have been lean for years. On TRT and the other supplements, I hover around 205-209 and have noticed a bit of water retention but is not entirely bothersome. The strength numbers in the gym are much higher which is nice, but my main concern is tackling this ED issue and restoring back good reliable erections/healthy sex life with my wife.

A bit of background -- I am 37, no injuries or other issues. I'm a 10 year fitness trainer and nutrition coach. I hardly drink alcohol (maybe 1-2 drinks with a dinner). I have a beautiful wife, two kids (2 and 5 year old), work full-time, school full-time (2nd bachelor's degree), and manage two business.

I often wonder if I am doing too much or over stimulating my brain, but I feel like I manage my time wisely where they never blend into each other. I value quality family and personal time, but when it comes to bedroom time with wifey, it's a huge soft spot and is a gamble.

Thanks for your time and any recommendations.

 

[Mountain Man]

Seems to be a high dose of test and a complicated protocol. Others have more knowledge that I about the protocols. I do know a lot about the psychological side and can definitely shed some light on that. I’d suggest daily cialis, 5 mg and start with 10 mg when sex is planned. You are not, in my opinion, incapable of great sex. It would seem the combination of where you are in life, the kids, work, school and the other stressors are the problem. I was in the same exact spot at about the same age. Sildenafil is not as good if you need to plan, which you do.
The biggest issue seems to be your expectations. Sex is a more broad thing than just orgasms, and when a relationship is in the spot you are in, there is a hyper focus on orgasms. Anxiety and unrealistic expectations make that even more difficult, as counterintuitive as that seems. Learning to give and receive pleasure can be incredibly exciting and it can feel like you are with your long time partner for the first time. You, and your wife, need to relearn how to flirt, tease, and excite each other. “Let me know if you are hard and we’ll try” isn’t going to help and actually makes things worse.

There are other ways to engage in good sex beyond intercourse. There are a lot of good books that can help. She Comes First is one, and He Comes Next, both by Ian Kerner are two good ones. Another one is this one, available for free. http://www.eso-garden.com/specials/complete_idiots_guide_to_tantric_sex.pdf
Share these books and ideas with your wife. It increases the excitement and anticipation needed for good sex. Once you relax and enjoy the journey of sex, as opposed to the destination, it does get better.

Biggest thing is relax. It is common, especially at that stage of life. Sounds exactly like my wife and I at age 40. Kids complicate things, but they can be taught when the door is locked to knock add stress management, meditation, cognitive behavioral therapy, and bibliotherapy, along with daily cialis and you’ll be fine. Have fun, enjoy your wife and your sex will remain the glue that holds you both together. We are having the most frequent and best sex of our lives at 66 and 64. I think that’s why sex was invented!

 

[bc0116]

Mountain Man, thank you for your outstanding and helpful advice! I will look into those. I really appreciate it!

 

[madman]

Mountain Man, thank you for your outstanding and helpful advice! I will look into those. I really appreciate it!

Regarding the mental aspects you have been given great advice as always thanks to Mountain Man.

Seeing as you are injecting a high dose of T 240 mg/week when were your labs drawn?

The proper way is to test at trough and if you are injecting Monday morning at 9 am than you would have blood work done the following Monday morning just before your next injection.

Looking over your labs your TT/FT levels are at the high end and if these are your true trough levels than your peak TT/FT levels will be much higher post injection/days following.

This can easily cause issues as not only will your testosterone levels be way too high at peak/early in the week but your main issue will be the fluctuations in your levels from injecting such a high dose of T once weekly as there will be an extreme between your peak--->trough T levels which can wreak havoc on the stability of ones mood/libido/erectile function/energy/overall well-being.

If your TT/FT levels on your most recent labs are true trough levels (7 days post injection) than it would be much more sensible to try lowering your dose and injecting more frequently as in twice weekly (every 3.5 days).

You could try lowering your overall weekly dose to 200mg/week (100 mg every 3.5 days) and stick to that protocol for 6-8 weeks gauging how you feel along the way than have blood work done to see where your TT/FT/e2 levels sit at true trough.

Most men on trt are using anywhere from 100-200 mg/week and even than 200 mg/week is not needed by most to achieve a healthy TT/FT levels.

Some men can even use less than 100 mg/week and yes some do use slightly higher doses than 200 mg/week but it is rarely ever needed to achieve healthy TT/FT levels.

Injecting lower doses more frequently as in your case twice weekly (every 3.5 days) will result in much less extremes between peak--->trough compared to injecting higher doses once weekly and your blood levels will be more stable throughout the week which can have beneficial effects on ones mood/libido/erectile function/energy and overall well-being.



I would also look into switching up your protocol as not only is your T dose very high but your TT/FT levels are not stable throughout the week.

Less frequent injections as in once weekly will result in very high peaks post injection and very high levels the following days after injection only to be followed by lower levels later in the week at trough.

From your initial blood work pre-trt:Feb 2018 initial blood results with no medications:

Now seeing as your FT was tested using the outdated and inaccurate linear law-of-mass action Vermuelen calculated method.

If we take your TT 584 ng/dL, SHBG 58 nmol/L and Albumin 4.5 g/dL than your FT is 8.48 ng/dL (lower end of the reference range).

Now from your most recent blood work on trt:Aug 2019 Blood results (I also got recent blood work done as a bi-annual but no changes in Rx at all):

Unfortunately you did not test your SHBG which you would most likely have seen drop due to the high dosed (240 mg/week) T injections.

We can figure this out by plotting number in the calculator.

If we take your new TT 1100 ng/dL, use an SHBG of 37 nmol/L and your Albumin 4.5 g/dL (same as pre-trt) than your new FT level is 25 ng/dL (just slightly over top end reference range).

Both of your FT levels pre and post trt are almost on point compared to your lab values.

Now if you truly want to know where your FT levels sit than you would need to have it done using the most accurate testing method such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) or simply use the newer calculated TruT method available online for free.

Your FT levels may be higher than you think!

So again if your lab work was done at true trough than your TT/FT (1100 ng/dL and 25.04 ng/dL) levels are much higher earlier in the week of your injection protocol.

 

[Systemlord]

1.2mg (240mg) of Test-cyp -- injecting 1x per week

This might be contributing to your ED issue, I would start to have erection issues with E2 35> pg/mL, as I get closer to 53 erections start to wane. You single large injection is more than likely spiking estrogen higher at peak, breaking up your shots twice weekly should help.

I have not tried Cialis or any other PDE-5 inhibitor. I've been open to those, but I don't like having to rely on one particular extreme drug for "just incase".

Cialis is known to change T/E2 ratios, typically pushing estrogen down (anti-E2) while testosterone remains higher. Cialis is taken daily or EOD and lasts 36 hours so you don't have to take it only when the time is right.

Cialis has other positive health benefits, it increases nitric oxide and increases blood flow and can even be beneficial to those with metabolic syndrome. I felt a mental as well as a physical benefit on Cialis.

 

[bc0116]

Thanks Systemlord and madman. Appreciate the feedback and tips.

 

[Shawn M]

Seems to be a high dose of test and a complicated protocol. Others have more knowledge that I about the protocols. I do know a lot about the psychological side and can definitely shed some light on that. I’d suggest daily cialis, 5 mg and start with 10 mg when sex is planned. You are not, in my opinion, incapable of great sex. It would seem the combination of where you are in life, the kids, work, school and the other stressors are the problem. I was in the same exact spot at about the same age. Sildenafil is not as good if you need to plan, which you do.
The biggest issue seems to be your expectations. Sex is a more broad thing than just orgasms, and when a relationship is in the spot you are in, there is a hyper focus on orgasms. Anxiety and unrealistic expectations make that even more difficult, as counterintuitive as that seems. Learning to give and receive pleasure can be incredibly exciting and it can feel like you are with your long time partner for the first time. You, and your wife, need to relearn how to flirt, tease, and excite each other. “Let me know if you are hard and we’ll try” isn’t going to help and actually makes things worse.

There are other ways to engage in good sex beyond intercourse. There are a lot of good books that can help. She Comes First is one, and He Comes Next, both by Ian Kerner are two good ones. Another one is this one, available for free. http://www.eso-garden.com/specials/complete_idiots_guide_to_tantric_sex.pdf


Share these books and ideas with your wife. It increases the excitement and anticipation needed for good sex. Once you relax and enjoy the journey of sex, as opposed to the destination, it does get better.

Biggest thing is relax. It is common, especially at that stage of life. Sounds exactly like my wife and I at age 40. Kids complicate things, but they can be taught when the door is locked to knock add stress management, meditation, cognitive behavioral therapy, and bibliotherapy, along with daily cialis and you’ll be fine. Have fun, enjoy your wife and your sex will remain the glue that holds you both together. We are having the most frequent and best sex of our lives at 66 and 64. I think that’s why sex was invented!

Thanks MM, as a fellow Forum Member in my 60's, I enjoy your insight and aspire to achieve the level of relationship that you have with your partner. Two books by Dr David Schanarch, PhD, have been helpful to me and my partner's work in progress: Passionate Marriage and Intimacy and Desire: Awaken the Passion in your Marriage. Also, in addition to the Kerner books you mention, Women's Anatomy of Arousal by Sheri Winston is helpful for both men and women in a relationship. Like Kerner, she places an emphasis partners' roles in "playing to higher levels of blissfulness"

 

[TorontoTRT]

TSH too high, E2 too low for the total testosterone and DHT too high. Dosage too high.
Drop to 200 mg a week split into 86 mg every 3 days
If you’re taking AI stop. Your test needs more conversion to E2 then DHT.

 

[Joe Sixpack]

Your fasting glucose is getting up there. You do not want to have glucose over 100. You are only 37. I would expect your glucose control to be better at this age. You will want to monitor this so that you don't walk yourself into type 2 diabetes.

Two possible causes here: Poor sleep and a carb heavy diet.

 

[wondering]

Your fasting glucose is getting up there. You do not want to have glucose over 100. You are only 37. I would expect your glucose control to be better at this age. You will want to monitor this so that you don't walk yourself into type 2 diabetes.

Two possible causes here: Poor sleep and a carb heavy diet.

Assuming the was a fasting test.