My Concerns With TRT, Erectile Dysfunction, And Overall Well Being

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Stpfan

Active Member
I have a couple of concerns with TRT, Erectile Dysfunction, and overall well being during the last 10 month of treatment. I apologize if this seems long but I’m trying to be detailed as possible in an effort for a more accurate resolution. Yes, lab reports show value but explaining overall well being is also important. Again, I will do my best to get right to the point.

Between the ages of 25-34 I experimented with oral steroids off/on. IMO I never aggressively took large amounts. Basically, 10-20mg every 24 hours and never went past 6 weeks cycling. Furthermore, I never did proper PCT. To give you more of a general idea (for example) I would probably cycle January 1st go 5-6 weeks and stop. Start my next cycle in May go 5-6 weeks and stop. In all essence maybe cycled 3 times a year? My sex life was good. I can’t complain. Probably the best sex of my life was between 30-33 years of age. There was maybe only 2 times during that yearly stretch where my body didn’t recover quickly. I think I was 34 and I was miserable for about 3-4 months. No, I didn’t see a doctor. Libido was dead. Erections were dead. I promised myself if I ever recovered I wouldn’t touch oral steroids again. After making a recovery and sex life was back to normal I continued to workout without any type of supplements. Basically, just natural food and concentrating on endurance at the gym. I would say the best shape of my life was at age 37. Quite possible I wore myself out achieving that body?

At age 41 I was getting ready for a cruise and wanted my body in the best shape. Yes, I used oral Oxandrolone for about 5-6 weeks at the gym (dumb move.) I went on that cruise and that was the last time I remember having a solid erection during sex. Ever since the steroid wore off I’ve had severe ED issues. Yes, I know I’m dumb for doing it. During that same year in September my recovery time at the gym was ridiculous. I would sleep 11-12 hours after every workout. It was the only way to feel refreshed. I had no idea my testosterone was low. I would just fight it off and pump myself up to keep working harder and harder. I noticed an extensive amount of brain fog. There would be night’s in which I could only sleep 4 hours and my body would just wake up. I couldn’t fall back asleep. I figured it was time to see a doctor.

February 2019 my doctor did several tests and discovered my Free Testosterone and Bioavailable Testosterone were extremely low. He only prescribed 50mg a week Test Cyp. I was still feeling miserable after 3 weeks and asked my doctor if he could bump up the dosage because I was doing research online and most people who were on TRT start around 100mg a week. He referred me to an Endocrinologist.

I also asked my doctor if he could make a referral to a heart specialist. He agreed. The cardiovascular specialist concluded everything is perfectly normal. He said I had great cardio health. No signs of anything causing ED.

My Endocrinologist looked at me and said “Well you look healthy. I don’t think you need TRT.” I said, “Well why do I feel like sh#$ then?” He said I want you to stop injecting for 21 days. Go to the lab and get blood work done. Then we’ll see. I said no problem. My testosterone results were worse than before. Worse than ever. The Endocrinologist prescribed 100mg of Test Cyp a week. I split up my injections 2 shots a week (every 3.5 days). After injecting the 4th time I finally had an erection lol and my sexual desire was back.

Then mysteriously it faded within about 3 weeks from being on 100mg a week. I still had brain fog. Some days I felt great. Some days I still felt like sh#$. I asked the Endocrinologist if he would bump up my dosage because I was still having ED issues. He said I’ll bump you up to 120mg a week. And boom! Erections are back within 8 hours from injecting. Life is good. Then, after 4 weeks of 120mg treatment I had ED issues again.

My question is why do I get a sexual urge after every increase of testosterone for about a week? And then it fades out? Currently, I’m on 160mg of Test Cyp a week and I still say my sex life is horrible. My doctor said 160mg is the limit. He won’t go any higher. But, here’s the kicker. I had a chest infection about 10 days ago and my regular doctor prescribed Prednisone and during the 3-4 days my libido and sexual desire felt like old times. I still had erectile dysfunction but clearly my libido and desire increased.

I have tried HCG during TRT from the reviews I read online. Naturally, you can get HCG overseas. I tried 250 IU’s every 3.5 days. That didn’t help my ED. I bumped it up to around 350 IU’s every 3.5 days. That didn’t help my ED. I even tried 500 IU’s every 3.5 days for about 3 weeks and that didn’t help my ED.

Yes, I have tried 25mg of Viagra and my erection was super strong. Probably lasted for about 4-5 hours with a 25mg dose. The problem is I really don’t like the side effects. There is a slight weighted feeling in the center of my chest. It tends to last for about 3-4 weeks after just one small dose. I’m trying my best to avoid Viagra. I also have tried Cialis 20mg. That also works very well except the side effects are brutal. Extreme body aches from the waist down. Mild aches in the lower back. It almost feels like a body fever. It doesn’t go away until about 24 hours from the initial dose.

Yes, I’ve tried Arginine and other herbal supplements to improve an erection. It works for about a week and then it fades out. I’ve tried every supplement except for Citrulline. I don’t know if that would work or not? I also read that Proviron could increase your free testosterone. But it does screw up your cholesterol. Most reports on the internet claim in dramatically increases your libido. But could you take it for the rest of your life? Probably not. Currently, my libido sucks. When you see a hot female model with her rack hanging out and you say to yourself “NOT INTERESTED” something is definitely wrong. That’s how I feel right now.



My other concerns with TRT

1. Before injecting testosterone I was an avid indoor tanner. My skin tans easily with no issues and no side effects. Ever since starting injecting Testosterone Cypionate my skin feels so weird while tanning. It’s an unbelievable “heat” sensation. It doesn’t feel good. It irritates the piss out of me. What is causing this unbearable heat feeling? I don’t even tan anymore. That’s how irritating it feels.

2. Even though I’m injecting 160mg of Test Cyp a week I still need 10+ hours of sleep a day after every workout. Is this normal? If I wake up with only 7-8 hours of sleep I’m extremely moody. My mind is very slow and I’m overall irritable. Any idea what’s causing this? I thought when you’re on TRT your body didn’t require this amount of sleep? My doctor told me my workouts were too grueling. I didn’t think 1 hour of weight lifting and 30 minutes of cardio was bad 3-4 times a week?

3. Furthermore, early on with TRT I was sleeping like a baby. Perfect sleep. The last 4-5 weeks it takes me almost 2 hours to fall asleep (no caffeine in the system.) And I feel like I never reach a deep sleep. I have no clue what’s going on?

4. At times I believe my hydration could be better? Or my body isn’t using the fluids wisely? I know I’m near a gallon a day of water (especially on workout days.) I urinate quite frequently but there are times I feel a tad dehydrated/exhausted. Are there times when you take in too much water causing vitamins and minerals to flush out? I only take Test Cyp and I do not take any vitamins. Should I be?

5. Does anyone believe that micro-dosing your injections (basically taking daily shots) help with E2 levels, high hemoglobin, and overall well being? I’ve been debating this back and forth. I’m wondering if the extra effort helps? Or you’re going to get the same results splitting your injection up every 3.5 days?

Hopefully someone can steer me in the right direction? Or is this ED situation hopeless? Thanks for reading. I appreciate your time.
 
Defy Medical TRT clinic doctor

S1W

Well-Known Member
Certainly can't answer all of your questions, but for discussion:

Daily shots in general do help to lower HCT/HGB. However, they may or may not lower E2 - some guys experience that dailies lower E2, other guys experience that dailies increase E2.

When I went to dailies, I found that the effort was not worth it to me - my HCT went down which was good, however, the subjective benefits I get on TRT were greatly diminished and E2 went higher than it had ever been on any TRT protocol (and TT/FT went way down).

Some guys swear by dailies. As with all of this TRT stuff, trial and error is the only way to know what works for you. It's a long road that requires a lot of patience.

Many find that a combination of daily low dose tadalafil + testosterone is helpful for ED issues.
 

Indy57

Member
Sorry if I missed it but what are your current E2, Total test and Free test levels? What are your current TRT meds and doses?Current bloodwork will help the people here better go help you. Are you taking an ai? SHBG would be good to have too!

Indy
 

Systemlord

Member
My question is why do I get a sexual urge after every increase of testosterone for about a week? And then it fades out?

I have the same problem, TRT decreases my urination and lose erections shortly before I almost stop urination. If your estrogen is high in relation to your testosterone (estrogen dominance), you will have ED. I took a diuretic while on TRT and within hours erections returned and felt great.

Your SHBG levels are critical, if you don't have this test result, you've never been properly evaluated and you might have to seek care privately by a doctor that does this for a living rather than some random endo who is not very experienced.

I have yet to find a knowledgeable endo within two different providers after years of looking and seems to be commonplace. If SHBG is low, this protocol is more than likely not ideal. I have low SHBG (13) and before I got estrogen lower and under control by injecting very small daily doses, erections came alive again.

TRT can deplete vitamins, minerals and even other hormones. That's why it's imperative you are working with a doctor that has the proper knowledge, otherwise you could struggle for years.
 
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slicktop

Active Member
Well, someone is going to say it, so it might as well be me: you need a full set of blood work for us (or anyone else) to be of much help. But on to some of your concerns and questions: I'm one of those that benefited quite a bit from daily injections. My theory is that those of us that tend to see our SHBG run at 25 or below tend to benefit the most from daily injections, but there's certainly some exceptions to that. There's been recent, good discussions revolving around the Tru T calculation that may benefit you as well. And in practice, the same weekly total amount of testosterone tend to produce a higher free t and total t when injected daily than when split into E3.5 for a lot (but not all) guys (again, it did for me). Dr. Crissler championed more frequent injections for that reason: the same total amount worked better for most men, and cost less. Win/win!

So your options? You can go to daily doses and see how that does at 160 a week, and there's a good chance that can work for you. If you're already self injecting, that's as simple as ordering a bunch of needles online and making the switch yourself. You could also switch to a telemedicine provider like myself and others have, and go with Defy. Not to talk smack about your doctor, but there's no magic number of 160mg, I don't know where he got that from. And if you have to do things behind your doctors back, is that really the right doctor for you?
 

bixt

Well-Known Member
If you found relief with prednisone, this suggests adrenal deficiencies, and you should look further in this direction. This is further corroborated by your frequenct urination, caused by low aldosterone, produced by the adrenals.

As others have pointed out, full blood panels are a must. I would recommend a 24 hour urine cortisol test as well.
 

Stpfan

Active Member
Certainly can't answer all of your questions, but for discussion:

Daily shots in general do help to lower HCT/HGB. However, they may or may not lower E2 - some guys experience that dailies lower E2, other guys experience that dailies increase E2.

When I went to dailies, I found that the effort was not worth it to me - my HCT went down which was good, however, the subjective benefits I get on TRT were greatly diminished and E2 went higher than it had ever been on any TRT protocol (and TT/FT went way down).

Some guys swear by dailies. As with all of this TRT stuff, trial and error is the only way to know what works for you. It's a long road that requires a lot of patience.

Many find that a combination of daily low dose tadalafil + testosterone is helpful for ED issues.

Thank you for the post. Always great to get knowledgeable feedback. If injecting daily was a 100% guarantee (for optimal quality)... I would do it. I just can't justify poking yourself 365 times a year... even with a very small needle... with zero results.
 

Stpfan

Active Member
Sorry if I missed it but what are your current E2, Total test and Free test levels? What are your current TRT meds and doses?Current bloodwork will help the people here better go help you. Are you taking an ai? SHBG would be good to have too!

Indy

I've had E2 at 9... I've had E2 at 35. I've had E2 at 52. I've had E2 as high as 82. Currently, my Endo didn't want me taking an AI because he wanted to see if my libido would come back without using one. It's not working. Furthermore, I feel my E2 is higher than 82 right now (blood work is due in about 14-21 days from now.)

I decided to take 0.25mg every injection (just to knock out some of the Estrogen.) I just started that a few days ago.

I think we're all different in regards to what high levels of estrogen does to the body. My waistline won't lower when I have high E2. I measure my waist and weight quite frequently. I also measure my food/meals daily. My face doesn't get fat or puffy with high E2. But, you definitely look stockier.

With high E2 and never taking an AI.... I never experience joint pain or muscle cramping at the gym etc. Yes, it has it's positives in that regards. But, my blood pressure is around 140 with high E2. When E2 is controlled.... my blood pressure is perfect... around 120.

My test levels have been around 1,000 and I was still having brain fog and not feeling 100%. I believe my test is now around 1,400-1,600 range. My SHBG has always been 28-30. It never moves from those numbers. I think I've had about 4 lab tests in 10 months.

Again, my entire point of TRT was to regain sexual function like old times. Apparently, it might be a lost cause?

Thank you for the post.
 

Stpfan

Active Member
If you found relief with prednisone, this suggests adrenal deficiencies, and you should look further in this direction. This is further corroborated by your frequenct urination, caused by low aldosterone, produced by the adrenals.

As others have pointed out, full blood panels are a must. I would recommend a 24 hour urine cortisol test as well.

Thank you for the post. I'm starting to believe I have some sort of adrenal issue. This is my first year being on TRT so I'm not up to par with everything to look for in regards to labs. I tried googling Adrenal Issues and basically "Testosterone Deficiency" pops up almost in every link. If your Testosterone levels have been above 1000 for about 6 months now without any consistency in regards to erections... What other "adrenal" tests should I ask my Endo to check for?

What I meant by frequent urination.... (sorry I didn't describe it better...) when you take in nearly a gallon of water in 16 hours.... I urinate basically every hour to 1.5 hours. Urinating probably around 28-32 ounces. I guess when I said frequent urination... it gets to be annoying taking a piss ever so often. lol Especially when you don't see any additional results by hydrating yourself? That's just my opinion.
 

Vman

Member
3. Furthermore, early on with TRT I was sleeping like a baby. Perfect sleep. The last 4-5 weeks it takes me almost 2 hours to fall asleep (no caffeine in the system.) And I feel like I never reach a deep sleep. I have no clue what’s going on?

My test levels have been around 1,000 and I was still having brain fog and not feeling 100%. I believe my test is now around 1,400-1,600 range. My SHBG has always been 28-30. It never moves from those numbers. I think I've had about 4 lab tests in 10 months.

Again, my entire point of TRT was to regain sexual function like old times. Apparently, it might be a lost cause?

If your TT is at least 1000 and might be 1400-1600, you are running some fairly high numbers. Some people do fine with TT at those levels, but a lot of people have sides when they run TT at those levels.

Your sleeping issue is very common with people that run higher TT levels. You might want to try melatonin. I'd start with 1mg instant (Natrol or others) 30 minutes or so before bed. If it doesn't do anything, try gradually moving up in dose 1mg every night up to a max of about 10mg. If you have trouble with staying asleep, you might want to try the dual layer or extended release melatonin. Also 400mg of magnesium glycinate 30 minutes before bed might help too.

As for your libido, you might consider trying the compounded scrotal cream. My libido was insane on the cream.
 
You mentioned having a slow mind, brain fog...in my experience that is high e2, when I get brain fog, I do an inventory of my e2 side effects such as brain fog, how often I pee (e2 can enlarge your prostate), if I had morning erection, libido, energy, overall feeling, joint soreness (I have sore knees and knuckles when I am low). My vision also seems poor on the brain fog days. I made a spreadsheet to track this. i believe i am very sensitive to e2 and arimidex, i take about .20 every 3.5 to 4 days and that changes depending on symptoms.
 
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Mich66

New Member
No mention of any thyroid tests? From my reading and such thyroid is critical to all you have mentioned. I'd suggest a full panel. T3,T4, with reverse 3, 4 plus antibodies.
 

Vman

Member
No mention of any thyroid tests? From my reading and such thyroid is critical to all you have mentioned. I'd suggest a full panel. T3,T4, with reverse 3, 4 plus antibodies.

I totally agree with this. Honestly, I think everyone should have a full thyroid panel and get their T3 to optimal levels before starting TRT.
 

Stpfan

Active Member
No mention of any thyroid tests? From my reading and such thyroid is critical to all you have mentioned. I'd suggest a full panel. T3,T4, with reverse 3, 4 plus antibodies.

Just reviewing past lab work. I've also questioned this... my mother had a thyroid issue in her 30's. My dad never had a thyroid problem. Before being placed on TRT and with extremely low free testosterone and low bioavailable testosterone I tend to experience cold hands quite frequently. Again, I'm just learning as I go.

My doctors ordered tests randomly. So, they aren't in any specific order.

This was the original blood work BEFORE STARTING TRT.

April 5, 2019


Total Testosterone - 302 ng/dL (Standard Range 250 - 1100 ng/dL)
Free Testosterone - 40.0 pg/mL (Standard Range 46 - 224 pg/mL)
Bioavailable Testosterone - 91.0 ng/dL (Standard Range 110 - 575 ng/dL)
SHBG - 30 nmol/L (Standard Range 10 - 50 nmol/L)
Serum Albumin - 5.0 g/dL (Standard Range 3.6 - 5.1 g/dL)

Cholesterol - 216 mg/dL (Standard Range 100 - 199 mg/dL)
Triglycerides - 111 mg/dL (Standard Range <150 mg/dL)
HDL Cholesterol - 39 mg/dL (Standard Range 40 - 90 mg/dL)
VLDL Cholesterol - 22 mg/dL (Standard Range NOT LISTED)
LDL Cholesterol - 155 mg/dL (Standard Range <100 mg/dL)
Non-HDL Cholesterol - 177 mg/dL (Standard Range - Borderline High)
Chol/HDL Ratio - 6.0 (Standard Range <6.0)

TSH - 2.00 ulU/mL (Standard Range 0.40 - 4.50 ulU/mL)

Sodium - 140 mmol/L (Standard Range 135 - 145 mmol/L)
Potassium - 4.6 mmol/L (Standard Range 3.5 - 5.2 mmol/L)
Chloride - 103 mmol/L (Standard Range 98 - 111 mmol/L)
Total CO2 - 28 mmol/L (Standard Range 20 - 29 mmol/L)
Anion Gap - 9 mmol/L (Standard Range 5 - 20 mmol/L)
Glucose - 95 mg/dL (Standard Range 60 - 139 mg/dL)
Blood Urea Nitrogen - 23 mg/dL (Standard Range 7 - 25 mg/dL)
Creatine - 1.33 mg/dL (Standard Range 0.60 - 1.30 mg/dL)
Glomerular Filtration Rate - 66 mL/min/1.73 m2 (Standard Range >60 mL/min/1.73 m2)
Calcium - 10.1 mg/dL (Standard Range 8.5 - 10.5 mg/dL)
Total Protein - 7.4 g/dL (Standard Range 6.4 - 8.3 g/dL)
Albumin - 5.0 gm/dL (Standard Range 3.5 - 5.1 gm/dL)
Total Bilirubin - 0.8 mg/dL (Standard Range 0.3 - 1.2 mg dL)
AST (SGOT) - 28 U/L (Standard Range <35 U/L)
ALT (SGPT) - 26 U/L (Standard Range 9 - 47 U/L)
Alkaline Phosphate - 60 U/L (Standard Range 33 - 120 U/L)

Vitamin D 25 Hydroxy - 36 ng/mL (Standard Range 30 - 100 ng/mL)

Keep in mind I wasn't eating 100% healthy or balanced IMO when I had Low T. As I recall back to the date around April 2019... I had Erectile Dysfunction. It was completely dead. No Libido. Felt like a zombie.



June 5, 2019

Thyroid Peroxidase Auto Antibody - <10 lU/mL (Standard Range 0 - 35 IU/mL)
Free T3 - 3.1 pg/mL (Standard Range 1.7 - 3.7 pg/mL)
Free T4 Thyroxine - 1.10 ng/dL (Standard Range 0.8 - 1.8 ng/dL)

I don't know why my Free T3 and Free T4 was checked on this date randomly? I guess doctors have their reasons?


August 13, 2019

Ok. This is sort of a weird situation that happened. My PCP referred me to an Endocrinologist. My Endocrinologist didn't believe I needed to be on TRT. What did this guy request? He requested me to stop all Testosterone Injections for 21 days. After 21 days get my labs done. Yes, this was crazy! I did what he asked me to do.... and here are the results.

Total Testosterone - 201 ng/dL (Standard Range 250 - 1100 ng/dL)
Free Testosterone - 27.8 pg/mL (Standard Range 46 - 224 pg/mL)
Bioavailable Testosterone - 59.5 ng/dL (Standard Range 110 - 575 ng/dL)
SHBG - 28 nmol/L (Standard Range 10 - 50 nmol/L)
Serum Albumin - 4.7 g/dL (Standard Range 3.6 - 5.1 g/dL)

TSH - 4.24 ulU/mL (Standard Range 0.40 - 4.50 ulU/mL)

Did my TSH sky rocket because my body was in shock having a good amount of Testosterone before and now... depleted? Who knows?

FSH - <0.5 mlU/mL (Standard Range 1.0 - 12.0 mlU/mL)
LH - 0.1 mlU/mL (Standard Range 0.57 - 12.07 mlU/mL)
Prolactin - 13.1 ng/mL (Standard Range 2 - 18 ng/mL)

Again, I'm not scheduled for more lab work until around 1st week in February. Anything I should request from my doctor? I apologize if I posted lab work that was unnecessary...
 

Stpfan

Active Member
Quick question in regards to E2 sensitive lab work.

The lab I use only has 2 choices when ordering any type of Estrogen or Estradiol test.

My doctor always selects this E2 Estradiol test.
Test Methodology: Chemiluminescence Immunoassay

OR

Estrogens Serum Fractionated - Combination of E1 and E2
Test Methodology: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Which choice should I tell my doctor for a more accurate test?
 

slicktop

Active Member
Quick question in regards to E2 sensitive lab work.

The lab I use only has 2 choices when ordering any type of Estrogen or Estradiol test.

My doctor always selects this E2 Estradiol test.
Test Methodology: Chemiluminescence Immunoassay

OR

Estrogens Serum Fractionated - Combination of E1 and E2
Test Methodology: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Which choice should I tell my doctor for a more accurate test?
FWIW, Dr. Crissler said the immunoassay was entirely too inaccurate for men, and Defy won't use it either to this day. While it isn't infallible, the liquid C test (Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)) is the most often the more accurate test for men. The way it was explained to me was that the immunoassay method works like this... imagine looking through binoculars at a pile of marbles on a cloudy day, consisting of all colors of the rainbow, including orange, maroon, red, pink, etc., and trying to only count the red ones.

Soon now, along will come gentlemen with some excellent information as to why the liquid-c test may not be that great either...
 

Systemlord

Member
My PCP referred me to an Endocrinologist. My Endocrinologist didn't believe I needed to be on TRT. What did this guy request? He requested me to stop all Testosterone Injections for 21 days. After 21 days get my labs done. Yes, this was crazy!

FSH - <0.5 mlU/mL (Standard Range 1.0 - 12.0 mlU/mL)
LH - 0.1 mlU/mL (Standard Range 0.57 - 12.07 mlU/mL)


This doctor doesn't understand things very well, it's going to take more than 21 days for the cypionate to wash out of your system and you can see it by looking at the LH which is still depressed. These test results show that you are still on TRT, these aren't natural levels.

This doctor doesn't know what he's doing and he's not using the correct estrogen testing.

Total Testosterone - 302 ng/dL (Standard Range 250 - 1100 ng/dL)
Free Testosterone - 40.0 pg/mL (Standard Range 46 - 224 pg/mL)
Bioavailable Testosterone - 91.0 ng/dL (Standard Range 110 - 575 ng/dL)

These levels aren't normal are aren't even in the normal range. I wonder what is this doctor thinking. :rolleyes:

There is a big stigma around TRT in western medicine and some doctors treat it like it's a plague.
 
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