New to Site and New to TRT (Advise Very Much Needed)

[RG4505]

Hey everyone. Thanks for having me on the site. I am not really sure how to keep my post from being super long.
I am pretty new to TRT. I have been battling low "T" symptoms for quite some time now, approximately 3 years or so. So, long history, to put it bluntly. Most of this started after I messed around with a few heavy Testosterone cycles like an idiot off and on for 2-3 years prior to my symptoms. I know, that was a stupid thing to do and I wish I would have been a lot smarter. Anyway, since then I have struggled with many issues ranging from acute onset anxiety, over stress, sleep issues, ED issues, irritability, fatigue, etc etc. Just a few stats if it helps before I dive into the lengthy thread......I am 35, 5'11", active occupation, pretty heavy workouts 5-6 days a week, no other previous medical history.

So, I of course have been to multiple doctors over the last 3 years and had countless tests performed from hormones to neurotransmitters, etc etc. The common thing that always has been present is the low total and free "T", no surprise there. However, the odd thing is, post AAS use, my levels always tested in the mid to high 200's, obviously extremely low. But, I was never offered TRT until my last urologist and that was June of this year. Odd thing was though, upon his test during my first appointment, my total was at 330. Which seemed odd (I'll have to come back to my thoughts on that later). Needless to say, he prescribed me Test Cyp. 100mg per week, HCG 1000iu's 3 times per week initially. After approximately 3 weeks upon my follow up, my total "T" was up to 736, which I thought was pretty good. Felt mentally better and my sleep was 100x's better. However, absolutely no change in libido, ED issues, etc. Well, at that time, my E2 jumped up to 41 with the highest scale being 42. So, he then added .5mg Anastrozole to my prescription and lowered my HCG to 500iu's 3x per week. Well, I continued with the protocol as prescribed and a few weeks after returning back to work, I started getting a touch of gyno in my left nipple. Felt very sensitive, almost like a bruise and there was a very small lump under the nipple. Well, I told him about it and he advised me to completely stop the HCG until my next appointment the next time I am home, which is late next month. Well, just due to a lot of research and a lot of worrying, I took some Tamoxifen for a few days which brought the gyno symptoms down tremendously, almost completely disappeared for the time being.

I know this is very long, and again I apologize, it's just a lot of information to try to get out. So, here we are basically just sticking with the Test Cyp. 100mg per week and nothing else until I can get home for follow up tests. Not feeling horrible but yet not great either. I still battle the libido and ED issues along with the anxiety and sleep issues. Mood is a little better I would say, but that's about it.

A strange thing though is I keep referring to it as "ED issues" and the reason I am not just flat out saying it's ED is the fact that I still have very consistent nocturnal/morning erections that sometimes last up to 20 minutes. So, it seems as though the "plumbing" is working. But, after I get up and start my day, it's literally like everything down there just says "I'm going to sleep". Lose sensitivity, doesn't "hang" relaxed as in the past, almost feels like zero circulation throughout the day. Zero spontaneous erections throughout the day. Very difficult to even successfully masturbate if and when I attempt it. But, back around to the morning time, all seems well for that short amount of time. Extremely confusing to say the least.

Just really looking for anyone that has ever experienced any of this, especially the ED issues as mentioned and if/how you went about successfully treating it??

Just a side note, I have used Cialis successfully off and on. Sometimes that doesn't work either. However, I don't see how that's the root issue being that I still achieve and maintain a what seems to be normal healthy erection in the mornings with absolutely nothing???

I wish I could make this post much shorter, again I apologize. Hopefully you guys won't mind the read and have some advise. Thanks

 

[Vince]

It would be nice to see all of your labs, along with the ranges.

There are members that can't handle HCG. So going off it was a good option.

 

[RG4505]

Unfortunately, my current urologist only checks my testosterone and e2

May 15, 2019:
Total T: 331ng/dL (264-916ng/dL)
Free T: 8.1pg/mL (8.7-25.1pg/mL)

June 24, 2019:
Serum T: 713ng/dL (175-780ng/dL)
Estrodial: 41.8pg/mL (7.6-42.6pg/mL)

I am not sure why he is not checking into LH, FSH, SHBG, TSH, T3, T4, prolactin, progesterone, etc etc.

This is all very confusing. The other doctors I have seen prior to starting the TRT used to check everything you could imagine all the way down to dopamine, norepinephrine, epinephrine, seratonin, cortisol, etc etc.

I am beginning to think this is not a hormone issue and more like something with the hypothalamus and neurotransmitters or something else, because if I can achieve nocturnal/morning erections, that should technically mean multiple things, for starters that during that time my T/E ratio is well balanced and also that there is obviously good blood flow on the "plumbing" aspect of things. Therefore, the only other thing I could possibly think of is some type of issue with relaxation or even the ability for nitric oxide to play it's role in the process.

 

[Guided_by_Voices]

Yours sounds a lot like the profile of people who benefit from higher DHT via scrotal T cream in addition to injections. Also, you might consider backing the workouts down to no more that two "heavy" days and two moderate days. Putting the body in a constant state of stress is unlikely to be beneficial and could be part of the problem.

 

[Wolverine]

1000ius of HCG 3 times a week is a lot. My E would skyrocket on that. I think even 500ius 3 times a week is too much. I do 300ius 3 times a week and still have E issues at only 100mg of T per week, I believe due to the HCG. But the HCG benefits to me (better flaccid hang, fuller testicles) outweigh the downsize (elevated E and Prog). Good thing to stay off HCG and get labs.

 

[RG4505]

Yea, I unfortunately haven’t been able to find anyone that’s had the same odd symptoms I’ve had. I am sure there’s not much at this point I can do other than just continuous labs at different times of the day. It’s hard to do being out of the country so much of the year. But hopefully something will get worked out. I just don’t see myself having to live off of ED drugs being that everything works just fine when I’m just waking up. Sounds to me like something is going on more so in the brain, hypothalamus, etc.

I’ve actually found a lot of research proving that former AAS users have actually been able to fully recover their natural HPTA functionality with a short protocol involving high doses of HCG, Clomid and Anastrozole. The fact that mine was actually coming up a little (still very low) makes me wonder if there is not a way for me to do the same. Problem is finding a doctor with an open mind. It seems as though the only thing that’s thrown at me is “testosterone for life”. I find that difficult to believe if I’m still producing at the “low normal” level. But, when I pass through Dubai next month, I’m gonna get every lab I can think of. My insurance covers me better out of country than when I’m actually home in the states. Doesn’t make sense, but is what it is.

 

[Vince]

You had the wrong estrogen test.

Why All Men Should be Tested with the Sensitive Estradiol Test

 

[Systemlord]

I see a potential problem with your TRT protocol, your injection once weekly and is a problem for a lot of men. So let's see what's happening, your injection a large dosage of test once weekly, you peak in 48 hours at which point levels are declining and by day 6 levels are lower.

I can tell you I don't respond at all to TRT doing this, in fact when levels are on the decline it feels like I'm not even on TRT, that changes when I start injecting very frequently. I only respond to TRT injecting at a minimum EOD because I have low SHBG, I don't feel much injecting twice weekly.

My libido and erections didn't come out to play until I got E2 <30 pg/mL and TT 400> ng/dL with FT at least midrange. When TT is 400-500 ng/dL and E2 is in the 40-50's, no erections or libido are present because that's a little too estrogen dominant for me.

 

[M.J]

I totally agree with systemlord when my estrogen is low is the only time i felt good, now I am struggling find my correct dose again but I keep noticing lower E morning wood/ strong erection high e all kind of problems belwo 30 seems ok I have been also between 15 and 19 which was fine also.

also the best libido/erection/morning wood I have ever had was when I did hcg monotherapy 500 eod but seems like some of the vials are not good I thought hcg is no working for me until I bought more vials from a different source and they started generating T and E AGAIN.

 

[RG4505]

I apologize for not specifying my injection schedule, I didn't realize I just listed the 100mg per week. I actually do break that down to two 50mg shots per week. I do 50mg on Tuesday morning and 50mg on Friday morning.

I am going to try to get my doctor to do more comprehensive testing this trip home. I feel like he's probably not using the "sensitive e2" test and for some he hasn't even mentioned testing LH, FSH, SHBG, TSH, T3, T4, DHT, DHEA, etc etc.

 

[falconberg]

Yea, I unfortunately haven’t been able to find anyone that’s had the same odd symptoms I’ve had.

What you are describing is very, very common in the forums and Facebook groups that I am a part of. If you look around a bit, you can find literally hundreds of stories or posts from people that started TRT, went through a honeymoon phase until their HTPA sensed the exogenous testosterone and stopped producing it naturally, then started noticing problems (which, in some cases, were not there before TRT). So begins the quest to find the right "optimization" that would offer the ever-elusive cure that would restore or improve their sexual function. They will decide it must be estradiol and optimize that to some level they think will work. When that doesn't help, they ask whether maybe it's DHEA? DHT? Dopamine/neurotransmitters? Prolactin? Progesterone? More AI? Less AI? More HCG? Less HCG? Etc., etc.

Admittedly, there is self-selection going on. The people doing well don't get on groups to ask for advice. But there is ample anecdotal evidence to convince me that, at least for some people, TRT causes or contributes to sexual dysfunction and no amount of tinkering with other hormone or nutrient levels will fix that. The only exception that I've seen is that the guys that use scrotal cream without injections generally self-report improvements in libido and ED more than guys that are just on injections, but that requires (a) acceptance of their claim that rocket-high levels of estradiol and DHT have no significant adverse health effects over time; and (b) willingness to begin or accelerate male pattern baldness due to the high DHT.

 

[Systemlord]

I actually do break that down to two 50mg shots per week. I do 50mg on Tuesday morning and 50mg on Friday morning.

If your SHBG is on the lower end, even twice weekly is far from optimal because while the estrogen may not be abnormally high, free estrogen percentage may be high. Your SHBG may not even be high, you just may be sensitive to estrogen.

I feel like he's probably not using the "sensitive e2" test and for some he hasn't even mentioned testing LH, FSH, SHBG, TSH, T3, T4, DHT, DHEA, etc etc.

This is common, it's because these doctor that ignore the critical hormones are inept to manage men on TRT and are just not interested is learning how to play this hormonal game, the profit potential just isn't there to spend the time and energy learn and there is little reward other than the satisfaction in seeing patients do well.

You can always go to Discount Labs and order everything on your own, it's likely your doctor will be unable to interpret the labs anyway.

 

[M.J]

I think if HCG work it would be much better than testosterone based on short experience HCG libido and morning wood I had was the best I have ever had maybe in my life time

 

[RG4505]

I appreciate your responses. I unfortunately can’t get back to the US until November. I have another appointment with my urologist and I have sent him a very comprehensive list of hormones that I want tested. If he says “no” then I will just purchase the tests myself. I’m really not sure what’s going on. It just doesn’t make much sense to me and I’ve been researching and reading for over the past three years trying like hell to find a solution. I find it very hard to believe that my system won’t be able to be “rebooted” so to speak on a heavy hcg protocol. I mean there are proven studies of multiple bodybuilders and recreational AAS users that utilized a heavy dose (short term) hcg protocol and a year later their natural production returned to normal. But it’s difficult to find a doctor that open minded to attempt that. Honestly, so far, testosterone at 100mg a week does hardly anything for me. Maybe a slight bit better sleep and maybe a tiny bit better performance in the gym, but not really anything to write home about. I just feel like there has to be more issues than just “low T”. If I’m having decent morning wood, then the plumbing has to be good as far as blood flow and also at that particular time the T/E ratio must be in its “sweet spot”. So why after that brief morning period does my body just seem to stop androgenic functionality as it seems? Just has me very lost at the moment.