Is my ED physical, psychological or hormonal?

TestBoosted · Monday at 11:56 AM

madman said:
This is something overlooked by many men suffering from ED!

Many young men can suffer from this.

*ED due to caverno-venous leakage (CVL), whether isolated or accompanying other causes of erectile dysfunction, is frequent specially among young adults

Thread 'Cavernoscanner: Technique and modelling in ED due to caverno-venous leakage'

Sep 2, 2023

This is something overlooked by many men suffering from ED!

Many young men can suffer from this.

*ED due to caverno-venous leakage (CVL), whether isolated or accompanying other causes of erectile dysfunction, is frequent specially among young adults

madman

ed; ct scan; venous leak; penile ultrasonography

Replies: 16

Forum: When TRT Is Not Enough (ED, Libido, & More)

Will read this.

TestBoosted · Monday at 12:00 PM

Melody68 said:
Hey TB, I feel badly for you, but I think you've found your way to some very bright people here on the board - hopefully they can help out.

I have shades of the same concerns as you. I'm older, 69, but am in good physical shape; also on TRT. I have only a limited response to Viagra so I tried Trimix, with the same less than ideal erection quality. My urologist is also thinking venous leak. I tried the rings but they don't make much of a difference.

The kicker, to me, is that I often wake up with a super rigid erection. Hard to believe that I can't get an adequate erection during waking hours, even if I use Viagra or Trimix, but then in the morning I'd wake up with a 10/10 erection. Maybe many things are psychological in nature . . .

Thank you for your kindness friend, I really appreciate it.

Regarding your situation, the fact that you wake up with 10/10 erections leads me to believe that your penis works fine. I would assume that your issues during the day may be more related to some medication you are taking or maybe some mental block.

In my case, I only wake up with soft erections, that's why I was very suprirsed when the NPT test stated that I had 3 episodes lasting 1 hour at 85% rigidity.

I know what it means to get a very good erection when waking up, as I used to get them almost every day for those 2 years where everything was functioning well. I never experienced that again in the past 4 years unfortunately

TestBoosted · Monday at 12:02 PM

Kenp said:
How is your libido?

Sounds like PSSD

Hi Kenp,

My libido is fine. I think and fantasize about women a lot during the day and I find myself glancing at women several times when I'm out. I would say that my libido is fine, I still am interested in the opposite sex.

Unfortunately, it's the physical aspect that is not working and that sometimes leads me to avoid getting into relationships because I already know that they won't last long due to my inability to perform.

TestBoosted · Monday at 12:31 PM

madman said:
Smart move cleaning up your diet as your blood markers were not stellar!

You are missing the most important blood marker here which would be free testosterone.

Always need to include critical blood markers RBCs, hemoglobin, hematocrit and ferritin/iron!

Run it by me again where your RBCs, H/H sit and have you ever tested ferritin/iron?

No need to test LH/FSH as your hpta will be shutdown when using exogenous T.

Ultra short-acting nasal T-gel (Natesto) is the only T formulation which would have the least impact on the suppression of the hpta.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Luckily you posted your SHBG and Albumin so we can easily calculate your FT using the go to linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.

In order to know where your FT truly sits you would need to have it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

If you live outside of the US and most likely will not have access to such then you would need to use/rely upon the calculated FTV.

The direct immunoassay is inaccurate and should never be used/relied upon.

If we calculate your FT and plug in your dismal trough TT 348.9 nmol/L, lowish SHBG 22.4 nmol/L and Albumin 4.6 g/dL then your trough FT 8.25 ng/dL would be close to the bottom end of the reference range.

Free & Bioavailable Testosterone calculator
View attachment 53170

Yes your peak TT/FT would be higher but still subpar!

Most healthy young males would be hitting a cFTV 13-15 ng/dL and this would be a short-lived daily peak to boot.

Always need to be mindful of your injection frequency/where trough FT sits.

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high!

The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.

Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.

Also going to be a big difference in peak--->trough on said protocol.

Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!

Even if you take those natty outliers in the 95th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot!

Clear as day looking over the results from your most recent protocol 78.75 mg TE/week (22.5 mg EOD) that your trough TT 348.9 nmol/L and more importantly trough FT 8.25 ng/dL is too low.

Looking over your results from June when you were injecting 100 mg TE/week (50 mg every 3.5 days) you would have been hitting a descent trough FT 14 ng/dL and you would still have room to increase it further if need be.

Again your peak TT and more importantly FT would be much higher.

If we calculate your FT and plug in your descent TT 500.3 ng/dL, lowish SHBG 16.30 nmol/L and Albumin 4.6 g/dL then your trough FT 14 ng/dL would be considered healthy.

Again you would still have room to increase it if need be.

Free & Bioavailable Testosterone calculator
View attachment 53171

Looking over the results when you were on the protocol 90 mg T/week split (30 mg 3x weekly) you only posted your trough TT and estradiol.

You never posted SHBG or Albumin but chances are your SHBG was still lowish and your Albumin hovered around the same as previously.

You were hitting a robust trough TT 666.2 ng/dL so if your SHBG was still lowish 16-22 nmol/L and Albumin hovered around 4.6 g/dL then your trough cFTV 17-19 ng/dL would have been hitting the higher-end and well in the healthy range.

Again your peak TT and more importantly FT would have been higher.

You need to increase your weekly dose of T and get your trough FT higher!

Wowww, thanks a lot for going through the task of calculating the free testosterone for the 3 of my protocols. It makes me very happy that there are still people like you who care and are willing to help others. You have truly made my day.

I agree, it seems that my last protocol (22.5mg EOD) is producing a very low total testosterone. I have since increased it to 27.5mg EOD since last week. Would you suggest me to stick with this protocol or should I go back to the 30mg 3 times a week? Maybe increase to 35mg 3 times a week? My only worry with both the 27.5mg EOD and 35mg 3 times a week protocol is estrogen going up. What would you suggest to do to keep estrogen in control?

Regarding RBC (Latest Bloods - 2), haemoglobin (Latest bloods - 3), haemocrit (Latest bloods -3), I have attached the latest results to this comment.

Regarding iron/ferratin, I don't think I have that.

Gman86 · Monday at 5:07 PM

TestBoosted said:
After the last blood test, I have increased my dose to 27.5mg EOD, but I fear that estrogen will spike again. Unfortunately, it seems that I will definitely need an AI, something that my doctor is very much against.

Ya if u can’t get ur hands on nandrolone, in order to try out the nandrolone base, which would keep estrogen in check without an ai, u might need an ai to get the proper test to estrogen ratio that would allow for optimal sexual function

TestBoosted said:
Regarding my TSH, this came at 2.6 micIU\L, which is in the normal range. However, before I lost weight, it used to come around 3ish, so there's definitely some hypothyroidism in place. I will discuss this with my doctor.

Ya I’m not sure if the range and units of measurement are the same here in the U.S. as where u are, but in the U.S., any TSH over 2 is pretty much hyperthyroidism territory, based on everything I’ve learned about thyroid. There’s a good chance u can get ur thyroid functioning properly just by optimizing ur diet, and lifestyle factors, like sleep, stress and working out regularly

TestBoosted said:
Regarding the cholesterol, why do you think I should drop the statin please? Without it, my total cholesterol would be higher than 5. Before medication, it used to hover around 6 and that was with diet and exercise. Unfortunately, I didn't win the genetic lottery when it comes to cholesterol because I always had high LDL (without medication), low HDL and high triglycerides, even when I was in better shape. Regarding my diet, for the past 4 months I have cleaned up my diet, eating mostly 0% fat greek yogurt, almonds, turkey slices, 1 apple a day, chicken, 3 tablespoons brown rice, lots of vegetables. I also only drink water. You can see the difference in my insulin resistance and cholesterol in the first 2 screenshots, although I do agree that the numbers could be much better. Again, unfortunately it seems that genetics are against me as my father was diagnosed with diabetes at 30 years old, so most probably those genes are very strong in me.

So I’ve been researching health/ longevity and diet nonstop basically my whole adult life. U could say I’m pretty obsessed with anything that has to do with optimizing the human body, but especially nutrition. So I can send u infinite info/ videos summing up everything I’ve learned over the years, or u can just trust that I know what I’m talking about when it comes to this stuff lol. But basically u want ur cholesterol levels very high. HDL and LDL, if optimal health/ decreasing ur risk of overall cardiovascular disease are ur goals. Then u want triglycerides and fasting insulin as low as possible basically. Get ur cholesterol levels as high as u can get them, and get ur insulin and triglycerides as low as u can get them, and that’s the ultimate combo to optimal health/ decreasing ur risk of having any type of cardiovascular disease. I can send u videos from very smart cardiologists explaining why this is the combo u want, again if avoiding any type of cardiovascular disease is the goal. Lmk if u want me to send u over any of those vids

As far as ur diet goes, it looks like u fear fats. Which is literally the worst thing u can do if optimal health is the goal. U don’t want to consume non-raw/ processed dairy on a regular basis. So wouldn’t consume that Greek yogurt on a regular basis. It’s just going to cause inflammation and issues throughout ur body. Almonds are a nut, obv, and nuts/ seeds/ legumes aren’t good for u, so definitely wouldn’t consume any of those on a regular basis. Again, just going to cause issues within ur body over time. Turkey slices aren’t ideal due to the things they put in deli meat. Apples aren’t too too bad, but they’re one of the most sprayed fruits, as far as pesticides go, so I personally wouldn’t consume non organic apples on a daily basis. Chicken is decent, but not an ideal source of animal meat to eat on a daily basis, just due to chickens being a monogastric animal, and if the chicken eats crap, the meat and fat aren’t going to be that great. Vegetables are bad for u, so unless u really enjoy eating them, I wouldn’t consume those regularly. If ur strictly eating them because u think they’re good for u, definitely just cut them out. Rice isn’t a great source of nutrition. Plus it contains too many anti nutrients. I’ll list some below. It also contains more arsenic than white rice, so never consume brown rice that isn’t organic. I would switch that carb source out for something like fruit and/ or raw honey.

So overall ur diet is actually pretty bad, not gonna lie lol. The best way to make it better/ optimize it/ optimize ur overall health, is to try and consume as much fatty ruminant animal/ red meat as possible each day. That’s the #1 thing anyone can do to optimize their diet/ health. Then as far as carbs go, I would get them from fruits and raw honey. Obv get organic fruits whenever possible. If it’s not an organic fruit, I just try to get fruits where u don’t eat the outer part. Like melons, or oranges, or mangos, for a few examples. Fruits where u at least peel off the outer part and only consume the flesh. They’ll still be pesticides in the flesh, but less than the outer part that u peel off. But basically just try to get as much of ur calories each day from fatty ruminant animal meat as u can, as well as other animals based foods, like pastured eggs (whole egg, never throw away the yolk), grassfed ghee/ butter, and if u really enjoy them, chicken and seafood. And the only oil I would consume/ cook with is organic unrefined coconut oil.

Phytic Acid:

Found in the bran of brown rice, phytic acid binds to minerals such as iron, zinc, calcium, and magnesium, making them less available for absorption.

Lectins:

- Plant proteins that can cause digestive discomfort and inflammation in some individuals.

Trypsin Inhibitors:

- Proteins that interfere with the digestion of protein.

Arsenic:

- A naturally occurring element that can accumulate in brown rice, especially if grown in contaminated soil.

Other Antinutrients:

- Brown rice also contains phenolic acids, which can have antioxidant properties but may also contribute to inflammation in high doses.

TestBoosted said:
Regarding my depression, my psychiatrist suggested adding 150mg Wellbutrin to 25mg Anafranil. I have added Wellbutrin for a month now, although I didn't notice much difference.

Thanks a lot again for your insightful information, really appreciate it!

Again, I would look into selegiline. I can send u infinite info on it if ur interested in learning more about it

Gman86 · Monday at 5:16 PM

@TestBoosted there’s a bunch of reasons why fatty ruminant animal meat should be the source of most of the calories anyone consumes on a daily basis, but a few of the reasons are because it packs way more nutrition than any other food per calorie, other than maybe beef liver, and contains vital micronutrients that u can’t get in any other foods. Also, ruminant animals have 4 chambers to their stomachs. I’ll paste an except from google that briefly goes over why ruminant animal meat is healthier than monogastric animal meat. But overall, basically ruminant animals can consume crap food, like the food that they feed most animals at farms, and they can turn that crap food into high quality meat. Meanwhile, when monogastric animals consume crap food, their meat is going to be a lot worse than if they consumed their natural diet.

Ruminant animals contain healthier meat because their multi-chambered digestive system allows them to convert grasses and forages into beneficial fats like omega-3s and Conjugated Linoleic Acid (CLA), and absorb vitamins and minerals from fibrous plants that monogastrics cannot. In contrast, monogastric animals, often fed corn and soy diets, can accumulate higher levels of inflammatory polyunsaturated fatty acids (PUFAs) in their meat, making ruminant meat, especially from grass-fed animals, a more beneficial choice

madman · Monday at 7:22 PM

TestBoosted said:
Thank you so much for this valuable information, really appreciate it!

Before I did the NPT (Nocturnal penile tumescense test), I was 99% convinced that I had venous leak. However, the NPT suggested I had 3 erectile episodes lasting 1 hour at 85% rigidity, which then put me in doubt whether my ED is truly psychological or caused by the antidepressants.

I have some questions regarding this:

i) Can depression or the anti depressants lead to NO response to Cialis, Viagra and Levitra?
ii) Can depression or the anti depressants lead to NO response to Caverject? Tried Caverject 5 times, with the same response each time (60% erection, penis head still soft)

iii) Can depression or the anti depressants cause the veins in the penis to NOT constrict when aroused, thus leading to loss of erection? In other words, can depression or the antidepressants mimic a venous leak?

Regarding dynamic cavernosography, I am interested in trying it. Do you know of any hospital or clinics in the UK, Italy, Spain or somewhere else in Europe that do this test? Unfortunately, only the Penile Doppler is done in my country.

Also regarding dynamic cavernosography, will it still give a correct result irrespective of the depression or anti depressants? In other words, is there a way for me to know that my erectile dysfunction is 100% being caused by a physical issue and NOT a psychological or medication issue?

Thank you so much!

If the NPT Rigiscan test was normal it would indicate that the physiological systems required for achieving and maintaining an erection are working well enough to produce strong erections under optimal conditions during sleep

The body is in a relaxed state and psychological stressors would be minimized which would rule out severe organic causes of ED (significant vascular disease, moderate-severe venous leak or major neurological damage).

A normal NPT would point towards psychogenic ED which is most likely the major issue in your case but
the results from the PDU could indicated possible venous leak which would most likely be mild as the results from the NPT Rigiscan test would rule out severe organic cause.

If you do have a mild venous leak then chances are you could have mixed ED where psychogenic ED is the significant player here and the physical component is mild.

Most SSRIs can easily have a negative impact on libido/erections.

Anafranil (clomipramine) has high sexual side effects.

Also keep in mind when you had the PDU if you were anxious or nervous during the test then it could easily cause a false positive as any negative psychological stress (being anxious/nervous) will cause the body to release adrenaline which is an erection killer!

Adrenaline is a vasoconstrictor, think sympathetic nervous system and penile smooth muscle.

You need to be relaxed before/during the test or the results can be skewed.

If the dose of the vasodilator (alprostadil) is not high enough this could also cause a false positive.

Seeing as you already had a PDU done twice and if you feel that the results were the same you could still look into getting a dynamic cavernosography to rule out venous leak.

The dynamic infusion cavernosometry/cavernosography (DICC) would be the gold standard for confirming a venous leak.

Sensitivity/Specificity is 90-100% for mild leaks.

It would be available at advanced urology or andrology centers and look for the ones affiliated with universities or major hospitals.

Overall any psychological inhibition can blunt these drugs (PDE5i, alprostadil) effects.

i) Can depression or the anti depressants lead to NO response to Cialis, Viagra and Levitra?

Yes depression or antidepressants can lead to a lack of response/reduced response to PDE5i as they can affect sexual arousal, libido, and the neurological pathways involved in erections.

ii) Can depression or the anti depressants lead to NO response to Caverject? Tried Caverject 5 times, with the same response each time (60% erection, penis head still soft)

Yes they can also contribute to a poor/no response to Caverject (alprostadil injection) as psychological factors like depression, anxiety, or stress could impair the response by increasing sympathetic nervous system activity, which would counteract the relaxation needed for a full erection.

Antidepressants, especially the SSRIs, can exacerbate this by affecting serotonin levels, which influence sexual function and arousal pathways

iii) Can depression or the anti depressants cause the veins in the penis to NOT constrict when aroused, thus leading to loss of erection? In other words, can depression or the antidepressants mimic a venous leak?

Yes depression can produce similar symptoms disrupting the autonomic nervous system, preventing proper smooth muscle relaxation.

Antidepressants, especially the SSRIs, can exacerbate this by affecting serotonin levels.

Also regarding dynamic cavernosography, will it still give a correct result irrespective of the depression or anti depressants?

It is generally reliable and less affected by depression or antidepressants compared to the less invasive tests like PDU and although they both use Cavarject to. induce a reaction their methodologies differ significantly in how they assess venous function and handle external influences l(psychological factors or medications).

DICC would be superior to PDU for ruling out a mild venous leak because it directly measures and visualizes venous outflow, minimizing the impact of depression, anxiety, or antidepressants, which skew can skew PDU results.

madman · Monday at 8:05 PM

TestBoosted said:
Wowww, thanks a lot for going through the task of calculating the free testosterone for the 3 of my protocols. It makes me very happy that there are still people like you who care and are willing to help others. You have truly made my day.

I agree, it seems that my last protocol (22.5mg EOD) is producing a very low total testosterone. I have since increased it to 27.5mg EOD since last week. Would you suggest me to stick with this protocol or should I go back to the 30mg 3 times a week? Maybe increase to 35mg 3 times a week? My only worry with both the 27.5mg EOD and 35mg 3 times a week protocol is estrogen going up. What would you suggest to do to keep estrogen in control?

Regarding RBC (Latest Bloods - 2), haemoglobin (Latest bloods - 3), haemocrit (Latest bloods -3), I have attached the latest results to this comment.

Regarding iron/ferratin, I don't think I have that.

I would just bump it up to 30-35 mg (3x weekly) or you could go with 30 mg EOD.

Keep in mind when you were injecting 30 mg (3x weekly) you would have been hitting a healthy trough FT.

As I stated in one of my previous replies:

Looking over the results when you were on the protocol 90 mg T/week split (30 mg 3x weekly) you only posted your trough TT and estradiol.

You never posted SHBG or Albumin but chances are your SHBG was still lowish and your Albumin hovered around the same as previously.

You were hitting a robust trough TT 666.2 ng/dL so if your SHBG was still lowish 16-22 nmol/L and Albumin hovered around 4.6 g/dL then your trough cFTV 17-19 ng/dL would have been hitting the higher-end and well in the healthy range.

Again your peak TT and more importantly FT would have been higher.

Injecting more frequently will clip the peak--->trough and blood levels will be more stable throughout the week.

it will also soften your peak and lower your trough.

It's a given driving up your FT will drive up your estradiol.

Downfall here is if you are carrying a lot of adipose you are going to run into issues.

Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.

Some men that are lean can still be high aromatizers. too.

Unfortunately there are still lots of men who rely on the use of an AI which would not be needed in most cases.

Need to be mindful when it comes to the use of an AI as some may fare better using micro-doses but for most they are not needed especially if you do not drive your trough/steadsy-state FT too high!

We need to tread lightly when trying to manipulate testosterone metabolites estradiol and DHT as they are needed in healthy amounts and are critical to our overall health.

Estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone's beneficial effects on mood, energy, libido, erectile function, cardiovascular health, brain, bones, tendons, immune system, body composition, and recovery.

Not a given that one would need to use an aromatase inhibitor.

Many men can run high-end or high FT/estradiol yet never have any issues with elevated e2.

Others may struggle when estradiol gets too high and fare better micro dosing an AI in order to keep e2 within a set range.

I run a higher end trough TT which has my trough e2 on the high-end.

I never have and never would touch an AI.

If I had any issues that may be related to elevated e2 then I would bring down my trough FT.

Some men will switch to injecting lower doses of T daily in order to try and bring down estradiol or hematocrit but many can still end up struggling on dailies if they are still running too high a trough/steady-state FT.

If anything I would use any of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) over an ND base as you will always need to make sure you are using low does T with ND or hCG in order to keep your estradiol in a healthy range.

Great formulation if you are one who struggles with elevated estradiol let alone elevated hematocrit.

Unfortunately where you live I think the only oral TU available would be Andriol which is rarely prescribed now as most do not fare well.

Keep in mind your RBCs, hemoglobin and hematocrit are already at the top-end of the reference range and this is with a shitty TT and more importantly trough FT level.

Hopefully you were hydrated (fluid/electrolytes) when you had your blood work done otherwise the results would be skewed.

If they were accurate and your trough FT is subpar then you may have an underlying issue contributing to such.

Have you ever been tested for sleep apnea?

Where did your RBCs, H/H sit pre-nth?

Yes would be a wise move to test your ferritin/iron as they are critical blood markers.

TestBoosted · 2025-10-09T15:06:55-0500

Gman86 said:
Ya if u can’t get ur hands on nandrolone, in order to try out the nandrolone base, which would keep estrogen in check without an ai, u might need an ai to get the proper test to estrogen ratio that would allow for optimal sexual function

Ya I’m not sure if the range and units of measurement are the same here in the U.S. as where u are, but in the U.S., any TSH over 2 is pretty much hyperthyroidism territory, based on everything I’ve learned about thyroid. There’s a good chance u can get ur thyroid functioning properly just by optimizing ur diet, and lifestyle factors, like sleep, stress and working out regularly

So I’ve been researching health/ longevity and diet nonstop basically my whole adult life. U could say I’m pretty obsessed with anything that has to do with optimizing the human body, but especially nutrition. So I can send u infinite info/ videos summing up everything I’ve learned over the years, or u can just trust that I know what I’m talking about when it comes to this stuff lol. But basically u want ur cholesterol levels very high. HDL and LDL, if optimal health/ decreasing ur risk of overall cardiovascular disease are ur goals. Then u want triglycerides and fasting insulin as low as possible basically. Get ur cholesterol levels as high as u can get them, and get ur insulin and triglycerides as low as u can get them, and that’s the ultimate combo to optimal health/ decreasing ur risk of having any type of cardiovascular disease. I can send u videos from very smart cardiologists explaining why this is the combo u want, again if avoiding any type of cardiovascular disease is the goal. Lmk if u want me to send u over any of those vids

As far as ur diet goes, it looks like u fear fats. Which is literally the worst thing u can do if optimal health is the goal. U don’t want to consume non-raw/ processed dairy on a regular basis. So wouldn’t consume that Greek yogurt on a regular basis. It’s just going to cause inflammation and issues throughout ur body. Almonds are a nut, obv, and nuts/ seeds/ legumes aren’t good for u, so definitely wouldn’t consume any of those on a regular basis. Again, just going to cause issues within ur body over time. Turkey slices aren’t ideal due to the things they put in deli meat. Apples aren’t too too bad, but they’re one of the most sprayed fruits, as far as pesticides go, so I personally wouldn’t consume non organic apples on a daily basis. Chicken is decent, but not an ideal source of animal meat to eat on a daily basis, just due to chickens being a monogastric animal, and if the chicken eats crap, the meat and fat aren’t going to be that great. Vegetables are bad for u, so unless u really enjoy eating them, I wouldn’t consume those regularly. If ur strictly eating them because u think they’re good for u, definitely just cut them out. Rice isn’t a great source of nutrition. Plus it contains too many anti nutrients. I’ll list some below. It also contains more arsenic than white rice, so never consume brown rice that isn’t organic. I would switch that carb source out for something like fruit and/ or raw honey.

So overall ur diet is actually pretty bad, not gonna lie lol. The best way to make it better/ optimize it/ optimize ur overall health, is to try and consume as much fatty ruminant animal/ red meat as possible each day. That’s the #1 thing anyone can do to optimize their diet/ health. Then as far as carbs go, I would get them from fruits and raw honey. Obv get organic fruits whenever possible. If it’s not an organic fruit, I just try to get fruits where u don’t eat the outer part. Like melons, or oranges, or mangos, for a few examples. Fruits where u at least peel off the outer part and only consume the flesh. They’ll still be pesticides in the flesh, but less than the outer part that u peel off. But basically just try to get as much of ur calories each day from fatty ruminant animal meat as u can, as well as other animals based foods, like pastured eggs (whole egg, never throw away the yolk), grassfed ghee/ butter, and if u really enjoy them, chicken and seafood. And the only oil I would consume/ cook with is organic unrefined coconut oil.

Phytic Acid:

Found in the bran of brown rice, phytic acid binds to minerals such as iron, zinc, calcium, and magnesium, making them less available for absorption.

Lectins:

Plant proteins that can cause digestive discomfort and inflammation in some individuals.

Trypsin Inhibitors:

Proteins that interfere with the digestion of protein.

Arsenic:

A naturally occurring element that can accumulate in brown rice, especially if grown in contaminated soil.

Other Antinutrients:

Brown rice also contains phenolic acids, which can have antioxidant properties but may also contribute to inflammation in high doses.

Again, I would look into selegiline. I can send u infinite info on it if ur interested in learning more about it

Thanks a lot for your advice!

I will try to convince my doctor to give me an AI as I tend to aromatize too much.

Regarding thyroid, I will discuss with the doctor. I have a feeling she won't prescibe thyroxine as my tsh is still within the range used in my country. I will try though.

I will search more on the diet tips you gave me, they sound very interesting. Thanks a lot

TestBoosted · 2025-10-09T15:12:38-0500

madman said:
If the NPT Rigiscan test was normal it would indicate that the physiological systems required for achieving and maintaining an erection are working well enough to produce strong erections under optimal conditions during sleep

The body is in a relaxed state and psychological stressors would be minimized which would rule out severe organic causes of ED (significant vascular disease, moderate-severe venous leak or major neurological damage).

A normal NPT would point towards psychogenic ED which is most likely the major issue in your case but
the results from the PDU could indicated possible venous leak which would most likely be mild as the results from the NPT Rigiscan test would rule out severe organic cause.

If you do have a mild venous leak then chances are you could have mixed ED where psychogenic ED is the significant player here and the physical component is mild.

Most SSRIs can easily have a negative impact on libido/erections.

Anafranil (clomipramine) has high sexual side effects.

Also keep in mind when you had the PDU if you were anxious or nervous during the test then it could easily cause a false positive as any negative psychological stress (being anxious/nervous) will cause the body to release adrenaline which is an erection killer!

Adrenaline is a vasoconstrictor, think sympathetic nervous system and penile smooth muscle.

You need to be relaxed before/during the test or the results can be skewed.

If the dose of the vasodilator (alprostadil) is not high enough this could also cause a false positive.

Seeing as you already had a PDU done twice and if you feel that the results were the same you could still look into getting a dynamic cavernosography to rule out venous leak.

The dynamic infusion cavernosometry/cavernosography (DICC) would be the gold standard for confirming a venous leak.

Sensitivity/Specificity is 90-100% for mild leaks.

It would be available at advanced urology or andrology centers and look for the ones affiliated with universities or major hospitals.

Overall any psychological inhibition can blunt these drugs (PDE5i, alprostadil) effects.

i) Can depression or the anti depressants lead to NO response to Cialis, Viagra and Levitra?

Yes depression or antidepressants can lead to a lack of response/reduced response to PDE5i as they can affect sexual arousal, libido, and the neurological pathways involved in erections.

ii) Can depression or the anti depressants lead to NO response to Caverject? Tried Caverject 5 times, with the same response each time (60% erection, penis head still soft)

Yes they can also contribute to a poor/no response to Caverject (alprostadil injection) as psychological factors like depression, anxiety, or stress could impair the response by increasing sympathetic nervous system activity, which would counteract the relaxation needed for a full erection.

Antidepressants, especially the SSRIs, can exacerbate this by affecting serotonin levels, which influence sexual function and arousal pathways

iii) Can depression or the anti depressants cause the veins in the penis to NOT constrict when aroused, thus leading to loss of erection? In other words, can depression or the antidepressants mimic a venous leak?

Yes depression can produce similar symptoms disrupting the autonomic nervous system, preventing proper smooth muscle relaxation.

Antidepressants, especially the SSRIs, can exacerbate this by affecting serotonin levels.

Also regarding dynamic cavernosography, will it still give a correct result irrespective of the depression or anti depressants?

It is generally reliable and less affected by depression or antidepressants compared to the less invasive tests like PDU and although they both use Cavarject to. induce a reaction their methodologies differ significantly in how they assess venous function and handle external influences l(psychological factors or medications).

DICC would be superior to PDU for ruling out a mild venous leak because it directly measures and visualizes venous outflow, minimizing the impact of depression, anxiety, or antidepressants, which skew can skew PDU results.

Thank you so much for the valuable information, I really appreciate it!

And thanks for going into detail how antidepressants and depression can affect response to PDE5 inhibitors and caverject. They are very informative.

Regarding Anafranil, I discussed with my psychiatrist and she is going to change my medication to Trazadone 50mg. Right now I am winding down from Anafranil. Hopefully this will result in positive changes.

Thank you for your suggestion regarding where to get dynamic cavernosography.

TestBoosted · 2025-10-09T15:25:30-0500

madman said:
I would just bump it up to 30-35 mg (3x weekly) or you could go with 30 mg EOD.

Keep in mind when you were injecting 30 mg (3x weekly) you would have been hitting a healthy trough FT.

As I stated in one of my previous replies:

Looking over the results when you were on the protocol 90 mg T/week split (30 mg 3x weekly) you only posted your trough TT and estradiol.

You never posted SHBG or Albumin but chances are your SHBG was still lowish and your Albumin hovered around the same as previously.

You were hitting a robust trough TT 666.2 ng/dL so if your SHBG was still lowish 16-22 nmol/L and Albumin hovered around 4.6 g/dL then your trough cFTV 17-19 ng/dL would have been hitting the higher-end and well in the healthy range.

Again your peak TT and more importantly FT would have been higher.

Injecting more frequently will clip the peak--->trough and blood levels will be more stable throughout the week.

it will also soften your peak and lower your trough.

It's a given driving up your FT will drive up your estradiol.

Downfall here is if you are carrying a lot of adipose you are going to run into issues.

Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.

Some men that are lean can still be high aromatizers. too.

Unfortunately there are still lots of men who rely on the use of an AI which would not be needed in most cases.

Need to be mindful when it comes to the use of an AI as some may fare better using micro-doses but for most they are not needed especially if you do not drive your trough/steadsy-state FT too high!

We need to tread lightly when trying to manipulate testosterone metabolites estradiol and DHT as they are needed in healthy amounts and are critical to our overall health.

Estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone's beneficial effects on mood, energy, libido, erectile function, cardiovascular health, brain, bones, tendons, immune system, body composition, and recovery.

Not a given that one would need to use an aromatase inhibitor.

Many men can run high-end or high FT/estradiol yet never have any issues with elevated e2.

Others may struggle when estradiol gets too high and fare better micro dosing an AI in order to keep e2 within a set range.

I run a higher end trough TT which has my trough e2 on the high-end.

I never have and never would touch an AI.

If I had any issues that may be related to elevated e2 then I would bring down my trough FT.

Some men will switch to injecting lower doses of T daily in order to try and bring down estradiol or hematocrit but many can still end up struggling on dailies if they are still running too high a trough/steady-state FT.

If anything I would use any of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) over an ND base as you will always need to make sure you are using low does T with ND or hCG in order to keep your estradiol in a healthy range.

Great formulation if you are one who struggles with elevated estradiol let alone elevated hematocrit.

Unfortunately where you live I think the only oral TU available would be Andriol which is rarely prescribed now as most do not fare well.

Keep in mind your RBCs, hemoglobin and hematocrit are already at the top-end of the reference range and this is with a shitty TT and more importantly trough FT level.

Hopefully you were hydrated (fluid/electrolytes) when you had your blood work done otherwise the results would be skewed.

If they were accurate and your trough FT is subpar then you may have an underlying issue contributing to such.

Have you ever been tested for sleep apnea?

Where did your RBCs, H/H sit pre-nth?

Yes would be a wise move to test your ferritin/iron as they are critical blood markers.

Thanks for your detailed explanation regarding testosterone vs estrogen. I have since moved back to 30mg 3 times a week since that gave me a good result. Noted about the AI.

I recently lost 8 kgs and I'm definitely not overweight, I guess I am just genetically high aromatizer.

When I took my test, I wasn't hydrated. I had been fasting for 12 hours and didn't have any water. Later I found out that this was actually detrimental, as my nurse found it difficult to draw blood.

I was tested for sleep apnea and they found I had a moderate case of sleep apnea (16 AHI). People who slept in the same room as me always complained I snored a lot. I think the snoring went way down after losing weight (Sleep score reduced from 80 to 35 on SnoreLab app, still above 25, considered normal, but much better than before).

Regarding Ferritin, I found some results starting from 2 years ago to today.

119 ng/ml
150 ng/ml
149 ng/ml
120 ng/ml

Normal range provided by hospital is 22-322 ng/ml

Gman86 · 2025-10-09T18:18:47-0500

TestBoosted said:
Thanks a lot for your advice!

I will try to convince my doctor to give me an AI as I tend to aromatize too much.

Regarding thyroid, I will discuss with the doctor. I have a feeling she won't prescibe thyroxine as my tsh is still within the range used in my country. I will try though.

I will search more on the diet tips you gave me, they sound very interesting. Thanks a lot

I wouldn’t go on synthetic thyroid meds anyways. If ur gonna take meds for ur thyroid, I would always go with NDT from pig thyroids. But ur thyroid values aren’t too far off. I’m sure u can optimize them simply by optimizing ur diet

TestBoosted · 2025-10-10T09:32:03-0500

madman said:
I would just bump it up to 30-35 mg (3x weekly) or you could go with 30 mg EOD.

Keep in mind when you were injecting 30 mg (3x weekly) you would have been hitting a healthy trough FT.

As I stated in one of my previous replies:

Looking over the results when you were on the protocol 90 mg T/week split (30 mg 3x weekly) you only posted your trough TT and estradiol.

You never posted SHBG or Albumin but chances are your SHBG was still lowish and your Albumin hovered around the same as previously.

You were hitting a robust trough TT 666.2 ng/dL so if your SHBG was still lowish 16-22 nmol/L and Albumin hovered around 4.6 g/dL then your trough cFTV 17-19 ng/dL would have been hitting the higher-end and well in the healthy range.

Again your peak TT and more importantly FT would have been higher.

Injecting more frequently will clip the peak--->trough and blood levels will be more stable throughout the week.

it will also soften your peak and lower your trough.

It's a given driving up your FT will drive up your estradiol.

Downfall here is if you are carrying a lot of adipose you are going to run into issues.

Most men that end up struggling with elevated e2 are most likely carrying a lot of adipose or are genetically high aromatizers.

Some men that are lean can still be high aromatizers. too.

Unfortunately there are still lots of men who rely on the use of an AI which would not be needed in most cases.

Need to be mindful when it comes to the use of an AI as some may fare better using micro-doses but for most they are not needed especially if you do not drive your trough/steadsy-state FT too high!

We need to tread lightly when trying to manipulate testosterone metabolites estradiol and DHT as they are needed in healthy amounts and are critical to our overall health.

Estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone's beneficial effects on mood, energy, libido, erectile function, cardiovascular health, brain, bones, tendons, immune system, body composition, and recovery.

Not a given that one would need to use an aromatase inhibitor.

Many men can run high-end or high FT/estradiol yet never have any issues with elevated e2.

Others may struggle when estradiol gets too high and fare better micro dosing an AI in order to keep e2 within a set range.

I run a higher end trough TT which has my trough e2 on the high-end.

I never have and never would touch an AI.

If I had any issues that may be related to elevated e2 then I would bring down my trough FT.

Some men will switch to injecting lower doses of T daily in order to try and bring down estradiol or hematocrit but many can still end up struggling on dailies if they are still running too high a trough/steady-state FT.

If anything I would use any of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) over an ND base as you will always need to make sure you are using low does T with ND or hCG in order to keep your estradiol in a healthy range.

Great formulation if you are one who struggles with elevated estradiol let alone elevated hematocrit.

Unfortunately where you live I think the only oral TU available would be Andriol which is rarely prescribed now as most do not fare well.

Keep in mind your RBCs, hemoglobin and hematocrit are already at the top-end of the reference range and this is with a shitty TT and more importantly trough FT level.

Hopefully you were hydrated (fluid/electrolytes) when you had your blood work done otherwise the results would be skewed.

If they were accurate and your trough FT is subpar then you may have an underlying issue contributing to such.

Have you ever been tested for sleep apnea?

Where did your RBCs, H/H sit pre-nth?

Yes would be a wise move to test your ferritin/iron as they are critical blood markers.

I have one other piece of information. The day I took my most recent testosterone test, I also took free testosterone but that result takes a while to come out. I finally received it today.

My free testosterone is 23.4 pg/ml. Range is between 7 and 26.

Total testosterone was 12nmol/L.

Oestradiol 111 pmol/L.

Albumin 46.9 g/L.

SHBG 22.4 nmol/L.

I was actually very surprised that I got this high value, given how low my Total testosterone was. I hope they didn't do a mistake on my total testosterone as I found it strange that on 30mg x3 weekly I had trouugh of 23 nmol/L while on 22.5mg x4 weekly I got 12 nmol/L.

These results make me think that whatever is causing my erectile dysfunction must not be hypogonadism or bad testosterone levels.

It must be something else, either a venous leak or antidepressants/depression. What do you think?

madman · 2025-10-10T10:28:25-0500

TestBoosted said:
I have one other piece of information. The day I took my most recent testosterone test, I also took free testosterone but that result takes a while to come out. I finally received it today.

My free testosterone is 23.4 pg/ml. Range is between 7 and 26.

Total testosterone was 12nmol/L.

Oestradiol 111 pmol/L.

Albumin 46.9 g/L.

SHBG 22.4 nmol/L.

I was actually very surprised that I got this high value, given how low my Total testosterone was. I hope they didn't do a mistake on my total testosterone as I found it strange that on 30mg x3 weekly I had trouugh of 23 nmol/L while on 22.5mg x4 weekly I got 12 nmol/L.

These results make me think that whatever is causing my erectile dysfunction must not be hypogonadism or bad testosterone levels.

It must be something else, either a venous leak or antidepressants/depression. What do you think?

I would ignore your FT results as there is no way you would be hitting a high-end FT with a far from stellar trough TT 341.6 ng/dL (12 nmol/L) even if you had low SHBG.

As I stated in one of my replies unfortunately you do not have access to the most accurate testing method for free testosterone the gold standard Equilibrium Dialysis so you would need to use/rely on the go to calculated method the linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.

If we take your far from stellar trough TT 341.6 ng/dL, lowish SHBG 22.4 nmol/L and Albumin 4.69 g/dL then your cFTV 7.96 ng/dL would be on the bottom-end of the reference range as in dismal!

Free & Bioavailable Testosterone calculator

This is why I told you to increase your weekly dose of T as your most recent trough FT is too low!

Again as I have stated numerous times on the forum over the years:

You need to pay attention to your trough FT on said protocol (dose of T/injection frequency).

Always need to be mindful of your injection frequency/where trough FT sits.

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high!

The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.

Yes many tend to aim for the higher-end but you need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.

Also going to be a big difference in peak--->trough on said protocol!

Many tend to overlook this and gun for a high-end/high trough FT regardless of their injection frequency only to end up struggling with sides especially in the long run.

The human body was never meant to be amped up on T let alone 24/7!

Running too high a trough/steady-state FT will hammer the s**t out of your dopamine and CNS to boot!

Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!

Even if you take those natty outliers in the 95th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot!

In order to aim for a healthy trough FT 15-25 ng/dL with a lowish SHBG 22.4 nmol/L you would need to hit a trough TT 600-932 ng/dL (roughly 20.8-32.3 nmol/L).

The most sensible move would be aim for a minimum trough 15 ng/dL which would leave room to increase your trough FT if need be!

No need to jack it up to the top-end off the hop!

Always better to start low and go slow as many will feel great without ever needing to hit a high/absurdly high trough!

It's a myth that needs to be put to rest!

As I stated previously you would have already been hitting a healthy trough FT 14-19 ng/dL when you were hitting a robust trough TT 500.3-666.2 ng/dL on your previous higher dosed protocols!

Again alll that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

For the majority if we are talking trough here it would be a healthy trough FT 15-25 depending on the injection frequency.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

Stick with your new protocol 90 mg T/week split ( 30 mg 3X weekly) and once you have reached your new steady-state (4-6 weeks) get your blood work done to see where your trough TT and more importantly FT sit and throw estradiol and DHT in there too.

Just test your trough TT and get SHBG/estradiol then calculate your FT using the linear law-of-mass action Vermeuelen using the online calculator which is available for free to the general public.

Forget relying on your current FT testing method which is out to lunch!

Kenp · 2025-10-10T12:23:37-0500

TestBoosted said:
I have one other piece of information. The day I took my most recent testosterone test, I also took free testosterone but that result takes a while to come out. I finally received it today.

My free testosterone is 23.4 pg/ml. Range is between 7 and 26.

Total testosterone was 12nmol/L.

Oestradiol 111 pmol/L.

Albumin 46.9 g/L.

SHBG 22.4 nmol/L.

I was actually very surprised that I got this high value, given how low my Total testosterone was. I hope they didn't do a mistake on my total testosterone as I found it strange that on 30mg x3 weekly I had trouugh of 23 nmol/L while on 22.5mg x4 weekly I got 12 nmol/L.

These results make me think that whatever is causing my erectile dysfunction must not be hypogonadism or bad testosterone levels.

It must be something else, either a venous leak or antidepressants/depression. What do you think?

Could be dopamine/neurosteroidal problems.

Have you tried dopamine agonists?

madman · 2025-10-10T14:51:49-0500

TestBoosted said:
I have one other piece of information. The day I took my most recent testosterone test, I also took free testosterone but that result takes a while to come out. I finally received it today.

My free testosterone is 23.4 pg/ml. Range is between 7 and 26.

Total testosterone was 12nmol/L.

Oestradiol 111 pmol/L.

Albumin 46.9 g/L.

SHBG 22.4 nmol/L.

I was actually very surprised that I got this high value, given how low my Total testosterone was. I hope they didn't do a mistake on my total testosterone as I found it strange that on 30mg x3 weekly I had trouugh of 23 nmol/L while on 22.5mg x4 weekly I got 12 nmol/L.

These results make me think that whatever is causing my erectile dysfunction must not be hypogonadism or bad testosterone levels.

It must be something else, either a venous leak or antidepressants/depression. What do you think?

It must be something else, either a venous leak or antidepressants/depression. What do you think?

Again look over my earlier replies post # 27/28.

You were already struggling with issues even when you were hitting a healthy trough FT on your previous protocols.

From your first post!

Below is a quick summary of what was said in the other thread:

i) Started experiencing ED at 22 or 23 years old.

ii) At first, doctors blamed anti-depressants I used to take.

iii) Blood test confirmed I had secondary hypogonadism and was put on testosterone.

iv) After being put on Nebido (testosterone undecanoate), erections came back full force after 3 months. I was finally cured and happy but this only lasted 2 years

e) Experimented with TRT dose. Changed to testosterone enanthate. Initially, SHBG was 16 nmol/L. Tried with 50mg twice a week, 30mg 3 times a week, 22.5mg EOD. Attached testosterone results at trough, all were good but no change in ED. (Results attached)

Even then you still need to make sure that you are sticking with a protocol that will put your trough FT in a healthy range.

The last thing you want to do here is have unhealthy T levels otherwise you are going to have numerous issues even if you address the depression/meds and the possibility of having a mild venous leak!