Sexual Dysfunction on TRT

[FONT=&quot]I'm 48 years old, 6'1, 225. Work out 1 hour per day on elliptical. Decent diet (grilled chicken, veggies), non smoker, drink on weekends and sometimes 5-6 drinks on a weekday. Started a CPAP machine 1 week ago for sleep apnea. Getting good night sleep now but still having issues with Dysfunction.[/FONT]
[FONT=&quot]Over the past 3-4 months, my sex drive is way down and my ability to have a long erection has diminished. Less penile sensitivity as well.[/FONT]

[FONT=&quot]DHEA 25 mg 2x per day, [/FONT]
[FONT=&quot]Testosterone injection SubQ into upper thigh, Monday and Thursday .3 (120mg)[/FONT]
[FONT=&quot]Anastrozol Just started going from .25 mg 2 times per week to 3 times per week[/FONT]
[FONT=&quot]HCG: .10 ML per day[/FONT]
[FONT=&quot]Tadalfil (generic from India): 10mg every 2nd or 3rd day or as needed, Sometimes will go a week without taking it each month,[/FONT]

[FONT=&quot]Each day: 500 mg Vitamin C, 29 grams Ferrous Fumurate, 4000iu D3, 2400 mg fish oil, 2 multivitamins,1 fiber, probiotic[/FONT]

[FONT=&quot]Last test results (taken Tuesday morning at 9am):[/FONT]
[FONT=&quot]DHEA 410 (range is 70-495)[/FONT]
[FONT=&quot]SHBG 16 (range is 10-50)[/FONT]
[FONT=&quot]Estradiol 22 (Ultrasensitive) (range 29 or higher)[/FONT]
[FONT=&quot]Testosterone (total) 553[/FONT]
[FONT=&quot]Prolactin 7.8 (range 4.5 to 19.4)[/FONT]
[FONT=&quot]Ferritin 45 (range 21-274)[/FONT]
[FONT=&quot]Hemaglobin: 19 and Hematocrit 58, Platelet 198 (range 150-450) ( I have not given blood since last year. I have erythrocyctosis not poly-PCV.. so the most important thing I watch is platelet count.[/FONT]

[FONT=&quot]Any ideas here or suggestions?[/FONT]

ManOnMission said:

I'm 48 years old, 6'1, 225. Work out 1 hour per day on elliptical. Decent diet (grilled chicken, veggies), non smoker, drink on weekends and sometimes 5-6 drinks on a weekday. Started a CPAP machine 1 week ago for sleep apnea. Getting good night sleep now but still having issues with Dysfunction.
Over the past 3-4 months, my sex drive is way down and my ability to have a long erection has diminished. Less penile sensitivity as well.

DHEA 25 mg 2x per day,
Testosterone injection SubQ into upper thigh, Monday and Thursday .3 (120mg)
Anastrozol Just started going from .25 mg 2 times per week to 3 times per week
HCG: .10 ML per day
Tadalfil (generic from India): 10mg every 2nd or 3rd day or as needed, Sometimes will go a week without taking it each month,

Each day: 500 mg Vitamin C, 29 grams Ferrous Fumurate, 4000iu D3, 2400 mg fish oil, 2 multivitamins,1 fiber, probiotic

Last test results (taken Tuesday morning at 9am):
DHEA 410 (range is 70-495)
SHBG 16 (range is 10-50)
Estradiol 22 (Ultrasensitive) (range 29 or higher)
Testosterone (total) 553
Prolactin 7.8 (range 4.5 to 19.4)
Ferritin 45 (range 21-274)
Hemaglobin: 19 and Hematocrit 58, Platelet 198 (range 150-450) ( I have not given blood since last year. I have erythrocyctosis not poly-PCV.. so the most important thing I watch is platelet count.

Any ideas here or suggestions?

Click to expand...

You inject on Monday and Thursday, but you pulled your labs on a Tuesday morning. The typical practice is to have blood drawn at true trough, just prior to an injection. Why did you increase your AI?

My doc thought my estrogen levels are still too high

When SHBG gets low it mean there is more free floating estrogen in the system. Estrogen still too high for me.

What CW is saying is that your testing is taken at the wrong time, as such it's pretty much invalid, and you based an AI dose off of that. There's only one viable way to test...trough. You didn't do that.

I do my testosterone shots on Monday and Thursday morning at 8:30 am. When am I supposed to do testing?

And I am now taking my Anastrazol on Monday, Weds and Friday

ManOnMission said:

I do my testosterone shots on Monday and Thursday morning at 8:30 am. When am I supposed to do testing?

Click to expand...

Before your 8:30 am injection, either Monday or Thursday morning.

Here are the instructions I got from the doc:
It does not matter what day of the week you have the draw, or how many test cyp shots you do each week, DO NOT EVER HAVE THEM DRAWN ON TESTOSTERONE INJECTION DAY. THAT DOES NOT MEAN HAVE THE LABS DRAWN IN THE MORNING, THEN DOING YOUR TEST CYP SHOT AFTERWARDS. NEVER BOTH ON THE SAME DAY, PLEASE!

For those on once per week test cyp shots, the second half of the week is best. But do not do HCG before your blood draw, or the day before; we just want to see what the test cyp is doing.

If you do test cyp shots more than once per week-—no matter what your HCG schedule--go ahead and take your HCG as directed. That is because it is always in effect.

The conventional TRT wisdom on here, and elsewhere, is to do a lab draw on the morning of an injection but before the injection. Your doctor is advising you to do the exact opposite.

Reasons for testing at trough.

Testing at trough gives a solid look at estradiol. It always follows in the wake of testosterone. Testosterone will have peaked earlier in the week, on trough day e2 is somewhere near its high point. You'll have a better sense of whether it needs to be managed tightly or allowed to float.

As noted, testosterone is at its low point on trough day. That means you have a good sense of how well your protocol is working if you measure at that time. If SHBG is a factor, high or low, if testosterone is either being bound and lost or clearing too quickly, it will be evident that morning.

Testing at Peak is sometimes necessary, particularly in the case of SHBG oriented issues, or to see if estradiol is stable or in flux. But a trough reading provides much more insight and permits adjustments far more easily.

ManOnMission said:

Here are the instructions I got from the doc:
It does not matter what day of the week you have the draw, or how many test cyp shots you do each week, DO NOT EVER HAVE THEM DRAWN ON TESTOSTERONE INJECTION DAY. THAT DOES NOT MEAN HAVE THE LABS DRAWN IN THE MORNING, THEN DOING YOUR TEST CYP SHOT AFTERWARDS. NEVER BOTH ON THE SAME DAY, PLEASE!

For those on once per week test cyp shots, the second half of the week is best. But do not do HCG before your blood draw, or the day before; we just want to see what the test cyp is doing.

If you do test cyp shots more than once per week-—no matter what your HCG schedule--go ahead and take your HCG as directed. That is because it is always in effect.

Click to expand...

ugh...HCG is always in effect...that whole thing is terrible.

The 553 TT is a little low for that protocol. At 120mg a week, I am usually in the trough ranges of 800-1100. You and your doc might want to increase your dosage but be conservative on the AI. I didn't have any ED issues when my TT was in the 400-500's prior to TRT. Only time I ever had ED and libido issues is when I crashed my E2 with Adex.