1. #1

    Erection issues after starting TRT

    Ok, 41 year old male no real health issues. June 17th 2017 I was put on TRT. I've posted about my experience a few times. Would things be better with better dr/clinic I'm sure it could be but it is what it is. Clinic has crashed my estrogen because they insist on giving me anastrozole compounded in my test. I was on injections 6-17-17 to 10-12-17, when they switched me to cream because hemocrits kept rising. It was 1 pump a day with 250mg of test and 1 mg of anastrozole. Then they swittched to 2 pumps because test wasn't going up (novemeber), then increased dose to 300mg of test and 1 mg of anastrozole 2 pumps a day because total test was 357 with 250mg dose. Anyways last blood test showed total t >1,500 (high end of range) 28.9 estradiol, 1.1 psa, liver enzymes good, hemocrits 48.8. Anyways no change in how I feel between both extreme (crashed estradiol 650 total t, and extremely high total t and decent estradiol)

    Anyways before starting TRT I would have issues with getting an erection say 2 out 5 times. Of those they were always related to me going to the gym and training, so it could be worked around (just don't have sex on days the gym was really hard). However, now, since about 1 month into TRT, I CAN NOT get an erection and keep it for more than a couple mins 5 out of 5 times! Some days are worse. I'd say I've successfully had sex 3 times over the last 10 months or so.

    I've told my so called clinic/Dr about it but nothing ever gets done. What can I do about this? I'm tired of not being able to get erections. I feel like I've been castrated, balls have shrunk and penis is useless. There has got to be a way to fix.

    I can't go to gym because no energy and no drive (I've missed about 2 months now, plus 2 months back in August because same reason). I have headaches that are constantly there, just gets better somedays and worse others. I want sex in my head but body DOES NOT respond. Help

    I understand "find a better dr" so if that's only response no thanks. I want to get with defy but don't have the $ right now and I'm in contract with these idiots. There has to be something to work around or something. I wish like hell I NEVER started trt! I feel worse now than ever did before.

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    Btw time frames above may or may not be exactly right, the months have ran together. 3 weeks ago was when I got blood work and that was 8 weeks after change to two pumps of 300mg a day. I go next week for another blood draw to see if switching to alternating from 1 pump one day to 2 pumps the next and 1 the next etc. Has got testosterone down to 700-900 range.

  4. #3
    this is what happens when man who doesn't need aromatase blocker uses it.. I had ed problems after arimidex for 2 years which were really bad during first year

  5. #4
    Quote Originally Posted by Tonyp56 View Post
    I understand "find a better dr" so if that's only response no thanks.
    Find a better Dr is exactly what you need to hear. Good luck with it.

  6. #5
    Quote Originally Posted by lowe2sucks View Post
    this is what happens when man who doesn't need aromatase blocker uses it.. I had ed problems after arimidex for 2 years which were really bad during first year
    ya 1mg at that. Holy cow.

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    Ok well that's good news glad to hear it. Again should have never thought about TRT. Regardless of who I went to (I've read people complain about TRT that go to defy too, seems AI is given there too!)

    I can't live my life as good as I could before trt so might as well just stop taking it and save my $ for something else like fireworks!

  8. #7
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    Quote Originally Posted by lowe2sucks View Post
    this is what happens when man who doesn't need aromatase blocker uses it.. I had ed problems after arimidex for 2 years which were really bad during first year
    I don’t understand why a doctor would prescribe an AI and HCG with an initial dose. Can someone explain the rationale on a first dose? I got to think more meds equals more could go wrong.

  9. #8
    You sound like a whiny bitch. Now don’t take that the wrong way. I bet I’d be exactly the same if some moron jacked up my TRT protocol.

    Solution is simple. Gather knowledge here to establish what would be a good protocol. Say 60mg 2x week test cyp with 250iu hcg each time and no ai. Go into that clinic, tell them you are the paying customer, and demand the treatment. Force your way out of the contract if they deny. Let them know all the bad press they are going to get to where it’s not worth the headache. In other words own your problem.

    Find a path to a good protocol. Few men won’t see the benefits of TRT with the right protocol. Very few. Just lots of stupid doctors. Well uneducated on specifics and arrogant anyway.

  10. #9
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    Quote Originally Posted by Mountain Man View Post
    I don’t understand why a doctor would prescribe an AI and HCG with an initial dose. Can someone explain the rationale on a first dose? I got to think more meds equals more could go wrong.
    As far as one first starting trt the most sensible approach would to be using testosterone only for the first 6 weeks and than having lab work done to truly know what effect testosterone (dose) has on ones total t/free and estradiol.

    Adding in hcg right away is not necessarily a bad choice but seeing as it mimicks lh which stimulates the testes to produce ITT (intra-testiscular testosterone) and that can also increase ones testosterone and estradiol, than by adding hcg when starting trt it will be another contributing factor to ones increase in testosterone and estradiol levels.

    As far as using aromatase inhibitors when starting trt they should only be added if someone is experiencing negative symptoms due to high e2 along with lab work showing it is too high on the estradiol (sensitive assay) pre-trt labs.

    Without knowing pre-trt e2 levels than blindly adding in an aromatase inhibitor on the assumption that because you are going to be increasing ones t levels whether through (injection/transdermal) and the increase in testosterone will result in increased e2 than it is foolish and dangerous because in many cases you end up crashing the patients e2.

    As we know low e2 can be just as bad or worse than high e2.

    Compounded a.i. with testosterone is absurd as first off many men do not need an a.i right away and some never do and secondly there is a stronger chance of crashing ones e2 let alone making it next to impossible to manipulate the a.i. dose should e2 issues arise.
    .

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    My first visit to this clinic, pre-trt labs. Estradiol was 14.8, I was <5 twice over the last 10 months.

    Anyways, latest is they wanted to add an extra 1mg pill to my protocol along with change in how many pumps each day. Total estradiol was 28.9 and Dr's excuse was wanting to keep me closer at pre-trt/baseline levels.

    Before I was taken off injections in October, protocol was 200mg of testosterone and 1mg anastrozole every 5 days, in my opinion this was way too high on both fronts and continued to crash estrogen and rise hemocrits high, so they switched me to cream (300mg of testosterone/1mg anastrozole per pump per week + 1mg of anastrozole-which I stopped taking 4 weeks in) because it wouldn't do that according to them.

    Total t was around 450 after 8 weeks, which he didn't feel enough, so he changed to 2 pumps (250mg of testosterone/1mg anastrozole) and then about 8 weeks later 357 or so, estradiol was 10.2, so then he upped to 2 pumps of 300mg and last test was >1,500.

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    So let me ask the question. What is a good protocol? Like I said 200mg every 5 days i feel is too much. I don't have any issues doing injections (eod, 3 days a week, every 3.5 days it don't matter). I actually like better than cream. That said I don't care if injections or cream, I just want out of this hell.

  13. #12
    A good protocol would be determined by your SHBG levels, this is how experience doctors determine dosing and injection frequency. Your doctors have been throwing noodles at walls to see what sticks, this isn't TRT, it's all random guess work for those that have no idea what their doing. It's really hard to suggest a protocol with knowing where your SHBG sits.

    It's no wonder why you hate TRT.

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    Quote Originally Posted by Tonyp56 View Post
    Ok well that's good news glad to hear it. Again should have never thought about TRT. Regardless of who I went to (I've read people complain about TRT that go to defy too, seems AI is given there too!)

    I can't live my life as good as I could before trt so might as well just stop taking it and save my $ for something else like fireworks!
    I've been on trt through Defy Medical forr 3 and 1/2 years now. I've never used an AI.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

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    Quote Originally Posted by Vince View Post
    I've been on trt through Defy Medical forr 3 and 1/2 years now. I've never used an AI.
    Well I'd say congrats to that.

    However, I've read plenty others here that go to defy and have an AI as part of their protocol.

    I agree that clinic I went to is crap. My mistake, my problem, but I'm stuck there at the moment and don't have $300 laying around to start with defy or whoever else that honestly I'd be rolling the dice on.

    Even when I start a real TRT treatment plan, apparently it will be YEARS before I am able to function. So I'm glad that you went straight to the front and never had issues, I wouldn't wish this on anyone.

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    Quote Originally Posted by Systemlord View Post
    A good protocol would be determined by your SHBG levels, this is how experience doctors determine dosing and injection frequency. Your doctors have been throwing noodles at walls to see what sticks, this isn't TRT, it's all random guess work for those that have no idea what their doing. It's really hard to suggest a protocol with knowing where your SHBG sits.

    It's no wonder why you hate TRT.
    I honestly don't know where my SHBG is, I know they were supposed to test on first/PRE-TRT blood work, but never really told me what it was. That said I'll ask on Saturday's appointment.

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    Quote Originally Posted by Tonyp56 View Post
    I honestly don't know where my SHBG is, I know they were supposed to test on first/PRE-TRT blood work, but never really told me what it was. That said I'll ask on Saturday's appointment.
    Once you find out your shbg than I would look into going back on injections without an aromatase inhibitor and start your protocol using a lower testosterone dose such as 100mg/week (50 mg every 3.5 days) although it still comes down to your shbg as it will dictate injection frequency.

    Gauge how you feel and at 6 weeks have labs done to see how that dose effects your total t/free t and estradiol. Than decide whether t dose needs to be increased slightly if your total t/free t are still low and your symptoms have not improved

    As far as your e2 is concerned if it comes back high using the estradiol (sensitive assay) test and you are experiencing negative symptoms than you need to look into adding an a.i. using a lower dose.

    Low shbg men tend to do better with injecting lower doses of testosterone more frequently (M/W/F, EOD or daily) mind you there are some that can even do every 3.5 days but it all comes down to how the individual responds to said protocol.

    Higher shbg men tend to do better injecting larger doses of testosterone once weekly.

    On average most with descent levels of shbg (not too high or low) tend to do well splitting weekly dose and injecting every 3.5 days but again intra-individual variability will also play a role as everyone responds different to testosterone regarding what dose will help them achieve healthy total t/ free t levels whether in the mid-normal physiological range or high-normal physiological range along with healthy e2 levels to experience relief/improvement of low t symptoms and overall improvement in ones well being.

    Some men can attain higher testosterone levels using lower doses of testosterone where as other need higher doses.

    Starting some one on 200 mg/week of testosterone is a very high dose and will result in very high supra-physiological t levels in most men.

    On average most men can achieve healthy physiological levels of testosterone using 100-150 mg/week and even than 150mg/week will put most over the high end of the physiological range.

    You were started on an extremely high dose for trt 200mg every 5 days.................of course ones testosterone/e2 levels would skyrocket.

    Not only was your starting dose very high but to make matters worse off the hop an aromatase inhibitor was added (1mg) which caused your e2 to crash.

    You definitely need to find a new doctor but as you state that is not going to happen.

    Yes there may be some that need 200mg/week but it is rare as that dose would put most well over the top end of the physiological range.

    I would say it is always best to start low and go slow and gauge how you feel along the way along with having the proper lab work done to decide if dose needs to be increased slightly or an aromatase inhibitor needs to be used.

    You know your body better than anyone but labs are critical to see how testosterone effects ones hormones/health markers!
    Last edited by madman; 05-13-2018 at 03:55 PM.

  18. #17
    Quote Originally Posted by madman View Post
    Once you find out your shbg than I would look into going back on injections without an aromatase inhibitor and start your protocol using a lower testosterone dose such as 100mg/week (50 mg every 3.5 days) although it still comes down to your shbg as it will dictate injection frequency.

    Low shbg men tend to do better with injecting lower doses of testosterone more frequently (M/W/F, EOD or daily) mind you there are some that can even do every 3.5 days but it all comes down to how the individual responds to said protocol.

    Higher shbg men tend to do better injecting larger doses of testosterone once weekly.

    On average most with descent levels of shbg (not too high or low) tend to do well splitting weekly dose and injecting every 3.5 days but again intra-individual variability will also play a role as everyone responds different to testosterone regarding what dose will help them achieve healthy total t/ free t levels whether in the mid-normal physiological range or high-normal physiological range along with healthy e2 levels to experience relief/improvement of low t symptoms and overall improvement in ones well being.

    Some men can attain higher testosterone levels using lower doses of testosterone levels where as other need higher doses.

    Starting some one one 200 mg/week of testosterone is a very high dose and will result in very high supra-physiological t levels in most men.

    On average most men can achieve healthy physiological levels of testosterone using 100-150 mg/week and even than 150mg/week will put most over the high end of the physiological range.


    You were started on an extremely high dose for trt 200mg every 5 days.................of course ones testosterone/e2 levels would skyrocket.

    Not only was your starting dose very high but to make matters worse off the hop an aromatase inhibitor was added (1mg) which caused your e2 to crash.

    You definitely need to find a new doctor but as you state that is not going to happen.


    Yes there may be some that need 200mg/week but it is rare as that dose would put most well over the top end of the physiological range.
    This is an excellent plan of action. You'd do well to heed the advice Madman offers as it's on the money and will, likely, help you sort things out.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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    Quote Originally Posted by madman View Post
    Once you find out your shbg than I would look into going back on injections without an aromatase inhibitor and start your protocol using a lower testosterone dose such as 100mg/week (50 mg every 3.5 days) although it still comes down to your shbg as it will dictate injection frequency.

    Gauge how you feel and at 6 weeks have labs done to see how that dose effects your total t/free t and estradiol. Than decide whether t dose needs to be increased slightly if your total t/free t are still low and your symptoms have not improved

    As far as your e2 is concerned if it comes back high using the estradiol (sensitive assay) test and you are experiencing negative symptoms than you need to look into adding an a.i. using a lower dose.

    Low shbg men tend to do better with injecting lower doses of testosterone more frequently (M/W/F, EOD or daily) mind you there are some that can even do every 3.5 days but it all comes down to how the individual responds to said protocol.

    Higher shbg men tend to do better injecting larger doses of testosterone once weekly.

    On average most with descent levels of shbg (not too high or low) tend to do well splitting weekly dose and injecting every 3.5 days but again intra-individual variability will also play a role as everyone responds different to testosterone regarding what dose will help them achieve healthy total t/ free t levels whether in the mid-normal physiological range or high-normal physiological range along with healthy e2 levels to experience relief/improvement of low t symptoms and overall improvement in ones well being.

    Some men can attain higher testosterone levels using lower doses of testosterone levels where as other need higher doses.

    Starting some one one 200 mg/week of testosterone is a very high dose and will result in very high supra-physiological t levels in most men.

    On average most men can achieve healthy physiological levels of testosterone using 100-150 mg/week and even than 150mg/week will put most over the high end of the physiological range.


    You were started on an extremely high dose for trt 200mg every 5 days.................of course ones testosterone/e2 levels would skyrocket.

    Not only was your starting dose very high but to make matters worse off the hop an aromatase inhibitor was added (1mg) which caused your e2 to crash.

    You definitely need to find a new doctor but as you state that is not going to happen.

    Yes there may be some that need 200mg/week but it is rare as that dose would put most well over the top end of the physiological range.

    I would say it is always best to start low and go slow and gauge how you feel along the way along with having the proper lab work done to decide if dose needs to be increased slightly or an aromatase inhibitor needs to be used.

    You know your body better than anyone but labs are critical to see how testosterone effects ones hormones/health markers!
    Just to throw this in, when I was doing 200mg testosterone/1mg anastrozole every 5 days the highest my total t got was 670 or so. (This was measured 5 days after injections, before I injected)

    But June 17th to October 12th was total time on injections, before they switched me to cream (when I actually started using cream.)

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    Madman thank you, I will do.

    Thanks

  21. #20
    I also am with defy and have nit taken an AI. They mentioned it as a possibility if needed, i said no. No big deal.

  22. #21
    Quote Originally Posted by Tonyp56 View Post
    Just to throw this in, when I was doing 200mg testosterone/1mg anastrozole every 5 days the highest my total t got was 670 or so. (This was measured 5 days after injections, before I injected)

    But June 17th to October 12th was total time on injections, before they switched me to cream (when I actually started using cream.)
    Youve gotten some very comprehensive advice. Run with it. Assuming 200mg cyp/5 days and lab values we are used to seeing that would indicate you metabolize test somewhat on the high end. I’d start with 70 e3.5 days or 75. Follow the advice regarding shbg though. Things get tricky if you are way outside average values.

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    Quote Originally Posted by user_joe View Post
    Youve gotten some very comprehensive advice. Run with it. Assuming 200mg cyp/5 days and lab values we are used to seeing that would indicate you metabolize test somewhat on the high end. I’d start with 70 e3.5 days or 75. Follow the advice regarding shbg though. Things get tricky if you are way outside average values.
    Ok thanks.

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    What is your hematocrit? When was last time you had a CBC done?

    If your hematocrit is too high and you are not being phlebotomized you will have erection issues as well as risk of cardiac issues.




    Quote Originally Posted by Tonyp56 View Post
    Ok, 41 year old male no real health issues. June 17th 2017 I was put on TRT. I've posted about my experience a few times. Would things be better with better dr/clinic I'm sure it could be but it is what it is. Clinic has crashed my estrogen because they insist on giving me anastrozole compounded in my test. I was on injections 6-17-17 to 10-12-17, when they switched me to cream because hemocrits kept rising. It was 1 pump a day with 250mg of test and 1 mg of anastrozole. Then they swittched to 2 pumps because test wasn't going up (novemeber), then increased dose to 300mg of test and 1 mg of anastrozole 2 pumps a day because total test was 357 with 250mg dose. Anyways last blood test showed total t >1,500 (high end of range) 28.9 estradiol, 1.1 psa, liver enzymes good, hemocrits 48.8. Anyways no change in how I feel between both extreme (crashed estradiol 650 total t, and extremely high total t and decent estradiol)

    Anyways before starting TRT I would have issues with getting an erection say 2 out 5 times. Of those they were always related to me going to the gym and training, so it could be worked around (just don't have sex on days the gym was really hard). However, now, since about 1 month into TRT, I CAN NOT get an erection and keep it for more than a couple mins 5 out of 5 times! Some days are worse. I'd say I've successfully had sex 3 times over the last 10 months or so.

    I've told my so called clinic/Dr about it but nothing ever gets done. What can I do about this? I'm tired of not being able to get erections. I feel like I've been castrated, balls have shrunk and penis is useless. There has got to be a way to fix.

    I can't go to gym because no energy and no drive (I've missed about 2 months now, plus 2 months back in August because same reason). I have headaches that are constantly there, just gets better somedays and worse others. I want sex in my head but body DOES NOT respond. Help

    I understand "find a better dr" so if that's only response no thanks. I want to get with defy but don't have the $ right now and I'm in contract with these idiots. There has to be something to work around or something. I wish like hell I NEVER started trt! I feel worse now than ever did before.

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    Quote Originally Posted by Ron View Post
    If your hematocrit is too high and you are not being phlebotomized you will have erection issues as well as risk of cardiac issues.
    Last blood test it was 48.7 I believe, they check it every time and I've never been at 50 or above. Though I've had phlebotomy 3 times now. No change in how I feel or erections after.

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    Sorry last blood work/blood draw was April 14th 2018.


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    Ok, Dr's appointment was nothing today. They took my blood for labs and had me fill out questionnaire about how I'm feeling (sex drive, mood, strength of erections, etc. Rather or not better, same, or worse) and then instead of Dr visiting with me the clinic manager came in.

    He more or less acted like it's all my fault, pointed out that normally they do 4 labs on most patients in the first year and month shy of a year for me they've done 10. That they've tried to keep a close eye on me and I'm simply not responding. He also said last time there was 3 things that were high; testosterone, estrogen, and hemocrits.

    Although when I went in and talked to Dr a month ago the only thing he mentioned being high was testosterone, went over my labs and said everything else was good, even mentioned that hemocrits were good.

    Anyways clinic manager is going to go over things with Dr on Tuesday, because that's the earliest they will get results, and figure out what to do next. Mentioned, stopping, because I'm not responding and no need in wasting money and time to not feel good.

    Anyways, blaming me for not responding to their treatment and then just wanting to leave me hanging by suggesting stopping= proved that they don't know what they are doing that much more. I get out of the contract so this makes me happy, they are basically tired of me, lol that's ok I'm tired of them.

    When they call next week, no matter what they say I'm telling them I'm walking and that I'm done. Will request in writing that I'm out of contract! I'll probably stop now, almost out of meds anyways and besides it isn't helping.

    That said, it will likely be a long time before I can begin at defy or somewhere else (don't have the $) and I know my testosterone is going to drop. Don't think I'll be any worse off, might even be in better place. Let my body find it's equilibrium, might be low-t but not stupid dr/clinic making me feel horrible. Shall see.

    Estimate 3-12 months before I can get to begin again.

  28. #27
    ^your on right path man there is nothing worse than trt protocol that will crash e2 levels.. testosterone solo is great though but your body won't respond to it until it recovers from e2 crash
    if you will decide to give trt another try - work with defy and tell them your previous trt protocol crashed your e2 so they don't give AI to you and try to manage e2 by other options

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    3-12 months before I have the $, who knows how long to get appointment etc...

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    Thanks. I wish I could go back to how I felt before, thought it was bad, lmao it was great compared to now.

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    Quote Originally Posted by lowe2sucks View Post
    if you will decide to give trt another try - work with defy and tell them your previous trt protocol crashed your e2 so they don't give AI to you and try to manage e2 by other options
    I will be giving it another try, just $ issues. I will be sure to give them all the info I have/remember. And tell them how I've felt.

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