At my wits end - progressively cannot achieve an erection

[GeauxBears]

Guys - realize this is a long read. Hoping for some help. I am 33 years old and have been on a stable TRT protocol for 3 or so years now. Recently, I’m progressively unable to achieve a solid erection. In my most recent consult in March, my doctor (who is great and well respected here) added Doxazosin as I complained that I was unable to complete intercourse due to losing my erection... this has given me morning erections for the first time in years which is great. But I have been increasingly unable to mentally cause myself an erection during the day, nor can my wife cause me to get one prior to intercourse.

My libido is good - I even think sometimes during manual stimulation that I might orgasm - without getting an erection! This has gotten progressively worse over the past several months.

Protocol
30mg T ED
0.07mg anastrozole EOD
500ius HCG twice a week
0.125mg Cabergoline twice a week
5mg Cialis ED (sometimes I cheat and go to 10mg just to see if anything will help)
3mg Doxazosin ED
90mg Armour Thyroid ED

My latest numbers:
Total T: 830 (264-916)
Free T: 20.9 (8.7-25.1)
E2-Sens: 25.3 (8.0-35)

SHBG: 15.5 L (16.5-55.9)
DHEA: 130.2 L (138.5-475.2)

TSH: 2.00 (0.450-4.500)
FT4: 1.14 (0.82-1.77)
FT3: 6.5 H (2.0-4.4)

Cholesterol numbers are good - am active on the Peloton and have minimal body fat. TRT has had a fantastic affect on my physique as well as mood stability. I do have a high stress job, suffer from a bit of generalized anxiety/high idle HR but no depression. I am generally very happy and grateful for life.

What am I missing here? 10 years ago, I would use Viagra every now and then to take the edge off performance anxiety and it gave me an erection that lasted several hours (incl. a massive headache and nasal congestion!). Now I take those drugs at similar dosages and have literally no response (that I can tell).

I do not feel “alive” down there.

Thanks for reading and for any suggestions. Plan on getting an out of cycle appointment with the doc soon to discuss.

 

[YBWV]

Guys - realize this is a long read. Hoping for some help. I am 33 years old and have been on a stable TRT protocol for 3 or so years now. Recently, I’m progressively unable to achieve a solid erection. In my most recent consult in March, my doctor (who is great and well respected here) added Doxazosin as I complained that I was unable to complete intercourse due to losing my erection... this has given me morning erections for the first time in years which is great. But I have been increasingly unable to mentally cause myself an erection during the day, nor can my wife cause me to get one prior to intercourse.

My libido is good - I even think sometimes during manual stimulation that I might orgasm - without getting an erection! This has gotten progressively worse over the past several months.

Protocol
30mg T ED
0.07mg anastrozole EOD
500ius HCG twice a week
0.125mg Cabergoline twice a week
5mg Cialis ED (sometimes I cheat and go to 10mg just to see if anything will help)
3mg Doxazosin ED
90mg Armour Thyroid ED

My latest numbers:
Total T: 830 (264-916)
Free T: 20.9 (8.7-25.1)
E2-Sens: 25.3 (8.0-35)

SHBG: 15.5 L (16.5-55.9)
DHEA: 130.2 L (138.5-475.2)

TSH: 2.00 (0.450-4.500)
FT4: 1.14 (0.82-1.77)
FT3: 6.5 H (2.0-4.4)

Cholesterol numbers are good - am active on the Peloton and have minimal body fat. TRT has had a fantastic affect on my physique as well as mood stability. I do have a high stress job, suffer from a bit of generalized anxiety/high idle HR but no depression. I am generally very happy and grateful for life.

What am I missing here? 10 years ago, I would use Viagra every now and then to take the edge off performance anxiety and it gave me an erection that lasted several hours (incl. a massive headache and nasal congestion!). Now I take those drugs at similar dosages and have literally no response (that I can tell).

I do not feel “alive” down there.

Thanks for reading and for any suggestions. Plan on getting an out of cycle appointment with the doc soon to discuss.

Your Labs and protocol look good and should be conducive to good function. Have you had your DHT and Prolactin tested?

When guys report good morning wood but poor function you have to suspect that the problem is more to do with neurotransmitters than with hormones.

In your shoes I would ask your Doc about the possibility of adding a small amount of TCream to your daily protocol. Maybe 1 click of the 100mg/ml to start with, applied daily to the scrotum. If the Cream raises your DHT, and improves the Androgen:Estrogen ratio then that may improve function.

There is plenty of opportunity with the Cream to titrate up and down; you can vary both the volume used and the application sites. It's my own belief, and personal experience, that keeping the hormones at good levels, but in flux, works better than trying to acheive a pharmaceuticaly induced stasis.

 

[Gman86]

Your DHEA is very very low. Have you ever tried supplementing with DHEA to raise it?

Have you ever gotten your RT3 tested? Those thyroid labs mean nothing without RT3.

Have you ever tried dropping the HCG? I’ve been off it for about 4 months now, and have morning wood every day, and erections are better than ever. Get them by just thinking about sex. You might also be able to drop the cabergoline by dropping the HCG. The only time I’ve ever had prolactin issues was while on HCG monotherapy.

You’re on such a low dose of ai. What happens if you go off it completely? I dropped HCG and my ai all at the same time 4 months ago, and again erections are better than ever. And my E2 is most likely around 70-90. My sensitive E2 was 72 on my last labs. That was while taking 122.5mg/ week of propionate. I’ve since raised my dose to 147mg/week, about a month ago. So my E2 has got to be through the roof. But no nipple issues, and erections are better than they’ve ever been. And libido is really good.

 

[Vince Carter]

Morning/night erections and random erections aren't good indicators of sexual health, IMHO, so I don't lend those much credence.
Your numbers no where look appalling to have a severe problem like you describe.

Can you sit down with porn and masturbate successfully? Is this isolated to to activity with your wife? How is your mental state...has performance anxiety wrecked your erection ability?

 

[GeauxBears]

Your Labs and protocol look good and should be conducive to good function. Have you had your DHT and Prolactin tested?

When guys report good morning wood but poor function you have to suspect that the problem is more to do with neurotransmitters than with hormones.

In your shoes I would ask your Doc about the possibility of adding a small amount of TCream to your daily protocol. Maybe 1 click of the 100mg/ml to start with, applied daily to the scrotum. If the Cream raises your DHT, and improves the Androgen:Estrogen ratio then that may improve function.

There is plenty of opportunity with the Cream to titrate up and down; you can vary both the volume used and the application sites. It's my own belief, and personal experience, that keeping the hormones at good levels, but in flux, works better than trying to acheive a pharmaceuticaly induced stasis.

Thank you. Yes, prolactin is high due to a prolactinoma (that started all of this several years ago), but it is under control - this is why I’m taking the cabergoline. For some reason they forgot to test prolactin last time around, but it should be around 8 and has been stable for a while.

Will see about getting DHT tested and talk to doc about the cream... thanks!

Your DHEA is very very low. Have you ever tried supplementing with DHEA to raise it?

Have you ever gotten your RT3 tested? Those thyroid labs mean nothing without RT3.

Have you ever tried dropping the HCG? I’ve been off it for about 4 months now, and have morning wood every day, and erections are better than ever. Get them by just thinking about sex. You might also be able to drop the cabergoline by dropping the HCG. The only time I’ve ever had prolactin issues was while on HCG monotherapy.

You’re on such a low dose of ai. What happens if you go off it completely? I dropped HCG and my ai all at the same time 4 months ago, and again erections are better than ever. And my E2 is most likely around 70-90. My sensitive E2 was 72 on my last labs. That was while taking 122.5mg/ week of propionate. I’ve since raised my dose to 147mg/week, about a month ago. So my E2 has got to be through the roof. But no nipple issues, and erections are better than they’ve ever been. And libido is really good.

Thank you! I will ask doc about DHEA supplementation. Yes, RT3 has been tested and looks good. I have been hypothyroid for quite some time and appear to have that dialed in. I’ll see about having that added to labs next time around just to make sure.

I need HCG to maintain fertility - I also seem to get a libido spike a day after taking it, so I’m hesitant to remove it, but will put it on the table in my next appointment.

Agree on the AI - FWIW while it’s prescribed EOD, I take it sometimes ED if I feel the E2 is rising too high (retaining water, clammy hands, getting warm, etc.), but will talk to doc about seeing if I’m perhaps too low on E2, which I know can cause ED issues.

Morning/night erections and random erections aren't good indicators of sexual health, IMHO, so I don't lend those much credence.
Your numbers no where look appalling to have a severe problem like you describe.

Can you sit down with porn and masturbate successfully? Is this isolated to to activity with your wife? How is your mental state...has performance anxiety wrecked your erection ability?

Understood on the morning/night erections. The reason I mentioned it initially is that I took it as a positive improvement after I started the Dox. I can sit down with porn and finish, but increasingly not with hardness that would allow me to penetrate. Said differently - there is no difference the erectile quality between a real-life encounter with wife and porn.

As mentioned I do struggle with anxiety - I’ve learned to manage the mental symptoms with CBT so I rarely panicky or anxious, but continue to struggle with the physical symptoms (e.g. turning red, sweaty, high idle HR ~90s, etc.).

But something has changed here in the past few months - I feel like something is actively inhibiting blood flow to the penis - similar to the experience of trying to perform after a heavy night of drinking. It’s just not working.

Here are the threads I’m exploring in addition to the comments above:

• Adrenal fatigue - doc ordered 4 point cortisol test and I just need to get it done
• Dig into a couple of OTC meds I’m taking to see if ED is a known side effect - Xyzal, ranitidine
• Supplement with Citrulline to see if more NO will help

Thanks for the advice so far and let me know of other thoughts.

 

[S1W]

It's my own belief, and personal experience, that keeping the hormones at good levels, but in flux, works better than trying to acheive a pharmaceuticaly induced stasis.

I also think there is something to this.

Understood on the morning/night erections. The reason I mentioned it initially is that I took it as a positive improvement after I started the Dox. I can sit down with porn and finish, but increasingly not with hardness that would allow me to penetrate. Said differently - there is no difference the erectile quality between a real-life encounter with wife and porn.

First of all, sorry to hear you're dealing with this. I've been there and it was really stressful. But I came out the other end and things are good again, so don't lose hope. Instead, just forget about it. Hard to do, but just stop trying to have sex unless you're REALLY ready to go. If you force it at half mast you risk physical injury to your penis. And forcing it when you're not really ready only feeds the mental gremlins when, once again, you get ED.

Stop watching porn. Period. You may feel the urge, but just don't do it. You want to recondition yourself so that your wife is THE source of sexual stimulus in your life. Also, watching dudes with donkey schlongs and their female counterparts faking ecstasy will not help you with any subconscious feelings of inadequacy that may or may not be affecting you. Remember, they're actors and most of those guys need Trimix to perform in those scenarios. If you haven't already done so, talk through this with your wife. Be 100% honest about how it makes you feel and how hard it has been for you. Get to the point where you're both willing to try and if you lose it, just laugh and give up and say "well, guess that's not happening right now". Again, don't force it. When that happens and you have to give up, just work on your oral skills - I bet your wife won't mind at all. If you wake up with a good nocturnal erection that seems to be sticking around, lube that thing up and wake your wife up. After a period of this, the ED may become so trivial that the ED anxiety may lose its power.

Nobody likes to hear that something is "in their head" but with ED that is a huge factor. Once it happens once or twice, the anxiety is there all the time. The fact that you do experience nighttime erections shows that at least physiologically, things appear to be working fine.

Based on your labs and protocol, I don't think there is a magic bullet drug/lab value for this that you're currently missing.

 

[jmyers]

I am unable to achieve quality erections when I take arimidix... no matter how small a dose, it kills me and HCG is the same for me. Both are erection killers. I dropped them a while ago and erections came back. Your shbg is so low. I wouldn’t touch HCG, my shbg is low 20’s. It does nothing but cause problems for me. I supplement with slow release a micronized DHeA and pregnenolone .Some people just can’t handle hCG. You need to start changing the variables. Kill something and see how you feel. Do some searches there’s a ton of guys who have problems with hCG. Good luck!

 

[Vince Carter]

All good advice but \I would like to see an additional test if it's affordable for you and that is "Estradiol, Free", and I recommend that based on your low SHBG. We don't have great insight but compared along with the LC/MS/MS test can be worthwhile.

 

[GeauxBears]

I also think there is something to this.



First of all, sorry to hear you're dealing with this. I've been there and it was really stressful. But I came out the other end and things are good again, so don't lose hope. Instead, just forget about it. Hard to do, but just stop trying to have sex unless you're REALLY ready to go. If you force it at half mast you risk physical injury to your penis. And forcing it when you're not really ready only feeds the mental gremlins when, once again, you get ED.

Stop watching porn. Period. You may feel the urge, but just don't do it. You want to recondition yourself so that your wife is THE source of sexual stimulus in your life. Also, watching dudes with donkey schlongs and their female counterparts faking ecstasy will not help you with any subconscious feelings of inadequacy that may or may not be affecting you. Remember, they're actors and most of those guys need Trimix to perform in those scenarios. If you haven't already done so, talk through this with your wife. Be 100% honest about how it makes you feel and how hard it has been for you. Get to the point where you're both willing to try and if you lose it, just laugh and give up and say "well, guess that's not happening right now". Again, don't force it. When that happens and you have to give up, just work on your oral skills - I bet your wife won't mind at all. If you wake up with a good nocturnal erection that seems to be sticking around, lube that thing up and wake your wife up. After a period of this, the ED may become so trivial that the ED anxiety may lose its power.

Nobody likes to hear that something is "in their head" but with ED that is a huge factor. Once it happens once or twice, the anxiety is there all the time. The fact that you do experience nighttime erections shows that at least physiologically, things appear to be working fine.

Based on your labs and protocol, I don't think there is a magic bullet drug/lab value for this that you're currently missing.

These points are well taken. I’m not closed to the fact that this may be psychologically induced - I know from my prior struggles with anxiety the power this can have and am keeping that line open.

What is particularly concerning here is the progression - I’ve had much more severe psychological events in my prior life that could still be overcome by Viagra. The fact that I’m non-responsive to Viagra (even the side effects that come with it) is pushing me away from the psychological component, at least for the moment. I feel like I’ve taken a placebo.

I am unable to achieve quality erections when I take arimidix... no matter how small a dose, it kills me and HCG is the same for me. Both are erection killers. I dropped them a while ago and erections came back. Your shbg is so low. I wouldn’t touch HCG, my shbg is low 20’s. It does nothing but cause problems for me. I supplement with slow release a micronized DHeA and pregnenolone .Some people just can’t handle hCG. You need to start changing the variables. Kill something and see how you feel. Do some searches there’s a ton of guys who have problems with hCG. Good luck!

Candidly I’ve always wondered this about arimidex. When I first started TRT I drove E2 too low and there is no amount of Viagra on earth that could get me a solid erection - so I have experienced this - but it doesn’t seem from the labs that E2 is too low. That said, I’ll talk to the doc about withdrawing arimidex since the dose is already so low, to your point.

All good advice but \I would like to see an additional test if it's affordable for you and that is "Estradiol, Free", and I recommend that based on your low SHBG. We don't have great insight but compared along with the LC/MS/MS test can be worthwhile.

My doc has run this in the past, I’ll see if I can get it added now. Is your hypothesis that because my SHBG is so low, my Free E2 is lower than what the Total E2 would indicate and thus I’d need to run higher to feel well?

 

[GeauxBears]

All good advice but \I would like to see an additional test if it's affordable for you and that is "Estradiol, Free", and I recommend that based on your low SHBG. We don't have great insight but compared along with the LC/MS/MS test can be worthwhile.

@Vince Carter I dug up some old labs from a little over a year ago. I don’t think I’ve had protocol changes since then, but I can’t be sure.

Total T: 913 (348-1197)
Free T: 27.3 H (8.0-25.1)

E2-Sens: 27.0 (8-35)
Free E2, Serum: 0.81 (0.2-1.5)
Free E2, Percent: 2.9% (1.7-5.4)

SHBG: 14.5 L (16.5-55.9)

 

[Vince Carter]

The Quest lab range of Free E is something like < 0.45...do you know what the lab range is there? That's more than twice the lab range you have there...

 

[GeauxBears]

The Quest lab range of Free E is something like < 0.45...do you know what the lab range is there? That's more than twice the lab range you have there...

@Vince Carter Thanks for the catch - added the ranges to the prior post.

 

[Vince Carter]

Something to think about...youre half the lab range and that's just at your lowest point.

My advice and what I give all low SHBG guys because it works for me is get your E2 sens to mirror your SHBG or a little bit less. Its something to explore if these E2 numbers are too high for you. If you need AI then so be it, your trough FT is already under the lab range so I wouldn't cut the dose any less than the 30mg you're using now.

 

[GeauxBears]

Something to think about...youre half the lab range and that's just at your lowest point.

My advice and what I give all low SHBG guys because it works for me is get your E2 sens to mirror your SHBG or a little bit less. Its something to explore if these E2 numbers are too high for you. If you need AI then so be it, your trough FT is already under the lab range so I wouldn't cut the dose any less than the 30mg you're using now.

Got it - I can’t imagine my E2 is on the high side - if anything it feels on the low side, but I certainly will keep this in mind.

 

[Neil]

Geaux. I feel your pain. Let's look at the positive though, you have a wife that's working with you. I'm lucky in that way myself. I'm in the same boat as you, the Viagra/Levitra used to work pretty well mostly, then the last couple of years not really at all. And I'm on T, have my E2 balanced, and also am on thyroid. What's worked for me is the following....I take two heaping teaspoons each of l-citrulline and of l-arginine (both bulk supplements brand, amazon), put those both in a shaker bottle, fill with water, and keep it in the 'frig. Every morning as I'm getting my coffee, I shake it up and drink a quarter of the bottle. It tastes like crap, I don't think about it. At the end of the fourth day, I wash out the bottle, and do it over. I take 5mg of Cialis every morning. I take one capsule Pycnogenol every morning (Healthy Origins brand, Amazon). And you may want to try tamsulosin instead of Doxazosin, it seems to be stronger. You can get it from ReliableRX. A tablet and a half works really well for me. And to guarantee the job gets done for me on date night, I take a quarter tablet of generic levitra from ReliableRX, and two Yohimbine HCL from Amazon. That gets me hard for sure. You have to take the tamsulosin about two hours before you need to be "ready". If that doesn't work, I would go with Bi-mix from Defy. I would do that before tri-mix, it seems with some guys the tri-mix puts them in the ER getting their dick drained. That's something I would not want to do.

 

[Indy57]

Guys - realize this is a long read. Hoping for some help. I am 33 years old and have been on a stable TRT protocol for 3 or so years now. Recently, I’m progressively unable to achieve a solid erection. In my most recent consult in March, my doctor (who is great and well respected here) added Doxazosin as I complained that I was unable to complete intercourse due to losing my erection... this has given me morning erections for the first time in years which is great. But I have been increasingly unable to mentally cause myself an erection during the day, nor can my wife cause me to get one prior to intercourse.

My libido is good - I even think sometimes during manual stimulation that I might orgasm - without getting an erection! This has gotten progressively worse over the past several months.

Protocol
30mg T ED
0.07mg anastrozole EOD
500ius HCG twice a week
0.125mg Cabergoline twice a week
5mg Cialis ED (sometimes I cheat and go to 10mg just to see if anything will help)
3mg Doxazosin ED
90mg Armour Thyroid ED

My latest numbers:
Total T: 830 (264-916)
Free T: 20.9 (8.7-25.1)
E2-Sens: 25.3 (8.0-35)

SHBG: 15.5 L (16.5-55.9)
DHEA: 130.2 L (138.5-475.2)

TSH: 2.00 (0.450-4.500)
FT4: 1.14 (0.82-1.77)
FT3: 6.5 H (2.0-4.4)

Cholesterol numbers are good - am active on the Peloton and have minimal body fat. TRT has had a fantastic affect on my physique as well as mood stability. I do have a high stress job, suffer from a bit of generalized anxiety/high idle HR but no depression. I am generally very happy and grateful for life.

What am I missing here? 10 years ago, I would use Viagra every now and then to take the edge off performance anxiety and it gave me an erection that lasted several hours (incl. a massive headache and nasal congestion!). Now I take those drugs at similar dosages and have literally no response (that I can tell).

I do not feel “alive” down there.

Thanks for reading and for any suggestions. Plan on getting an out of cycle appointment with the doc soon to discuss.

Drop the HCG- leave everything else the same ( for now ) maybe try Genes Stack in addition. The HCG did not work for me and once I dropped it everything worked again!

Good luck!
Indy

 

[GeauxBears]

Thanks for all of the feedback. I’m thinking my first step will be to ask to supplement DHEA, considering my TRT protocol has been consistent for quite some time and some intensive research (see below). It’s the only smoking gun I see right now:

Dehydroepiandrosterone and Erectile Function
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119841/

“Several studies have reported decreased serum DHEAS levels in patients with ED and denoted that decreased secretions of DHEA and DHEAS are important risk factors for ED in aging men. DHEA levels reach their peak in the third decade of age in men. The serum DHEAS levels were significantly lower in the younger patients with ED compared with non-ED patients. Diminished DHEAS levels, especially in young men with ED, may either be an etiologic factor for ED or a negative consequence of it. However, patients treated with DHEA had a statistically significant increase in all domains of the IIEF in contrast to the placebo group.”

 

[fifty]

Dhea is the cheapest and easiest attempt

 

[GeauxBears]

Dhea is the cheapest and easiest attempt

Yep - it’s also unexplainably low in me right now and these studies seem to indicate it has some direct action on NOS pathways...which could explain why the PDEi drugs aren’t working for me recently.

 

[Gman86]

Every hormone is extremely important for many different functions of the body. Having one hormone out of whack can, and usually does, cause significant issues. I can’t stand when someone will have a hormone out of balance, and totally ignore it, and only focus on optimizing the more popular hormones, like testosterone. It makes absolutely no sense. The body literally cannot function properly unless all hormones are in balance, or at least not drastically out of balance. Plus, the body works synergistically. So correcting one hormone deficiency can sometimes make another hormone work better, without even messing with that other hormone. So good job on realizing that your low DHEA is clearly part of the issue. May not be the entire problem, but I can guarantee that it is contributing. True optimization only comes when all hormones, vitamins and minerals are in balance. It might seem like a lot to tackle, but it’s really not that bad. Most things are probably gonna be fine and in balance. Just check everything, find out what’s out of balance, and correct the deficiencies one by one.