At my wits end

[SixHouse]

Would love to get some opinions, but unless someone says something profound I'll likely do a complete reboot, stop everything, and see what happens.

I've been on TRT for several years now and nothing has improved in terms of symptoms. I look great, I'm in better shape than ever, very healthy overall.

Zero sex drive, and on the rare occasion that I am in the mood, there's either no hope of an erection, or I'll get a semi-erection that only lasts for a minute or 2. If I overdose on Viagra and actually get an erection that lasts for a few minutes, the lack of sensitivity means I never have an orgasm. The ****ed up part is, the reason I started this journey was because I had some mild ED and at times had to take a 50mg Viagra. But when I did I was a rock star. Now things are much much worse. And I'd love to have those old problems back.

For the longest time I have been doing 50mg Cypionate every 3.5 days, and 500iu HCG also every 3.5 days.

I am attaching a PDF of my full lab report that was done recently. My new doctor looked at the results and said I should up the Cypionate to 50mg 3x a week instead of twice a week, leave the HCG as is, and add 25mg DHEA every day. Well I've been doing that and I think things are actually worse now.

Unbelievably sick and tired of the trial and error with nothing ever "working."

If someone reading this is VERY knowledgeable based on either education or lots of personal experience, I'd love to hear your thoughts. Looking at the numbers from my labs, and hearing my symptoms, what should I change about my protocol? Or should I just stop all of it like I'm considering?

 

[johndoesmith]

Lack of libido is your only complaint?

Did TRT help your other symptoms?

 

[Nashtide]

Labs look awesome. Need to test prolactin.

 

[sh1973]

I’ve been on trt 8 years with the exact same problems. I feel for you, but sadly I can offer no help. I’m as clueless as you. All looks good on paper, but zero libido.

 

[Will Brink]

If someone reading this is VERY knowledgeable based on either education or lots of personal experience, I'd love to hear your thoughts. Looking at the numbers from my labs, and hearing my symptoms, what should I change about my protocol? Or should I just stop all of it like I'm considering?

When I see someone with great labs and otherwise feeling OK other than ED, by process of elimination it's probably not hormonal, but psychological. People always look for a physical solution to what's often a psychological issue. In every respect, sex is as much in our mind as it is in our bodies, if not more so. Seen many seemingly healthy men with ED that was not physical in nature, but they didn't want to see that, and never addressed it.

One guy was late 20s, good shape, hormones all good, etc, but could not get or hold and erection. All tests came back fine. I suggested it was psychological, which he rejected. Doc gave him a shot (this was pre viagra, etc), which worked great. Interestingly, he only needed it once because once he realized he'd be able to get an erection no matter what, his fears, performance anxiety, etc was gone, and poof, no more ED.

When I pointed that out him, that it had in fact never been as physical/hormonal problem but a psychological one, did he start working with a therapist, and that was the end of that problem, which he suffered on and off most of his adult life, and it was traced back to a bad experience he'd had as a young man.

 

[Vince Carter]

I conucr about Prolactin. Though E is probably where I'd go, because 23.2 is "in range" means nothing that it's what YOU need to have for E. By most normal accounts 23 is broaching the low side for E also given your SHBG is @ 40.5. Have you run higher E2 or are you consistently low 20s?

 

[at15]

i would like to see you switch to propionate. 25 mg every other day. drop hcg for now.....please report back.

 

[ERO]

When I see someone with great labs and otherwise feeling OK other than ED, by process of elimination it's probably not hormonal, but psychological. People always look for a physical solution to what's often a psychological issue. In every respect, sex is as much in our mind as it is in our bodies, if not more so. Seen many seemingly healthy men with ED that was not physical in nature, but they didn't want to see that, and never addressed it.

One guy was late 20s, good shape, hormones all good, etc, but could not get or hold and erection. All tests came back fine. I suggested it was psychological, which he rejected. Doc gave him a shot (this was pre viagra, etc), which worked great. Interestingly, he only needed it once because once he realized he'd be able to get an erection no matter what, his fears, performance anxiety, etc was gone, and poof, no more ED.

When I pointed that out him, that it had in fact never been as physical/hormonal problem but a psychological one, did he start working with a therapist, and that was the end of that problem, which he suffered on and off most of his adult life, and it was traced back to a bad experience he'd had as a young man.

He has both no libido and ED. While I am sure its' possible, I doubt having no libido at all is purely psychological. TRT has given me low to no (at times) libido as well so I can relate.

 

[Systemlord]

If I'm not mistaken you stated you started this journey because you had some mild ED, which means the problem existed before TRT correct? If so it could just mean venous leakage could have progressed over several years and during this time the stress of it all could have spun this issue into both psychological AND a physical one where before it was just a physical issue. I don't see how quitting TRT will fix an issue that existed pre-TRT.

I'm going to have to agree with Will on this one as the mind is quite powerful and can affect us in physical ways, to some degree I know what you're going through because I've been on TRT for 9 months and erections are still hit and miss, yet I can't stop staring at women when I leave my house. My issue is physical as my libido has been firing on all cylinders earlier on and I keep reminding myself that everything will be alright because I know if I let it stress me out it could end up much worse for me.

Stress will kill your libido if you let it and I believe this added to your pre-existing condition of mild ED. I doubt it's TRT.

Another thing I want to add, my libido was insane when my E2 got higher. Your E2 could be low for you, E2 creates emotion in us guys so perhaps you need more emotion (E2) to drive your libido! Your E2 is at the bottom of normal E2 range, are you certain it actually stays at the bottom without dipping below?

Going by just your labs, they look excellent!

 

[CSI007]

Please see my thread: https://www.excelmale.com/forum/showthread.php?8911-My-journey-so-far-with-low-testosterone

The end of the thread has some interesting information about how I have been feeling recently and my ED issue. I am very much like you however, my libido is generally extremely good to insane.

I had E2 in the mid 40s with Total T in the mid 700s - I think my HCG lost it's potency and I dropped my E2 into the mid 30s and my total T and free T took a hit as well. As it was sliding downward I hit a spot where my libido was insane and I completely recovered penile function without the use of PDE5 inhibitors. Sadly, it only last about a week. Using a newly mixed (but old 6 months old) HCG and seeing if I can get my numbers back up.

 

[HealthMan]

Estradiol levels make or break my libido and erection quality. My libido was the highest when my estradiol was slightly off range (high). However I always get gyno if my estradiol gets to mid/high 30s. So for me it is a fine line between feeling great and getting gyno. Before you give up on TRT try to raise your estradiol. I wasnt able to open the pdf with your numbers but if you are taking an aromatase inhibitor try to lower the dosage. If you are not using one and you still have room to increase testosterone dosage try that.

 

[Pacman]

Do you take or have you been taking any other medications, such as Adderall? I do know that if you recently quit ("recently" = within the last year) the sex drive and pleasure can take time to come back. I don't know your history, but just throwing that out there...

A second thing I thought of, and this is probably so far left field it's probably ridiculous - but I recall this House episode where this asexual couple lived happily and Dr. House realized that it was a brain tumor that caused the condition. I do feel kind of stupid bringing up a fiction TV show in a discussion like this, but I do know they based a lot of their stories on real conditions. So may be worthwhile to invest a couple hundred bucks into visiting a neurologist? Just to be on the safe side?

 

[Mountain Man]

He has both no libido and ED. While I am sure its' possible, I doubt having no libido at all is purely psychological. TRT has given me low to no (at times) libido as well so I can relate.

This is complicated, but I agree with Will Brink. There's a lot of missing info here:

No libido for what? Are you in any kind of relationship or are you just masturbating? That can make a huge difference.
Are you using porn? If so, does your anxiety about this prevent you from seeking out real partners and real relationships?
How old are you? It is usually an anxiety issue when a young guy can't perform. Multiple failures and a lot of self doubt sets the stage for something like this, and a lack of libido can be a protective factor where a guy almost denies himself the thoughts because a libido with the belief that one can't perform is too painful.

100% agree with Will on the looking for a solution that is not psychological. Most of us, myself included, want a quick fix. If you are a young and healthy male, then 100 mg Viagra should turn you into a rhino, but that alone wil not guarantee a good erection. ED meds in and of themselves will not give an erection, but will enhance one.

I suggest you you meet with a urologist that specializes in ED. “Men's Clinics” are the rage now and regardless of your age, you should seek an expert in this. My thought is that you need a partner that you trust, who wants to be with you and work through this for both of you. There are many behavioral interventions that can help and that, along with ED meds can lead to some success. The reality is that sex is pretty simple. Our brains make it this monumental struggle and a lot of us are too competitive about it. If we “fail” we often find reasons to not even play. Some of these reasons are so subconscious we don't even realize what we are doing. I often wonder how many guys like yourself are in solid relationships. When I was in my late 40s I began to experience ED. Did what the commercial suggested and had that “talk with my doctor.” My doctor was my age, suggested pde5 and told me he used them himself and they work great. They did work great, but I don't think they would have been so good if I wasn't 18 years into a solid marriage. Without a good relationship it can seem that failure is not an option. With a good relationship, failure is no big deal. Huge differ for a guy.

See an expert, do some research, and tackle this head on.

 

[SixHouse]

Thanks everyone. The reason my doctor told me to increase the Cypionate was because they felt my E might be low, so adding testosterone could increase E to where it needs to be. I have only been doing the new 3x per week Cypionate protocol for 2 weeks so I'm going to give it a little longer, get more labs done, and see what it all looks like.

Does anyone think I should also increase HCG to 3 times a week? That would be 1500iu per week instead of the 1000 I'm doing now.

 

[Vince]

Thanks everyone. The reason my doctor told me to increase the Cypionate was because they felt my E might be low, so adding testosterone could increase E to where it needs to be. I have only been doing the new 3x per week Cypionate protocol for 2 weeks so I'm going to give it a little longer, get more labs done, and see what it all looks like.

Does anyone think I should also increase HCG to 3 times a week? That would be 1500iu per week instead of the 1000 I'm doing now.

I don't think increasing HCG from 1000iu to 1500iu would do much on how you feel. I do agree on raising your amount of Testosterone you're injecting.

 

[Charliebizz]

Six house. What was your reason for trt in first place? Was it libido and E.D. you say you feel great and look great is that atttributed to trt at all. How were you physically and health wise before trt

 

[Will Brink]

He has both no libido and ED. While I am sure its' possible, I doubt having no libido at all is purely psychological. TRT has given me low to no (at times) libido as well so I can relate.

Then you're underestimating the role psychology plays here.

 

[Saul]

My only comment to bring to the discussion is sleep quality. I have read, been told by others, and even personally noticed, that sleep amount and quality can affect libido. Pre-TRT my libido was very low and it has improved with TRT but still swings about, which I think is due to sleep and stress and being tired/relaxed. I think libido is the trickest one. Clearly it is in the head but I don't know how therapy is going to make someone get interested or aroused at the wife of 20 years or even the young lady in the short skirt. When my libido was low, there was no interest in sex at all, regardless of fetish, shape or age.

 

[FeelingLost]

My only comment to bring to the discussion is sleep quality. I have read, been told by others, and even personally noticed, that sleep amount and quality can affect libido. Pre-TRT my libido was very low and it has improved with TRT but still swings about, which I think is due to sleep and stress and being tired/relaxed. I think libido is the trickest one. Clearly it is in the head but I don't know how therapy is going to make someone get interested or aroused at the wife of 20 years or even the young lady in the short skirt. When my libido was low, there was no interest in sex at all, regardless of fetish, shape or age.

I think penile sensitivity and intensidy of climax is much harder to fix than libido.

I had zero libido for almost 10 years and developed ED about 3 years ago.
My last protocol change sent my trough TT to 1175 and FT to 35 with E2 at 28.
I was chasing my wife around the house and 3 hours after sex I was horny again.

 

[SixHouse]

I think penile sensitivity and intensidy of climax is much harder to fix than libido.

I had zero libido for almost 10 years and developed ED about 3 years ago.
My last protocol change sent my trough TT to 1175 and FT to 35 with E2 at 28.
I was chasing my wife around the house and 3 hours after sex I was horny again.

Can you tell me what your new/changed protocol is for comparison?