Basic erection questions

[GeauxBears]

I wanted to crowdsource some thoughts on erection issues I'm having.

Background

• I am 33 years old, generally healthy
• Started TRT at age 28 - after symptoms, discovered a pituitary tumor and T levels in the 100s. Ruled out primary hypogonadism.
• TRT has done wonders for my physical appearance and state of mind, but has not helped much with sexual issues
• Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
• PDE5is are not very effective
• PT-141 is the most reliable in giving a firm erection, but I hate the GI side effects
• I am low SHBG

Questions

• Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
• If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
• Could E2 be a factor here? Or thyroid?

Latest Labs

• T - 749 (300-1080) - 22mg T ED
• FT - 245 (47-244)
• SHBG - 16 (16.5-55.9)
• E2 - 24.8 (10-42) - 0.1mg anastrozole EOD
• FT3 - 3.6 (2.2 - 4.2) - on 60mcg Armour ED - these labs were taken prior to my daily dose
• FT4 - 0.85 (0.80-1.90)
• TSH - 1.83 (0.40-4.1)
• Prolactin - 10 (4-26)

 

[MarcoFL]

Maybe see what your RT3 is running. For me dropping the anastrozole helped all things libido.

 

[GeauxBears]

Maybe see what your RT3 is running. For me dropping the anastrozole helped all things libido.

Thanks - did you see any degradation in erections with the increased E2 post dropping AI?

 

[Gman86]

Maybe see what your RT3 is running. For me dropping the anastrozole helped all things libido.

Do u use any natural ai type supplements, like DIM or Calcium D-Glucarate, for a few examples

 

[Vince]

I agree about dropping the anastrozole. Let your E2 run up higher, and hopefully that will help.

 

[DixieWrecked]

I wanted to crowdsource some thoughts on erection issues I'm having.

Background

• I am 33 years old, generally healthy
• Started TRT at age 28 - after symptoms, discovered a pituitary tumor and T levels in the 100s. Ruled out primary hypogonadism.
• TRT has done wonders for my physical appearance and state of mind, but has not helped much with sexual issues
• Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
• PDE5is are not very effective
• PT-141 is the most reliable in giving a firm erection, but I hate the GI side effects
• I am low SHBG

Questions

• Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
• If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
• Could E2 be a factor here? Or thyroid?

Latest Labs

• T - 749 (300-1080) - 22mg T ED
• FT - 245 (47-244)
• SHBG - 16 (16.5-55.9)
• E2 - 24.8 (10-42) - 0.1mg anastrozole EOD
• FT3 - 3.6 (2.2 - 4.2) - on 60mcg Armour ED - these labs were taken prior to my daily dose
• FT4 - 0.85 (0.80-1.90)
• TSH - 1.83 (0.40-4.1)
• Prolactin - 10 (4-26)

Great question and great post. I am sure stopping the ai will help things but I don't know how much of an effect it will have on your erections. According to your blood work you are really healthy. For me, TRT has hurt my erections/libido and helped in every other department. Not sure what the solution is at this point but continue to try new things.

How do you dose the PT141. Just when you need it or a couple times week? Where do you get it from?

 

[GeauxBears]

Great question and great post. I am sure stopping the ai will help things but I don't know how much of an effect it will have on your erections. According to your blood work you are really healthy. For me, TRT has hurt my erections/libido and helped in every other department. Not sure what the solution is at this point but continue to try new things.

How do you dose the PT141. Just when you need it or a couple times week? Where do you get it from?

It is prescribed by Defy and I get it from Empower. I take 0.15 ml and it gives me rock hard erections for hours, but I can‘t stand the nausea. I’m more curious in why that works vs. PDE5s or anything else I’ve tried. It doesn’t increase libido as it is documented to; it just gives me raging erections that need to be satisfied lol.

Why do I not have morning erections? What should I do to rule things out there or potentially improve - I think it’s all related.

 

[Cataceous]

In addition to dropping the AI I would experiment with lower doses of testosterone. With lowish SHBG you likely don't need so much. I think you could reduce the cypionate to as little as 12 mg daily without becoming hypogonadal. There's a decent chance you'd feel better dosing somewhere between this and your current 22 mg. Just give things lots of time to settle between changes.

For further perspective: If you had average SHBG then with your current free testosterone your total testosterone would be over 900 ng/dL, according to the Vermeulen calculator. And if the average guy your age had your SHBG of 16 nMol/L then his total testosterone would be about 500 ng/dL. You're sitting 50% higher than that. What if this level is unnatural for your body? This and the loss of upstream hormones are two of the most common reasons why guys have problems with TRT.

Regarding nocturnal erections, they do seem to be an indicator of when things are working right. They can also be surprisingly sensitive to minor perturbations. I recently tried adding a mere 1 mg nandrolone (NPP) to my daily protocol and was surprised at the disruption caused by such a seemingly minor change, including a major reduction in nocturnal erections. This makes the whole system more sensitive than I would have suspected. The takeaway is that trial and error are necessary components of TRT dosing.

 

[GeauxBears]

In addition to dropping the AI I would experiment with lower doses of testosterone. With lowish SHBG you likely don't need so much. I think you could reduce the cypionate to as little as 12 mg daily without becoming hypogonadal. There's a decent chance you'd feel better dosing somewhere between this and your current 22 mg. Just give things lots of time to settle between changes.

For further perspective: If you had average SHBG then with your current free testosterone your total testosterone would be over 900 ng/dL, according to the Vermeulen calculator. And if the average guy your age had your SHBG of 16 nMol/L then his total testosterone would be about 500 ng/dL. You're sitting 50% higher than that. What if this level is unnatural for your body? This and the loss of upstream hormones are two of the most common reasons why guys have problems with TRT.

Regarding nocturnal erections, they do seem to be an indicator of when things are working right. They can also be surprisingly sensitive to minor perturbations. I recently tried adding a mere 1 mg nandrolone (NPP) to my daily protocol and was surprised at the disruption caused by such a seemingly minor change, including a major reduction in nocturnal erections. This makes the whole system more sensitive than I would have suspected. The takeaway is that trial and error are necessary components of TRT dosing.

Great points, and yes, am planning to first experiment with removing AI, then lowering T.

 

[DixieWrecked]

It is prescribed by Defy and I get it from Empower. I take 0.15 ml and it gives me rock hard erections for hours, but I can‘t stand the nausea. I’m more curious in why that works vs. PDE5s or anything else I’ve tried. It doesn’t increase libido as it is documented to; it just gives me raging erections that need to be satisfied lol.

Why do I not have morning erections? What should I do to rule things out there or potentially improve - I think it’s all related.

How often do you take it? Once a week?

 

[GeauxBears]

Less than. Probably a couple of times a month.

 

[3DMission]

@GeauxBears your situation sounds very similar to mine. I stopped AI and that helps significantly, my body was very sensitive to AI’s and just a little ruined any sexual performance.

I also recommend small doses of T. This was a life-changer for me. I take 14mg per day. That’s daily shots to the 7th hashtag on .5 27gauge needle. It’s very little, but drastically changed my life. In low SHBG too, so just taking a little T gave my body what it needed.

I also notice a huge difference with HCG. If I stop taking HCG then my libido goes away entirely. I can still get and maintain a solid erection, but no desire unless I first get myself hard. With HCG, I have nocturnal erections, morning wood, and I feel very sexual. I think this has to do with the other minor hormones involved that HCG caters to verse just T alone. I only take 300 IU’s every M, W, F.

 

[madman]

I wanted to crowdsource some thoughts on erection issues I'm having.

Background

• I am 33 years old, generally healthy
• Started TRT at age 28 - after symptoms, discovered a pituitary tumor and T levels in the 100s. Ruled out primary hypogonadism.
• TRT has done wonders for my physical appearance and state of mind, but has not helped much with sexual issues
• Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
• PDE5is are not very effective
• PT-141 is the most reliable in giving a firm erection, but I hate the GI side effects
• I am low SHBG

Questions

• Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
• If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
• Could E2 be a factor here? Or thyroid?

Latest Labs

• T - 749 (300-1080) - 22mg T ED
• FT - 245 (47-244)
• SHBG - 16 (16.5-55.9)
• E2 - 24.8 (10-42) - 0.1mg anastrozole EOD
• FT3 - 3.6 (2.2 - 4.2) - on 60mcg Armour ED - these labs were taken prior to my daily dose
• FT4 - 0.85 (0.80-1.90)
• TSH - 1.83 (0.40-4.1)
• Prolactin - 10 (4-26)

• Primary complaints are low libido & erectile dysfunction (inability to get/sustain an erection or it's too soft for penetration)
• PDE5is are not very effective
• Should I be having nocturnal/morning erections? I don't. If so, what should I focus on first?
• If PT-141 works, but PDE5is don't, what does that indicate as a source of the dysfunction?
• Could E2 be a factor here? Or thyroid?

When hormones are healthy let alone underlying vascular health then one should experience nocturnal/spontaneous erections.

Drop the AI and you need to know where your FT truly sits on your current protocol before thinking about lowering your weekly dose of T.

The only way to know where FT truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

 

[MarcoFL]

Thanks - did you see any degradation in erections with the increased E2 post droppi

Do u use any natural ai type supplements, like DIM or Calcium D-Glucarate, for a few examples

I do not use anything. I find that the lowest possible dose is best way to manage my E2.