Comprehensive Blood Work for ED - What is Needed?

[Dishing]

I've had ongoing issues with ED for about a year now. I generally have zero issues with achieving an erection and my libido doesn't seem to be a problem. However, I struggle to get full, 100% erections and I lose them easily. They tend to slowly go down over time. I generally cannot, and do not, achieve full erections, while sleeping or masturbating. I do occasionally achieve full erections with my partner but they never last for more than a handful of seconds before going down.

At this point, it feels like I've tried everything with regards to a full thyroid panel, testing prolactin, testing estradiol, etc. That said, at this point, I'd like to compile a comprehensive tests that could discover/uncover any possible hormonal reasons for ED.

Besides a full thyroid panel, prolactin, and estradiol, what tests would be necessary before essentially moving on to the next line therapy: Trimix.

Thanks for any help.

 

[CoastWatcher]

Just prior to Christmas you posted with essentially the same issues. Nothing has changed in that time? This only presented itself after you'd run steroid cycles. The blood work you had in December indicated that you'd tested your estradiol with the standard test rather than the sensitive test, but even on the standard you were posting low estradiol. You also noted you'd suppressed your prolactin with Cabergoline.

Neither estradiol nor prolactin are waste products - low levels can disrupt sexual and erectile issues. Where do these values stand today?

Have your total and free testosterone remained in the lower end of the ranges as they were?

Cortisol - I know you tested it, but was that serum or the saliva four tube test?

 

[Dishing]

It actually presented at the very beginning of the steroid cycle. Within one week.

Symptoms are exactly the same, that's correct. It's been six months.

I can't be sure what the values are right this second but I had blood work showing normalization a few months ago. LabCorp ranges.

In any case, I'm hoping to get more blood work ASAP that is more comprehensive and could find even some of the less common problems that be the root cause. I want to be able to present a full picture with this next set of blood work and not be told that I forgot a few important or even unlikely tests.

 

[belzano]

I would be interested to know which panel of tests you ultimately go for. Life Extension foundation used to offer a very comprehensive panel for $440 or so but I can't find it now. They have another one called Complete Hormonal Panel but it's not as extensive.

 

[CoastWatcher]

Go to Discountedlabs.com. The best prices for self-testing. All work is done by LabCorp.

 

[Dishing]

Can anyone recommend an extensive panel? Is there something that would suffice on DiscountedLabs?

 

[CoastWatcher]

Can anyone recommend an extensive panel? Is there something that would suffice on DiscountedLabs?

There are a number of panels available at Discountedlabs.com. The pre-TRT panel would be comprehensive.

 

[Dishing]

It doesn't include a full thyroid panel, though?

 

[Dishing]

Is there anything I should consider besides the following:

Testosterone, total, free
Estradiol, sensitive
Thyroid, FT3, FT4, TSH, RT3, antibodies
Prolactin, serum
Lipids
CBC
CMP

What about DHT and DHEA? Would those values be important specifically with regards to ED?


It's important to note that I pretty much feel fine in all other regards. I don't have issues with mood, energy, and, generally, even my libido has been pretty normal. Obviously knowing I can't count on staying hard has a psychogenic effect on libido but what can you do?

 

[CoastWatcher]

Is there anything I should consider besides the following:

Testosterone, total, free
Estradiol, sensitive
Thyroid, FT3, FT4, TSH, RT3, antibodies
Prolactin, serum
Lipids
CBC
CMP

What about DHT and DHEA? Would those values be important specifically with regards to ED?


It's important to note that I pretty much feel fine in all other regards. I don't have issues with mood, energy, and, generally, even my libido has been pretty normal. Obviously knowing I can't count on staying hard has a psychogenic effect on libido but what can you do?

I'd do the four tube cortisol check.

 

[Dishing]

Thank you, CW.

 

[belzano]

Check out Elite Hormone Panel by Life Extension. I think it works out to be cheaper than discounted labs.

 

[Nelson Vergel]

For ED, I would check:

Blood Tests:

DHT
Total and Free T
Sensitive Estradiol
DHEA-S
TSH, free T3 and free T4
CBC and CMP
PSA

Not a blood test: Blood pressure
Not a blood test: List of medications to determine potential ED as a side effect.
Not a blood test: Sleep study
Not a blood test: Doppler ultrasound of the penis
Not a blood test: Digital rectal exam to test for BPH

Blood Test Total $262- 5%= $248.50

 

[madman]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336024/ Vascular/endothelial health play a strong role in ed.

 

[Dishing]

Nelson,

Thanks so much for your post. I still fully plan on getting that blood work done within the week. However, it was one of your non-blood-test suggestions that has resolved 90%+ of my ED.

For almost a year now, I have been taking Doxylamine Succinate in order to help me sleep. It is a non-prescription, over-the-counter antihistamine. Because of this, on multiple occasions, I had forgotten to mention this to my doctor and urologist. It turns out that antihistamines, in general, are known to cause ED in some men with prolonged use. Upon learning that fact, I immediately ceased use of the product.

While it has only been a week since I have discontinued use, I am finally getting "100%" erections again. My erection quality isn't fully reliable just yet, but the consistency has improved on a literal daily basis.

I can't tell you how big of a relief this is after over a year of trying various hormone tests and protocols trying to normalize all of my levels. While I feel extremely stupid that I did eliminate all pharmaceuticals from the very beginning, I am glad to be making progress in the right direction after what has been a year of utter frustration.


Too-long-didn't-read:
I was taking an over the counter drug to help me sleep (doxylamine succinate -- an antihistamine). I stopped. My ED issues are suddenly nearly resolved and getting better daily.

 

[Dishing]

Still having major problems after all.

Blood work reveals normal testosterone, estradiol, prolactin and sex hormones in general.

However, I think I may be hypothyroid?

TSH: 3.66, r .45-4.5
FT3: 2.9, r .2.0-4.4
FT4: 1.26, r .82-1.77
RT3: 24.6, r 9.2-24.1, HIGH

TSH appears quite high even though free t3 and free t4 are mid-range. Reverse T3 is out of the range to the high side. Surely this is a problem?

 

[CoastWatcher]

Still having major problems after all.

Blood work reveals normal testosterone, estradiol, prolactin and sex hormones in general.

However, I think I may be hypothyroid?

TSH: 3.66, r .45-4.5
FT3: 2.9, r .2.0-4.4
FT4: 1.26, r .82-1.77
RT3: 24.6, r 9.2-24.1, HIGH

TSH appears quite high even though free t3 and free t4 are mid-range. Reverse T3 is out of the range to the high side. Surely this is a problem?

Your thyroid results call for further investigation. However, when you wrote that you have "normal" levels of testosterone, estradiol, prolactin, and so forth, I pause and wonder. So many doctors mistake "in range" for "normal" (particularly in the field of androgen therapy). My own doctor won't use the term, she feels it is misleading. Now, I'm not saying that's your situation, but it's worth consideration.

 

[Sakuraba39]

Dishing, are you taking cytomel? It looks like your T3 is pooling.

 

[Dishing]

E2 on sensitive assay was 21. Prolactin was 8. Total test 560. Lab corp ranges. Free test was above mid-range, IIRC but I can't recall the exact value.

I am not taking Cytomel or any other kind of thyroid medication. I have been, however, dieting for the past 8 weeks and I am down about 10lbs. That said, a little dieting shouldn't cause this type of result with my thyroid, right?

 

[Sakuraba39]

10lbs in 8 weeks? No