Consistent ED & Low Libido

[BoredStiff]

Long-time lurker, I usually just enjoy reading the forums but I've been having a problem that I can't seem to resolve.

I'm 37 and have been on TRT since I turned 31 after repeatedly testing in the low 200's and having no libido/ED. Those issues have been hit or miss the whole time though, there are months where I can function normally, but I've also lost various relationships because I'll go months without getting an erection or even wanting sex. I've tried going as high as 300mg/wk of enanthate, and as low as 80mg/wk, doesn't seem to make a difference.

I tend to usually do better by taking a daily dose of 6.25mg exemestane and driving my e2 down, but even that doesn't always work. One interesting note is that in 2019, I accidentally took double the exemestane dose as I was using a research liquid, for 6 months I crashed my e2 down to 6 pg/ml (confirmed via sensitive blood work), and that entire time I felt amazing, mood was great, libido was through the roof... I know this goes against common wisdom, but why do I usually feel better with crashed or very low estradiol?

My current bloodwork after 3 months on 120mg/wk and 500iu HCG/wk with no AI (I have not had an erection in these three months, and no desire, also feel very lethargic and unmotivated)
Total T: 790 ng/dl
Free T: 21 pg/ml
E2 (sensitive): 32 pg/ml
SHBG: 28.2 nmol
Free T3: 2.9 (2.3-4.2 Range)

That bloodwork looks very solid to me, but I don't feel well at all. Could prolactin or DHT be an issue? I can almost guarantee I could temporarily fix the libido/ED by popping a letrozole pill for 2-3 days, from past experience, but I can't grasp why crashing or drastically lowering my e2 does that.

 

[Systemlord]

I accidentally took double the exemestane dose as I was using a research liquid, for 6 months I crashed my e2 down to 6 pg/ml (confirmed via sensitive blood work), and that entire time I felt amazing

It's fluid build up, when E2 is low you tend to not hold onto water (pee a lot more) like you do when elevated. When I overdosed on vitamin D, I was urinating like there was no tomorrow due to excessive calcium build up in my kidneys and this is when my erections were at their best or after donating blood and getting a little dehydrated.

My last phlebotomy I got IV fluids right after and didn't get the better erectile strength.

So the takeaway here is it's not the estrogen, but probably the fluid build up from the testosterone and you are just using the AI as a band-aid.

Try lowering your TRT dosage.

 

[equel]

Its Kinda obvious isnt it? You need low e2 to feel optimal.

 

[Dicky]

You have already tried all kinds of different dosing. If you didn't try changing the frequency of injects, then that is a good avenue to pursue.

Some men have reported doing better on one testosterone ester than another. If you are on enanthate, I would try going to cypionate. I know it shouldn't matter. But it is not so uncommon that it does matter. You could also try testosterone cream applied to the scrotum. I get good results using cream.

You could also try a different AI and see how you react to that.

I would be hesitant to use more AI to drive your E2 down long term.

 

[BoredStiff]

Its Kinda obvious isnt it? You need low e2 to feel optimal.

Yes and it's what I do for a random date, just pop a letrozole and I'll usually be good for a 2 or 3 days (usually, because even that isn't always guaranteed). I cant consistently keep my e2 in the single digits just to get erections though, at least I don't think I safely can.

I've tried the daily 10-12mg microdoses, no difference.