Diminished erections in early 40s

[ResearchIt]

At age 43 my body's sexual condition is not quite as good as when I was 25 or 30, but everything still works fine when I have sex. However, I hardly ever have morning erections anymore, I used to have them every morning. My nocturnal erections are generally ok, but also sometimes weaker than they had been previously in my life. And from time to time, even during sex, my erections are weaker, which never ever used to happen. Also my penis feels a bit shriveled when flacid, whereas before it was squishy and more responsive. This all started about age 41.5.

I had a penile ultrasound done and it showed I had no plaque build up whatsoever, no scarring, no venous leakage, and blood flow was excellent, no ED. I am healthy, fit, low body fat, no medication, no medical conditions at all. It's strange to me that my erections started changing at age 41.5. Seems 10-12 years too soon.

I wish I had blood labs from my 20s and 30s to compare to my labs today, but I don't. My last lab came back 702 TT, 14.9 FT, 425 DHEA, 4.6 Prolactin, 24.5 Estradiol Sensitive, 64 DHT, although my SHBG is on the higher end, usually in the high 40s.

A 2.5mg dose of Cialis will make my erections during sex like they were when I was younger, but I still don't get morning erections the days after I take the medication.

Every month or so I'll have a strong morning erection like I used to have every morning in my 20s and 30s. This leads me to think the recent change is hormonal or chemical, not physical since it can come back occasionally.

Are weaker erections a big deal or not in terms of being a canary in the coal mine?

Do you think the change in my erections is hormonal? (i.e. something that would show up in a lab)

Is having diminished erections in your early 40s a condition to get treated and is it treatable? (and I don't mean with PDE5 inhibitors, but something that actually addresses the issue, bringing my body back to the way it was 5 or 10 years ago?

I have considered trying legitimate shockwave therapy, but want to rule out a hormonal issue or other issue before trying that. Thanks for any feedback.

 

[Golfboy307]

Diminished duration and strength of erections will happen to almost all of us eventually. Your hormone profile looks great, and you took the initiative to have a penile ultrasound which shows good blood flow.

How is your blood pressure? Is it creeping up there a bit? When I started to have mild ED in my late 40's, by BP had crept up to 140/85 on average. Any amount of research will tell you that the stiffening of the arteries and malfunction at the endothelial level can lead to weaker, shorter lived erections. Blood flow can be fine, but if the artery walls stiffen up, its harder to maintain the correct blood flow "trapping" in the penis. Different somewhat from venous leak. Now, my T was low as well at that time so I had both issues.

Other things to look at: neurotransmitters, psychological/relationship ship issues, too much porn, thyroid, cortisol.

PDE-5 inhibitors are the first and best "treatment" plan and have other benefits, provided the side effects aren't bad for you.

No way I would consider T treatment if those are your average numbers.

 

[ResearchIt]

Thanks for that feedback, very helpful! It feels better to know we are all in the same boat eventually, I'm just surprised my boat arrived earlier than I expected given my health!

I have a medical grade blood pressure machine at home to measure it reguarly, and it always comes back normal, like 100-120/70-80 type range.

My partner is very attractive and she and I have a great relationship so no issues there.

I don't think the diminished erections are psychological as I am very relaxed about sex, even the occasions when things aren't working great lol. In addition, my nocturnal and morning erections are effected, which I think maybe means it is more physiological than psychological.

I don't spend any time on porn, I prefer real life

Thyroid and Cortisol have been checked multiple times and levels are good I think. FSH is 3.5, LH 4.5, TSH 1.5, Free T3 3.9, Free T4 1.3, Cortisol(AM) 7.5

I appreciate your thoughts on T treatment. My range recently is usually 600-800. I might consider it if it brought me back to being 30 again this way, but it sounds like that probably isn't the case for me.

I respond very well to PDE-5 inhibitors, even an eighth or a tenth of a standard dose does the trick, but I was hoping to phsycially fix whatever changed in me.

Your comments about artery walls stiffening up even with decent blood flow, I have thought about that as well and wonder if might be the issue. Or maybe my natural nitric oxide production down there slightly degraded for some reason. I've thought perhaps real medical grade shockwave therapy might cause regeneration that would help with that. But, I wanted to rule out any other hormonal or chemical causes before trying that treatment. If I do the treatment, I'll let you guys know how that goes.

Are there any neurotransmitter tests that are useful?

Is Rigiscan testing to measure nocturnal erections productive?

I am probably being too thorough and careful, especially given how my symptoms might be considered minor by some, but any other ideas about tests that could be done to isolate what changed in me?

Given my age I just would like to be thorough, proactive, and preventative about it if there is a way.

Thanks so much!

 

[Systemlord]

My last lab came back 702 TT, 14.9 FT, 425 DHEA, 4.6 Prolactin, 24.5 Estradiol Sensitive, 64 DHT

I wouldn't say these Free T results are great, nothing to brag about.

If the Equilibrium Dialysis or Ultrafiltration method wasn't used, the results may not be accurate.

It's common for Cialis to not work well when hormones aren't optimal.

I laugh when someone say hormones levels look great on paper, no treatment needed without knowing the gene CAG repeat lengths (level of activity at the androgen receptors), because if you have longer CAG repeats, more testosterone is needed to force exchanges between tissues.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men - PMC

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter ...

www.ncbi.nlm.nih.gov

Unfortunately, no consensus has been reached regarding the lower TT threshold defining TD, and there are no generally accepted lower limits of normal TT [60]. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not.

Meanwhile the number of CAG (cytosine–adenine–guanine triplet) repeats in androgen receptor differs in men and influences the androgen receptor activity. Hence testosterone sensitivity may vary in different individuals. It has also been argued that the magnitude of the decrease in serum T concentrations might be a better predictor of hypogonadism than the actual concentrations of TT and BT.

The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical hypogonadism.

 

[Systemlord]

The interesting thing is I've had those Free T levels (midrange) on TRT and had symptoms of ED and lower libido. These problems disappear when I raise my Total T and Free T levels.

When all other medical conditions are ruled out, when having sexual issues, it's almost always hormone related. The higher end SHBG is the smoking gun. We know testosterone declines with age and that SHBG increases with age and that the two are linked!

The body is responding to the T decline in the only way it can, to scavenge T on the decline, the body increases the SHBG.

 

[Golfboy307]

I would agree with System Lord, you might want to retest the Free T given the higher SHBG. That being said, if you respond that well to a micro dose of PDE5 inhibitors, it just may be a slight reduction in NO levels and you need to focus on boosting that key molecule.

All I am saying is that TRT is a big commitment and to undertake it at those levels might be a bit premature. (I have been on it for 7 years with good results, but it's neither quick or temporary).

 

[Systemlord]

I wanted to ask a question regarding the lower end prolactin, do you smoke?

 

[Systemlord]

Are weaker erections a big deal or not in terms of being a canary in the coal mine?

Erectile troubles are the predictor of future cardiovascular problems.

 

[ResearchIt]

Thanks, I appreciate the feedback on the Free T levels and SHBG. I wish my SHBG wasn't as high as it is and wish I had labs from when I was 35 and 30 to compare how things have changed. I have had a lot of labs done in the last year, but didn't have the ability until recently when I switched doctors to use specific testing methods. I just had a lab done yesterday with Quest and they used Equilibrium Dialysis for Free T, so that will be interesting to see in the next week or so when results come back.

That's the interesting thing, even a small 2.5mg does of Cialis works great on me.

Where would I go to get the CAG repeat test done?

 

[ResearchIt]

I wanted to ask a question regarding the lower end prolactin, do you smoke?

I do not smoke and never have. No alcohol either.

 

[ResearchIt]

I would agree with System Lord, you might want to retest the Free T given the higher SHBG. That being said, if you respond that well to a micro dose of PDE5 inhibitors, it just may be a slight reduction in NO levels and you need to focus on boosting that key molecule.

All I am saying is that TRT is a big commitment and to undertake it at those levels might be a bit premature. (I have been on it for 7 years with good results, but it's neither quick or temporary).

I am going to retest Free T and SHBG regularly using the same lab going forward with the Equilibrium Dialysis method for Free T.

I agree and want to investigate and exhaust all options before doing anything. If there are any other tests or things to check that I haven't, please let me know!

 

[tareload]

I wouldn't say these Free T results are great, nothing to brag about.

If the Equilibrium Dialysis or Ultrafiltration method wasn't used, the results may not be accurate.

It's common for Cialis to not work well when hormones aren't optimal.

I laugh when someone say hormones levels look great on paper, no treatment needed without knowing the gene CAG repeat lengths (level of activity at the androgen receptors), because if you have longer CAG repeats, more testosterone is needed to force exchanges between tissues.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men - PMC

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter ...

www.ncbi.nlm.nih.gov

You left out this graph:

Kinda important wouldn't you say?

@ResearchIt: FYI always qualify any lab results you post with associated units and reference ranges.

 

[Systemlord]

You left out this graph:

Kinda important wouldn't you say?

View attachment 20402

@ResearchIt: FYI always qualify any lab results you post with associated units and reference ranges.

That's why I provided the link, but yeah, I should have included the graph as it shows symptoms starting at 577 ng/dL if you're unlucky enough to have long CAG repeats!

 

[Willyt]

I wouldn't touch TRT with your numbers. Many of us would kill for that hormone profile!

Try L-Citrulline and low dose 2.5mg daily Cialis assuming your blood pressure is not too low. And plenty of cardio.

 

[madman]

I wouldn't say these Free T results are great, nothing to brag about.

If the Equilibrium Dialysis or Ultrafiltration method wasn't used, the results may not be accurate.

It's common for Cialis to not work well when hormones aren't optimal.

I laugh when someone say hormones levels look great on paper, no treatment needed without knowing the gene CAG repeat lengths (level of activity at the androgen receptors), because if you have longer CAG repeats, more testosterone is needed to force exchanges between tissues.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men - PMC

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter ...

www.ncbi.nlm.nih.gov

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]


Now, how common would that be?

Variations in CAG Repeats of Men’s Androgen Receptor Gene

As the mediator of androgen actions, the androgen receptor (AR) plays a central role in establishing both physical and behavioral sex differences. The AR gene contains a CAG repeat polymorphism that is related to the strength of androgen actions on target tissues and that is correlated with...

www.excelmale.com

*In humans, the AR gene comes in many forms, called alleles. The best-studied alleles are those involving a CAG repeat sequence that encodes a polyglutamine tract near the amino end of the androgen receptor. This CAG repeat has different lengths in different people. In humans, the number of AR CAG repeats ranges from as few as 9 to as many as 36, but population averages are typically between 17 and 24 (Chamberlain et al., 1994; Hsiao et al., 1999; Irvine et al., 2000; La Spada et al., 1991). Individuals with higher numbers of AR CAG repeats will normally have diminished testosterone action on cellular functioning, effectively making males with high AR CAG repeats less masculine regarding most sexually dimorphic traits when compared to males with fewer AR CAG repeats (Loehlin et al., 2004; Simanainen et al., 2011)

* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16. Five countries had averages in the 17.00s; they were Swaziland (17.00), Zambia (17.00), Sierra Leone (17.30), Nigeria (17.58), and Senegal (17.90). Five countries had averages of 23.00 or higher; they were Lithuania (23.00), Mongolia (23.00), Ireland (23.07), Thailand (23.10), and Romania (23.16).

 

[madman]

Can see it now all those on the bro forums claiming that they need to be running those absurdly high TT/FT levels due to having high/highish SHBG or better yet my longer CAG repeat length bruh!

LMFAO!

 

[madman]

I am going to retest Free T and SHBG regularly using the same lab going forward with the Equilibrium Dialysis method for Free T.

I agree and want to investigate and exhaust all options before doing anything. If there are any other tests or things to check that I haven't, please let me know!

*My last lab came back 702 TT, 14.9 FT, 425 DHEA, 4.6 Prolactin, 24.5 Estradiol Sensitive, 64 DHT, although my SHBG is on the higher end, usually in the high 40s.

Would not even consider jumping on trt without knowing where your FT level truly sits.

Critical that you are using accurate assays TT (LC/MS-MS) and Free testosterone (Equilibrium Dialysis or Ultrafiltration), especially in cases of altered SHBG!

Blood work needs to be done in the morning between 7-10 am in a fasted state.

Even then would be better to test around 8 am as we always want to test at the peak.

If you lift weights take a week off before getting blood work done.




Dig through post #19/20

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

 

[ResearchIt]

I really appreciate the feedback. I am going to continue working on all the non-TRT things I can do to boost my Total T, Free T and lower my SHBG.

I'll post some future labs here as well using the correct methods along with reference ranges.

I am going to look into further testing to see if I can determine what caused this change given that I am healthy and this shouldn't be happening. For example, is it that my testicles aren't working as great anymore or is it that my hypothalamus(GnRH) or pituitary(LH) have declined? Or do I have the high SHBG gene or abnormal androgen receptor gene?

Has anyone had this genetic testing done? Where would you get it done?

Maybe my efforts will be futile, but I want my morning erections back haha!

 

[3percent]

I wouldn't touch TRT with your numbers. Many of us would kill for that hormone profile!

Try L-Citrulline and low dose 2.5mg daily Cialis assuming your blood pressure is not too low. And plenty of cardio.

@Willyt how much mg of L-citrulline?

 

[Willyt]

@Willyt how much mg of L-citrulline?

I have learned the hard way to start with microdose and work your way up instead of the reverse. For example, with Cialis I have gotten results with dose low as 0.62mg (1/4 of 2.5mg tablet).