ED my whole life - ready for TRT?

[JohnsonC]

Blood work august 2019:

Testosterone: 421 ng/dl (normal range: 219 - 906)
SHBG: 42 nmol/L (normal range: 16 - 55)
Free Androgen Index: 34.80 (normal range: 24 - 104)
Prolactin: 213 mlU/L (normal range: 86 - 324)
Oestradiol: 69 pmol/L (normal range: 0 - 192)
TSH: < 2,9 (normal range: < 8)

I just ordered a blood test for cortisol. The result should be available within a few days.

Blood work October 2015 (when I first manned up and went to the doctor with my problem):

(normalområde to the right means normal range, let me know if I need to translate anything else)

I'm 33 years old and have been suffering from ED and low libido pretty much my whole life. I almost never wake up with erections and I never get spontaneous erections. I've used Viagra bought from the internet since my first sexual encounter at 17. Every now and then I've had a period of a few weeks or months where everything have worked great without any pills - but my estimation is that I've suffered from ED 95% of the time. WHEN things are working erections are super strong, so I'm pretty sure that physically my penis is in fine condition and don't have any damage etc. It does feel like a hormonal problem.

I'm 100% sure it's not mental and I've tried desperately to optimize everything for the last 10 years (diet, training, sleep, stress, supplements etc.). Nothing made a big difference. Tonkat Ali did for a while at high doses (made me a complete sex animal for a few weeks), but after a while it felt like it was not good for my prostata (feeling like I had to pee all the time, even though I just went etc.). Eating a huge surplus of calories (especially from high sugar foods) have also worked wonders sometimes, but it's not sustainable in the long run as the surplus will have to be so big that it will make me fat quickly. I'm not under eating, fat or unhealthy, my BMI is 22 and I get a healthy amount of exercise from hiking, mountainbiking etc. every week. I eat a balanced diet with enough protein, carbs and fat. I used to do a lot of intense strength training but it made things even worse to the point of not being able to have sex even while on viagra. So these days I try to do less stressful training but just enough to be healthy. Besides my ED I'm suffering from some kind of IBS, so there's not many things I can eat without upsetting my stomach and having to go to the toilet all the time. I've managed to work with what i CAN eat though, so I do eat along recommendations for testosterone optimization. I'm almost never sick. I'm a bit tired sometimes and can sometimes nap many times a day. I don't feel deeply depressed or anything though. My sexual problems is definitely the only thing I can't accept anymore. I'm sure I could feel happier, more energetic etc. but it doesn't seem like a huge unbearable problem to me at the moment.

TRT is super rare here. I've never heard of anyone being on it. Doctors have all told me that my bloodwork is fine and that I'm completely normal. They've suggested couple therapy, written prescriptions for viagra, asked if I was stressed etc. Nothing have worked. I always accepted their answer and accepted that I will have to eat viagra for the rest of my life in order to have sex. But after reading a lot about testosterone in the last month or so I'm learning that the "normal ranges" are bogus, and that my free T is possibly the problem.

What do you guys think? Should I start TRT?

I found one clinic in the whole country that can do this. It's run by a highly respected doctor and I've seen his testosterone research cited on this site. I'm not sure yet if they will accept me as a client, but over the phone it sounded like they would and I'm waiting for them to get back to me. They do a LOT of testing before prescribing anything, so time will tell if they're willing. If they won't I already found a reliable source of pharma grade testosterone that I can self prescribe. Obviously not the best solution, but the options here in Scandinavia are super limited and I can't live like this anymore.

Thank you in advance!

 

[Systemlord]

Testosterone: 421 ng/dl (normal range: 219 - 906)
SHBG: 42 nmol/L (normal range: 16 - 55)
Free Androgen Index: 34.80 (normal range: 24 - 104)

Normally T declines after age 30 and usually begins a gradual decline, but in modern civilization in the passed ten years we are seeing a sharper decline in men of all ages. Your levels are normal, but for an old man, in fact your levels closely match up with 75-84 year old men, none of your doctors consider you age when looking at your testosterone.

It's fairly common for doctors to tell the patient there testosterone levels are normal, the problem with this is doctors are taught in medical school in range is normal, only with testosterone that is not the case and a lot of doctors don't make to correct diagnosis because they lack knowledge in sex hormones.

Testosterone is not that complicated, TT is the inactive portion of testosterone, SHBG binds testosterone and weakly binds estrogen, so if one were to have SHBG on the high end of the range, you would expect to see the free portion of testosterone on the lower end which is actually what we see in your case.

If you were to take me for example, my SHBG is low (14) which means if I have the same TT levels as you do, with SHBG low my free portion of testosterone would be sufficiently elevated, in fact on TRT at your TT level I am thriving and my FT would be almost at the top end of the ranges.

Your TSH is actually a little elevated, most doctors use reference ranges to determine normal status, only now we know the ranges are not normal, the normal healthy adult has a TSH between 1-1.5. You need to test "thyroid hormones" T4, fT3, rT3 and both antibody testing.

Reference ranges for TSH and thyroid hormones

Optimal vs Normal Thyroid Levels for All Lab Tests & Ages

 

[JohnsonC]

Thank you very much Systemlord. Highly appreciated. It all starts to make sense. I just ordered a thyroid test for:

• Free Thyroxine (FT4)
• Free Triiodothyronine (FT3)
• Thyroid Stimulating Hormone (TSH)
• Thyroglobulin Antibodies (TGAB)
• Thyroid Peroxidase Antibodies (TPO/TPEX)

This was the best test I could find available here. It doesn't have the rT3 and it's FT4 not T4. I hope it will be useful. Will post results here within 7-10 days when it's done. I think the clinic I'm in contact with have access to more advanced tests than what I can order on my own so if they accept me as a client maybe they will test the rT3 etc. Thank you once again.

 

[Vince Carter]

A lot of Thyroid testing is of little use without Reverse T3, pooling is a serious issue with FT3 and and without the RT3 test you can look good as far as FT3 levels, but if it's pooling and not getting in to your cells it's not very useful.

 

[JohnsonC]

Thank you very much Vince. I will keep looking for a place that can test for reverse T3.

 

[JohnsonC]

My Thyroid test results are in. Not sure if this brings anything new to the table that points in any direction? I still can't find anyone here who does something called Reverse T3. I suspect they may call it something completely different here and that's why I can't find it.

The hormone clinic I talked to have scheduled my first consultation in around 10 days. They ordered a lot of blood tests for me that will have to be done in advance so I will go do them on monday. I will ask them about the reverse T3 as well as they're highly experienced in this and also treat thyroid disorders.

 

[Systemlord]

If you start TRT, I expect to see TSH increase as TRT increases metabolic rates and your thyroid will need to meet demands and with TSH at 3.0 already I expect your thyroid to struggle.

I have never seen a man feel optimal on TRT with TSH 3.o> and I've had my head buried in these TRT boards for almost everyday for 3 years.

Reverse T3 is not some forgotten hormone, those that are knowledgeable will know what it is and its function. Maybe this clinic you hold in high regard does deserve a reevaluation.

You say these people at this clinic seem pretty knowledgeable, to this I say there is always a bigger fish in the pond.

 

[Gman86]

I have to agree with systemlord. All the thyroid experts that I’ve ever researched basically all say any TSH above 2.5 is indicative of hypothyroidism, regardless what the other labs are. A few don’t even like the TSH to be over 2. They find that when people feel good, and are not on thyroid replacement, their TSH is usually 1.5 or less.

 

[JohnsonC]

Maybe I have made myself unclear. I haven't talked to the clinic about Reverse T3 yet, and it's not them who have done these blood tests I just posted. I didn't even meet with them yet. They ordered a lot of new blood tests for me that I will do in the hospital on monday, and then I'll have my first consultation with them 8th of October when all the results are in. At this consultation I will ask them about reverse T3. I just googled it and found out that the reverse t3 is not a part of the healthcare system in my country anymore. So doctors can't do it. I haven't seen it offered at any of the private blood testing companies here either though, but hopefully will get access to it some other way.

 

[JohnsonC]

The clinic is this one by the way: https://www.cphclinic.com/about

 

[Systemlord]

Your country probably doesn't have access to rT3 testing.

 

[Cataceous]

Your country probably doesn't have access to rT3 testing.

Looks to me like they probably do: Nordic Lab

 

[JohnsonC]

Great! Thanks a lot for pointing me to this lab.

 

[JohnsonC]

Already got the results for most of the blood work I did this morning. I have never received results this fast before. It must be because I did them at a hospital with in-house facilities for this. I would really appreciate any inputs on this. Most notably progesteron is high and out of range - not sure if this is related to my symptoms? From what I've read low progesterone is connected to ED and low libido - but not sure about high?

Ferritin;P: 260 (range: 17-320)
Iron;P: 24 (range: 9-34)
Vitamine B12: 630 (range: 150-800)
Albumin;P: 43 (range: 36-48)
FSH: 5,2 (range: 1-15)
LH: 3,3 (range: 1,2-10,6)
Progesteron;P: 3,3 (range: 0-3) (out of range)
Prolaktin;P: 175 (range: 64-256)
PSA: 0,33 (normal range: < 3)
25-Hydroxy-Vitamin D(D3+D2);P: 111 (50-160)

There's a lot more results, but I've translated the numbers that seems to be of most use on these boards. All of the other numbers are within range.

Testosterone and SHBG is pending, but I've posted recent numbers earlier in this thread.

Thank you in advance!

 

[JohnsonC]

Finally! Had my first consultation with the clinic today. I was there for 2 hours as we went through everything, did a full physical exam etc. It was such a great experience for the first time in my life to meet a doctor who really cared about these symptoms. He was unhappy about the fact that only nebido and gels are approved here, but he had obtained a special license to get testosterone enanthate imported for his clients. Very nice. He told me that he wasn't sure that TRT would fix my sexual symptoms which is my main problem, as I do not experience that many symptoms otherwise related to low t. But he said we should defintely give it a try for 6-12 months as I'm running out of options. To my big surprise we started right then and there and he gave me a 250 mg IM injection. I will have another one in 2 weeks. He asked if I wanted to inject at home or come to the clinic. As it's close to my office I decided to go there for the shot in the beginning as it will also allow me to have more face to face dialogue with them until things settle. Having shots every other week is obviously not aligned with the information on these boards (and most other) where 1 week is recommended to be the longest between shots. The injection might be some kind of depot though, possibly testoviron depot which might work with this schedule. But I forgot about the brand. Now I follow hit protocol and see what happens. If I start crashing in week 2 I will talk to them about it. They seem very flexible and open minded, though have to be over-compliant to operate in this country. I'm just excited that I got a place to work with now who actually cares about me.