ED, No Libido, Seeing A Urologist Now

[madman]

February 3, 2020

Total Testosterone 917 ng/dL (Standard Range 250 - 1,100 ng/dL)

Free Testosterone 189.8 pg/dL (Standard Range 46.0 - 224.0 pg/dL)

Bioavailable Testosterone 390.2 ng/dL (Standard Range 110.0 - 575.0 ng/dL)

SHBG 23 nmol/L (Standard Range 10 - 50 nmol/L)
--------------------------------------------------------------------------------------------------


All these labs were pulled January 21, 2021



Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)




Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)
--------------------------------------------------------------------------------------------------

Sit back and take a good look at the difference in how much you have driven down your SHBG since last year as it went from 23.0--->14.7 nmol/L yet your TT level was not too far off on both protocols 900--->800 ng/dL and even with your current labs with TT 800 ng/dL seeing as your SHBG is only 14.7 nmol/L your FT would still be high.

I would retest your TT (LC/MS-MS) and FT (ED or UF) at the trough on your current protocol to see where your FT level truly sits as again it may very well be higher than you think.

Also with a low SHBG of 14.7 nmol/L, I would strongly consider switching to injecting daily or EOD using lower doses of T.

 

[swoops36]

Just a quick rundown of what i'm going through. I'm 43 years old. Diagnosed with low testosterone in April of 2019 (age 41). Took about a year trying to dial in the right amount of Testosterone weekly. I've had an Endocrinologist take me completely off of Testosterone (which was the dumbest thing he could do.) And I've had several different dosages. 100mg of Test Cyp to around 190 mg of test cyp weekly.

During this time I have severe ED. I'm not even aroused by a mental image or a touch. It's the weirdest feeling I'm going through in my life. I've been married for 20+ years and my wife is beautiful... skinny, implants... a complete doll. A blessing in my life honestly. Unfortunately, with my medical condition... whatever it may be... I have lost sexual desire and naturally she believes she's causing it. Which clearly she's not. I'm financially secure... no house payments. No CC debt. No problems. Just trying to enjoy life... in which the last 2 years have been absolutely hell on earth. I have natural confidence typically in everything in life... just born that way... but the last 2 years... something is mechanically wrong with my brain.... and/or sexual function. Don't know exactly what's causing this... but I've been through so many medical tests. My PCP believes I'm depressed and prescribed me Lexapro 5mg about 3 months ago and I refuse to be on any form of anti-depressants because I don't feel like I'm depressed. My PCP keeps telling me to take the drug and I keep saying No!

My Endocrinologist has me on Test Cyp at 130mg a week roughly. I take 65mg every 4 days. So in all essence I guess it's 130mg every 8 days. I probably feel my best on it... if there is such thing as a best? I don't take an AI at all. Estradiol stays roughly around 35-40 at the low point.

I have noticed the last 2 years or so I tend to be more openly emotional. I cry when watching a touching part in a movie. If there's a song on the radio that makes me think of my younger days... I can cry all of a sudden. I never had this problem before. I just figured that the high and low Estradiol is causing this? I still don't feel like I'm depressed because I really don't worry or fear anything. I workout 3-4 times a week. 1 hour 30 minutes to 2 hours. Cardio included... I try to stay as healthy as possible.

One odd thing I've noticed with being on Testosterone is that my blood pressure was around 140+/82 when I wasn't on TRT. Who knows how long I was testosterone deficient? I wouldn't know? Maybe 2 years without being treated? But in 2020 my blood pressure stayed at 118-122/72 for about 6 months at each checkup and I was satisfied. Then, it lowered to 116.... 114.... 112.... 108.... 106... and it's now at 102/62 my last checkup January 2021. My Endocrinologist told me it's perfect at 102/62. My PCP said she's satisfied with it... she just doesn't want it lower than 100. And a new Urologist I just started seeing said... he's also happy with it being 102/62 as long as I never have any dizzy spells. I asked my Endocrinologist is being on TRT causing my blood pressure to drop? He said.... no... it could be another medical issue causing this... but he said 102 is fine.

So I just started seeing this Urologist... hoping that he could steer me in the right direction. He's very well known and nothing but excellent reviews online. During my first session I explained to him all of my issues. ED, no libido... and lack of penile sensation. He wanted me to do a "low point" testosterone reading. A "high point" testosterone reading. A free testosterone evaluation right after injection. He told me to wait 8 hours after injection and then run to the lab and get it done. I don't know exactly why he told me to do that? I thought after you inject test cyp it takes at least 36 hours-48 hours to reach your high point? Right??

So... here are my labs... can anyone explain to me why he told me to check my "high point" 8 hours after injecting???

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

One thing that works for the ED is 100mg of Viagra (generic form). One pill lasts in my system for about 48 hours. The problem is I have no sensitivity. I'm not really aroused. Nothing goes to my brain saying... WOW! I'm having so much fun!! It's more like.... you're a machine and you are just performing the act with no feeling involved. Yeah... you get to see the girl get off... but honestly... it's really hard for me to reach orgasm. I could last probably an hour without reaching orgasm if I wanted to. Something is seriously wrong.

I'd even consider taking oral steroids to fix my mind.... whatever is causing this craziness in my brain. Nothing seems to excite me anymore.

Thanks for reading... any comments or ideas to fix this... I'd greatly appreciate it.

Have you checked prolactin? Had an MRI? How about DHT?
with your low shbg i‘d do shots EOD or daily, small injections, maybe 20mg daily to start.
no clue why you’d want to check test levels after 8 hours, not even close to peaked by then (as you discovered). Your doc may not be as good as he thinks lol

 

[madman]

Have you checked prolactin? Had an MRI? How about DHT?
with your low shbg i‘d do shots EOD or daily, small injections, maybe 20mg daily to start.
no clue why you’d want to check test levels after 8 hours, not even close to peaked by then (as you discovered). Your doc may not be as good as he thinks lol

Take a closer look at his labs!

Something very wrong there.

He is injecting 65 mg T every 4 days.....his TT 803 ng/dL @8 hrs post-injection.....no f***ing way he is hitting a trough TT 798 ng/dL 4 days later (96 hrs) just before his next injection.

When using exogenous esterified T there will be an initial burst release and T levels start rising within the first few hours and true peak when using the most commonly prescribed esters will be 8-12 hrs post-injection.....even then within 24 hrs.

Look over the Antares Xyosted (enanthate) study and that is using strictly subcutaneous injections.....Tmax 10 hrs.

Sift through the literature.....Nieschlag studies show levels peaking at 24 hrs.

Regardless his doctor should be testing at trough (lowest point) let alone using accurate assays TT/e2 (LC/MS-MS) and FT (equilibrium Dialysis or Ultrafiltration).


Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)

 

[Stpfan]

February 3, 2020

Total Testosterone 917 ng/dL (Standard Range 250 - 1,100 ng/dL)

Free Testosterone 189.8 pg/dL (Standard Range 46.0 - 224.0 pg/dL)

Bioavailable Testosterone 390.2 ng/dL (Standard Range 110.0 - 575.0 ng/dL)

SHBG 23 nmol/L (Standard Range 10 - 50 nmol/L)
--------------------------------------------------------------------------------------------------


All these labs were pulled January 21, 2021



Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)




Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)
--------------------------------------------------------------------------------------------------

Sit back and take a good look at the difference in how much you have driven down your SHBG since last year as it went from 23.0--->14.7 nmol/L yet your TT level was not too far off on both protocols 900--->800 ng/dL and even with your current labs with TT 800 ng/dL seeing as your SHBG is only 14.7 nmol/L your FT would still be high.

I would retest your TT (LC/MS-MS) and FT (ED or UF) at the trough on your current protocol to see where your FT level truly sits as again it may very well be higher than you think.

Also with a low SHBG of 14.7 nmol/L, I would strongly consider switching to injecting daily or EOD using lower doses of T.

I appreciate all your input Madman. Thank you. How am I driving my SHBG down? Naturally, I don't believe it's intentional... I just don't know if it's a good thing that it's constantly lowering? I do remember a long time ago probably around August of 2019 my SHBG was around 28 or so. Is it a good thing that it's 14.7 now? When doing Low Point and High Point Test.... I injected into the muscle right deltoid if that makes a difference?

I'm trying to find a lab report in which.... My PCP wanted my TSH levels checked... I injected around 65mg of Test Cyp approximately 48 hours prior to blood work. And my Testosterone levels were well above 1500. And naturally my Endocrinologist noticed the lab report and he bitched me out... saying that if he ever sees a high report like that again he reduce my prescription. That's why I only show him my lowest numbers... typically right before injecting. I always write down all my injection notes. Time/Date stamped because I want to know how to balance this out on my own. It's the only way to learn.

Ok I found the lab report....

I injected 65 mg of Test Cyp on August 4, 2020 at 3:13 PM

Lab work was drawn on August 6, 2020 at 3:48 PM

So this would be post injection results at 48 hours.

Total Testosterone >1500 ng/dL (Standard Range 240 - 890 ng/dL)

Estradiol 56 pg/mL (Standard Range 11 - 44 pg/mL)

Free T4 1.10 ng/dL (Standard Range 0.8 - 1.8 ng/dL)

TSH 2.43 ulU/mL (Standard Range 0.4 - 4.5)

Free T3 2.9 pg/mL (Standard Range 1.7 - 3.7) TAT for Free T3 1 Day

WBC Count 8.4 K/uL (Standard Range 4.0 -11.3)
RBC Count 6.28 M/uL (Standard Range 4.30 - 5.90)
Hemoglobin 18.3 g/dL (Standard Range 13.6 -17.6)
Hematocrit 55.8% (Standard Range 40.0 - 50.0%)
MCV 88.8 fl (Standard Range 82 - 97)
MCH 29.1 pg (Standard Range 27.3 - 33.4)
MCHC 32.7 g/dL (Standard Range 32 - 36)
RDW 13.6% (Standard Range 11.6 - 14.8)
Platelet Count 228 K/uL (Standard Range 150 - 450)
Mean Platelet Volume 8.7 ft (Standard Range 7.4 - 10.4)

 

[Stpfan]

Have you checked prolactin? Had an MRI? How about DHT?
with your low shbg i‘d do shots EOD or daily, small injections, maybe 20mg daily to start.
no clue why you’d want to check test levels after 8 hours, not even close to peaked by then (as you discovered). Your doc may not be as good as he thinks lol

Prolactin was checked only once

8/13/19 Prolactin 13.1 ng/mL (Standard Range 2 -18 ng/mL)

I had a 2nd Endocrinologist that worked with me for about 2 months. He said he would write an order for an MRI but he would require me to quit Testosterone Cyp completely for 30 days. I said are you out of your mind??? He said... well if you don't do this... I can't write the order and be your doctor. My current Endocrinologist refuses to write an order for an MRI. I'm just curious... what would an MRI show?? Or what would they be looking for??? I could try to have my Urologist possibly look into writing me an order for an MRI?

DHT was never checked.

The low SHBG is all new to me... Don't know how or why it's happening???

04/05/2019 SHBG 30
04/16/2019 SHBG 40
06/05/2019 SHBG 30
08/13/2019 SHBG 28
02/03/2020 SHBG 23
03/03/2020 SHBG 21
10/16/2020 SHBG Lab work was drawn but they mishandled the vials. Error on Report. Doctor still wrote my Test Cyp Prescription.

01/21/2021 SHBG 14.7

 

[Systemlord]

How am I driving my SHBG down?

You can hammer SHBG down by injecting larger T dosages, the larger the injection, the bigger the potential impact to SHBG. Also low thyroid hormones and diabetes can suppress SHBG.

I'm just curious... what would an MRI show?? Or what would they be looking for???

An MRI would show whether or not a hormone secreting tumor on the pituitary gland is causing an elevation in prolactin which if high enough could then cause low testosterone, but if prolactin was within normal ranges it would be pointless to order an MRI because prolactin isn't elevated.

Let's say you did have a hormone secreting tumor on the pituitary gland, prolactin would still be elevated even though you are on TRT.

 

[Stpfan]

You can hammer SHBG down by injecting larger T dosages, the larger the injection, the bigger the potential impact to SHBG. Also low thyroid hormones and diabetes can suppress SHBG.

That's really interesting about the SHBG... because I felt my thyroid wasn't dialed in properly in 2019... Some TSH scores were in the 4's to mid 4's. I felt that it was causing the SHBG to go higher. Also, there's this hormone specialist.... near my area... I did a phone consultation with him... he claims he likes all of his patients to be at 15 for SHBG. If not at 15... at least below 20. So the way he was talking.... that's optimal. Funny... because I did the phone consultation with him a long time ago... back when my SHBG was around 24 or so. I've been injecting the exact same amount of test cyp. I have no idea why it's dropping? Not taking anything else... no vitamins etc... except for my Levothyroxine 25mcg daily.

 

[Systemlord]

Also, there's this hormone specialist.... near my area... I did a phone consultation with him... he claims he likes all of his patients to be at 15 for SHBG.

I have diabetes and when not under control my SHBG is in the low teens and when I improve my lifestyle it increases passed 20, so if I can help it I don't want my SHBG low and neither should you.

I'm sure your doctor means well, but I think your doctor is a little ridiculous wanting all his patients SHBG at 15.

 

[buckeye22]

Just a quick rundown of what i'm going through. I'm 43 years old. Diagnosed with low testosterone in April of 2019 (age 41). Took about a year trying to dial in the right amount of Testosterone weekly. I've had an Endocrinologist take me completely off of Testosterone (which was the dumbest thing he could do.) And I've had several different dosages. 100mg of Test Cyp to around 190 mg of test cyp weekly.

During this time I have severe ED. I'm not even aroused by a mental image or a touch. It's the weirdest feeling I'm going through in my life. I've been married for 20+ years and my wife is beautiful... skinny, implants... a complete doll. A blessing in my life honestly. Unfortunately, with my medical condition... whatever it may be... I have lost sexual desire and naturally she believes she's causing it. Which clearly she's not. I'm financially secure... no house payments. No CC debt. No problems. Just trying to enjoy life... in which the last 2 years have been absolutely hell on earth. I have natural confidence typically in everything in life... just born that way... but the last 2 years... something is mechanically wrong with my brain.... and/or sexual function. Don't know exactly what's causing this... but I've been through so many medical tests. My PCP believes I'm depressed and prescribed me Lexapro 5mg about 3 months ago and I refuse to be on any form of anti-depressants because I don't feel like I'm depressed. My PCP keeps telling me to take the drug and I keep saying No!

My Endocrinologist has me on Test Cyp at 130mg a week roughly. I take 65mg every 4 days. So in all essence I guess it's 130mg every 8 days. I probably feel my best on it... if there is such thing as a best? I don't take an AI at all. Estradiol stays roughly around 35-40 at the low point.

I have noticed the last 2 years or so I tend to be more openly emotional. I cry when watching a touching part in a movie. If there's a song on the radio that makes me think of my younger days... I can cry all of a sudden. I never had this problem before. I just figured that the high and low Estradiol is causing this? I still don't feel like I'm depressed because I really don't worry or fear anything. I workout 3-4 times a week. 1 hour 30 minutes to 2 hours. Cardio included... I try to stay as healthy as possible.

One odd thing I've noticed with being on Testosterone is that my blood pressure was around 140+/82 when I wasn't on TRT. Who knows how long I was testosterone deficient? I wouldn't know? Maybe 2 years without being treated? But in 2020 my blood pressure stayed at 118-122/72 for about 6 months at each checkup and I was satisfied. Then, it lowered to 116.... 114.... 112.... 108.... 106... and it's now at 102/62 my last checkup January 2021. My Endocrinologist told me it's perfect at 102/62. My PCP said she's satisfied with it... she just doesn't want it lower than 100. And a new Urologist I just started seeing said... he's also happy with it being 102/62 as long as I never have any dizzy spells. I asked my Endocrinologist is being on TRT causing my blood pressure to drop? He said.... no... it could be another medical issue causing this... but he said 102 is fine.

So I just started seeing this Urologist... hoping that he could steer me in the right direction. He's very well known and nothing but excellent reviews online. During my first session I explained to him all of my issues. ED, no libido... and lack of penile sensation. He wanted me to do a "low point" testosterone reading. A "high point" testosterone reading. A free testosterone evaluation right after injection. He told me to wait 8 hours after injection and then run to the lab and get it done. I don't know exactly why he told me to do that? I thought after you inject test cyp it takes at least 36 hours-48 hours to reach your high point? Right??

So... here are my labs... can anyone explain to me why he told me to check my "high point" 8 hours after injecting???

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

One thing that works for the ED is 100mg of Viagra (generic form). One pill lasts in my system for about 48 hours. The problem is I have no sensitivity. I'm not really aroused. Nothing goes to my brain saying... WOW! I'm having so much fun!! It's more like.... you're a machine and you are just performing the act with no feeling involved. Yeah... you get to see the girl get off... but honestly... it's really hard for me to reach orgasm. I could last probably an hour without reaching orgasm if I wanted to. Something is seriously wrong.

I'd even consider taking oral steroids to fix my mind.... whatever is causing this craziness in my brain. Nothing seems to excite me anymore.

Thanks for reading... any comments or ideas to fix this... I'd greatly appreciate it.

You are correct in saying no to the anti depressant meds. They will make libido and erections worse. You can supplement 5-HTP (mood) and pregnenolone (focus and mood) instead which may help a little. Also try an occasional vitamin b12 injection or sublingual.
Aging has an effect on mood, like women in menopause, men go through change of life as well, get hypogonadism and supplement TRT. You will never feel like you were when u were 22, that’s normal, that’s expected, and it’s a tough pill to swallow.
Since u r already doing 2x week and u feel good in injection day then maybe try to break it up to 3x week. Everyone’s dose is different but I wouldn’t go less than the 120mg wk because less than that won’t support muscle.
Instead of high dose viagra which lowers BP by the way, maybe ask your dr about a 5 or 10mg daily cialis as this also supports healthy T levels and libido, and keeps your pro state in check. Hcg can also help as well in all departments, ask your dr about supplemental hcg 2x week, a day before T injections or 12 hours earlier. Keeps your penis and testicules feeling fuller, raises T, maintains fertility, etc. this is optional of course but it’s something I never want to stop in my protocol
your E2 level is normal. What u r describing is not symptoms of high E2. you may need to change your workout routine and or do something new all together. Join a boxing gym, try muay Thai and or Jiujitsu, for fun and exercise in addition to your other workouts. It’s amazing for me, I don’t compete and don’t want to, I just love learning it.
R u watching porn at all? If so, stop! This is shown to cause problems. Cleanse your mind.

 

[Mack19]

I have diabetes and when not under control my SHBG is in the low teens and when I improve my lifestyle it increases passed 20, so if I can help it I don't want my SHBG low and neither should you.

I'm sure your doctor means well, but I think your doctor is a little ridiculous wanting all his patients SHBG at 15.

I thought having low (range) SHBG was good because it meant more free T - I have a lot to learn

 

[David House]

I have diabetes and when not under control my SHBG is in the low teens and when I improve my lifestyle it increases passed 20, so if I can help it I don't want my SHBG low and neither should you.

I'm sure your doctor means well, but I think your doctor is a little ridiculous wanting all his patients SHBG at 15.

Systemlord,

What kind of A1C or glucose ranges do you see that impacts SHBG. My A1C was 5.7 with glucose at 106 for October. SHBG 17.8 (19.3-76.4). TT 707 FT 23.6 E2 16.2 (8.0-35.0)

Results on 1/14 TT 328 but no FT or SHBG test, A1C 6.0 with glucose at 120.

Seems a direct correlation in T level drop and diabetes along with slight weight increase 5 to 10 lbs.

 

[Systemlord]

I thought having low (range) SHBG was good because it meant more free T - I have a lot to learn

Low SHBG is associated with elevated levels of triglycerides and low density lipoprotein (LDL). Low SHBG levels of SHBG are linked with multiple cardiovascular illnesses in both men and women, including heart disease, type 2 diabetes, and high blood pressure.

Now you understand why I have issue with your doctors comment about wanting SHBG low.

 

[ERO]

I thought having low (range) SHBG was good because it meant more free T - I have a lot to learn

Low SHBG is something that those of us that have it would not wish on our worst enemy. We struggle to feel any benefits from TRT even if blood work looks great "on paper." Aside from the rare unicorn, none of us here on the forum with SHBG at 15 or lower would describe that as good.

 

[gerardo]

Low SHBG is associated with elevated levels of triglycerides and low density lipoprotein (LDL). Low SHBG levels of SHBG are linked with multiple cardiovascular illnesses in both men and women, including heart disease, type 2 diabetes, and high blood pressure.

Now you understand why I have issue with your doctors comment about wanting SHBG low.

My Shbg is short. 11. And my triglycerides are very high. Difficult to control my triglycerides. I take statins but I don't like it. What do you use to lower triglycerides in addition to physical exercise and decrease carbohydrate consumption?

 

[3DMission]

@Stpfan I’m sorry to hear you’re having to experience this, I know how hard this road can be. My symptoms and SHBG levels were similar to yours.

Switching to everyday injections is an absolute must try for you. My doctor advised against it, but the guys here encouraged me to try it and I have never felt better in my whole life. It was truly life changing for me. I take .07 per day (7’th marker on .5cc syringe) of T Cyp, which I think is 14mg. With low SHGB, everyday injections is a must try. Give it at least 6 weeks, but I started feeling better within 2-3 weeks.

HCG is also a MUST for you. If you’re not taking HCG, get this now!!! When I was on T Cyp monotherapy I had no penile sensitivity and just felt like a machine when I could have sex. HCG activates all the other downstream hormones and gives a more sense of well-being. This varies amongst guys, but with symptoms like yours, it’s worth a try. If you’re not on HCG at all, then I’d start with loading stage of 500 IU’s M, W, F for two weeks then lower down to 400 IU’s and adjust from there. Personally I’m at 300 and that’s just enough to maintain.

Most likely, none of the above will make any sense to your doctor and it’s doesn’t have to, because this is art just as much as it is science. Doctors can’t always understand hormones, why one person feels a certain way, and there’s not one size fits all treatment. That’s hard for doctors to accept. My Endo swore everyday injections would make no difference whatsoever. I am no taking less T than ever before and feeling better than ever!

Since your doc may not understand, it may be difficult to get on this protocol. You already have the T, so just switch to smaller doses everyday, you’ll have more than enough with your current dosage and buy the Easy Touch syringes on Amazon. For HCG, if he is skeptical, tell him you want to maintain fertility and ask for a script of 12,000 IU’s to be sent to Empower Pharmacy. MUCH cheaper method.

Personally, I think you made the right decision of staying away from an AI and anti-depressants. AI’s took me down a dark road by crashing my E2. You do not want to go there. Anti-depressants can alter your brain chemistry forever and you only want to take if absolutely needed, not just to try something different.

I’m confused by your low blood pressure. How’s your salt intake?

Also, this sounds weird, but are you cold often when you should normally be warm and do you have an urge, a craving to chew dirt or want to chew something gritty or crunch ice to where chewing on dirt or clay actually sounds good?

Lastly, did I miss why you need to give frequent blood donations? Is this a must?

 

[barry1]

First think I'd do is drop the lexapro. Wellbutrin for depression if needed. Seems some of you guys sweat too much over timing this and that. I'd pick a dose, say 100mg-120mg IM weekly, consistently, check free and total and estradiol in 6 weeks. Seems you're a little heavy on estrogen. I've been on T several years, 74 y/o now. Looking back, I realize I was dealing with Low T symptoms in my 40s. I like to keep my free around 18-20. Life is good, sex is good for me. Hoping for the best for you. The only sexual issue I have is a dramatic decrease in semen volume and consistency. Wasn't expecting that. I expect, and cope with, "age-related changes" but not happy with that one. Any suggestions welcome. Don't say "hold off for a bit". Doesn't work, just gets me edgy and irritable.

 

[3DMission]

@barry1 have you tried HCG? HCG helps with semen load/volume for me.

First think I'd do is drop the lexapro. Wellbutrin for depression if needed. Seems some of you guys sweat too much over timing this and that. I'd pick a dose, say 100mg-120mg IM weekly, consistently, check free and total and estradiol in 6 weeks. Seems you're a little heavy on estrogen. I've been on T several years, 74 y/o now. Looking back, I realize I was dealing with Low T symptoms in my 40s. I like to keep my free around 18-20. Life is good, sex is good for me. Hoping for the best for you. The only sexual issue I have is a dramatic decrease in semen volume and consistency. Wasn't expecting that. I expect, and cope with, "age-related changes" but not happy with that one. Any suggestions welcome. Don't say "hold off for a bit". Doesn't work, just gets me edgy and irritable.

 

[Stpfan]

Thanks for all the posts fellas. Much appreciated!

Had the follow up appointment earlier today. Really a bunch of BS....

We went over all the symptoms I was experiencing. ED, No Penile Sensation. You feel no desire... numb to anything. He said why didn't you take the Lexapro 5mg that your PCP wanted you to take? I said because the majority of the people around me who have taken it... their lives aren't better. In fact... it seems their lives are worse. I said yeah... I have ED and yeah... my sex life is lousy... my goal is to run optimal being on TRT... not average. But seeing how other peoples lives are.... in regards to anti depressants... I guess that's just the hand I was dealt in life? I said your only recommendation is me seeing a psychiatrist? He said... your hormone levels are above normal. This is s mental issue and not really a hormonal issue. (And I was trying to act professional as possible... because this is a bunch of BS.) I said... what other protocol do you recommend?

1. He said you can switch to a Testosterone Gel. It will probably run $50.00 a month from a compound lab. But, before I allow you to do this.. you must first quit your current protocol for 30 days COLD. We will run labs again.... and then we will run the Testosterone Gel protocol. I was like.... wow.

I said... do you have any other ideas??

2. If you feel it's your Estradiol that's causing the ED or other imbalance... you will drop your Testosterone injections to 50mg every 3.5 days. And I will prescribe you Anastrozole. You will take it 1 mg every 3.5 days on your injection days. Then we will run labs 6 weeks after you've started the Anastrozole. I said... why can't you just prescribe the AI right now on my 130mg of Testosterone Cyp a week?? I feel fine on it. He said... in all actuality.. your testosterone will increase even more taking the AI... and I can't allow you to do that.

I said... well what about running other labs like... 4 point salivary cortisol? DHEAS? Pregnenolone? Prolactin? Etc??? He said... there's no need to run these labs. Wouldn't matter with your sexual desire or ED.

So... there you have it... he's basically saying everything is in my head.... and I need to see a psychiatrist lol Yep... it's in my mind! lol I told him... doctor... if you had ED for 3 years... and you're still in your early 40's.... and you had no issues in your 20's at all... and you had all the confidence in the world back then.... and all of a sudden it's gone... your head wouldn't be right either. There's nothing wrong with my mind. I said thank you for your professionalism... and walked out.

Should I try just supplementing DHEA and Pregnenolone? How many MG's? Or any other advice?

 

[3DMission]

Thanks for all the posts fellas. Much appreciated!

Had the follow up appointment earlier today. Really a bunch of BS....

We went over all the symptoms I was experiencing. ED, No Penile Sensation. You feel no desire... numb to anything. He said why didn't you take the Lexapro 5mg that your PCP wanted you to take? I said because the majority of the people around me who have taken it... their lives aren't better. In fact... it seems their lives are worse. I said yeah... I have ED and yeah... my sex life is lousy... my goal is to run optimal being on TRT... not average. But seeing how other peoples lives are.... in regards to anti depressants... I guess that's just the hand I was dealt in life? I said your only recommendation is me seeing a psychiatrist? He said... your hormone levels are above normal. This is s mental issue and not really a hormonal issue. (And I was trying to act professional as possible... because this is a bunch of BS.) I said... what other protocol do you recommend?

1. He said you can switch to a Testosterone Gel. It will probably run $50.00 a month from a compound lab. But, before I allow you to do this.. you must first quit your current protocol for 30 days COLD. We will run labs again.... and then we will run the Testosterone Gel protocol. I was like.... wow.

I said... do you have any other ideas??

2. If you feel it's your Estradiol that's causing the ED or other imbalance... you will drop your Testosterone injections to 50mg every 3.5 days. And I will prescribe you Anastrozole. You will take it 1 mg every 3.5 days on your injection days. Then we will run labs 6 weeks after you've started the Anastrozole. I said... why can't you just prescribe the AI right now on my 130mg of Testosterone Cyp a week?? I feel fine on it. He said... in all actuality.. your testosterone will increase even more taking the AI... and I can't allow you to do that.

I said... well what about running other labs like... 4 point salivary cortisol? DHEAS? Pregnenolone? Prolactin? Etc??? He said... there's no need to run these labs. Wouldn't matter with your sexual desire or ED.

So... there you have it... he's basically saying everything is in my head.... and I need to see a psychiatrist lol Yep... it's in my mind! lol I told him... doctor... if you had ED for 3 years... and you're still in your early 40's.... and you had no issues in your 20's at all... and you had all the confidence in the world back then.... and all of a sudden it's gone... your head wouldn't be right either. There's nothing wrong with my mind. I said thank you for your professionalism... and walked out.

Should I try just supplementing DHEA and Pregnenolone? How many MG's? Or any other advice?

@Stpfan did you catch my earlier post? Switch to every day injections and add HCG on M, W, F. On T alone I lose penile sensitivity and sexual desire is not the same. I need HCG to bring everything together and with your low SHGB the every day T injections will work much better. I was previously doing the same protocol as you with the same symptoms until i switched. No, your doctor will not understand.

 

[slicktop]

Bro, I'm sorry, but you need to RUN from this doctor. Do not walk, do not pass go, etc. There is NO reason to "go cold" for 30 days, that's f'ing retarded. That's all I needed to hear. Please consider Defy. Seriously, you need an expert, not someone that's throwing darts to see what sticks. I honestly believe they'd get you sorted out quicker than anything else you're trying presently.

I think you'd benefit from AI, but nowhere NEAR what your doc recommended at 2mg a week. That's a LOT.

I'm going to share a very unpopular opinion on this board due to your circumstance and all you've tried so far. I know there's some magic formula ratio between testosterone and estradiol that works for lots of guys, but that does NOT work for me. I've tried it more than once, and I won't do it again. Personally, I do best when my E2 is no more than 25% higher than my SHBG. My SHBG runs in the low 20's, so I aim to keep my E2 there as well and I feel great. On my previous test only protocol, that meant taking .25mg of anastrozole twice to three times a week, but now on a nandrolone/testosterone protocol I rarely take any AI (less test, less aromatization...nandrolone doesn't convert to estrogen much).

That said, this is not my official advice, but what *I* would do if I were you: I would get the script for anastrozole from the doc and also switch to more frequent test injections, at least twice a week if not every other day. Low SHBG guys tend to benefit from more frequent injections, and I can't imagine it making things worse for you. I'd then look up the vodka/microdosing instructions for anastrozole and start .125mg every other day while taking a quality DIM supplement. I'd pay close attention to my moods, erections, sex drive, etc, and when I notice an improvement, BACK OFF cause that means it's working. Take the AI to every third day once you see an improvement. In the meantime, get all your paperwork ready and start the process of switching to Defy and get some help from experts.

Good luck, sir. I hate that you've struggled this much!