ED ongoing issues

[TRTinNY]

Guys,

About two months back I crashed my estradiol. Prior to that my sex life was relatively reasonable although I've been battling with ongoing penis sensitivity issues for a long while. I was waking with morning wood on Cialis for a while prior to the crash and now nothing. I have a hard time getting erections at all and my penis is completely not sensitive. I have even taken a break from masturbating and porn and sex for a few days.

I'm 38 years old and in pretty good shape and weigh about 220. My body fat percentage is about 18 or 19.

I'm a low SHBG guy who hovers between 13 and 17.

I was previously on vybriid for depression from my divorce but came off of it in January.

My e2 sensitive has been between 18 and 49 recently. I can't seem to get it dialed in but not sure that's all my problem or not.

I take 26mg testosterone cypionate daily. I also take a daily Cialis. As well I do 300iu hcg twice a week. I take .125mg anastrazole as I feel necessary. I take 25mg of DHEA daily from empower. Also take daily vitamin d and coq10.

Last Saturday 7/20 Was the last time I took anastrazole. My e2 was verified to be 30 on 7/16 and I was having pretty bad erection issues.

I'm not sure if I should have a full panel done or what I should be checking.

I know my iron levels are low most likely from donating blood.

My morning glucose is slightly elevated at 105 and my a1c at last check was 5.9 but I'm not a diabetic.

I know my hematocrit runs on the higher side in the low 50s.

I smoke a pack a day of cigarettes.

I don't know my prolactin, pregnenolone or cortisol levels.

My thyroid function is good.

I don't know free e2 and haven't checked my testosterone or free test levels in like 3 months. Only estradiol levels.

Any thoughts what I can do or check to try to get this all under control? I'm getting divorced and this erectile dysfunction problem is killing me.

 

[Vince Carter]

Beside Erection issues, which come from, too, high estrogen...what makes you say you crashed your E. I mean physical symptoms...sore/achy joints is a usually clear low E symptom, much else of the low and high symptoms can mirror one another.

There's plenty here to work with though. I'm going with you're E is higher than you think it is. Test E2 LC/MS/MS, and "Estradiol, Free". I have all sorts of ED and sensitivity problems when my E is too high, for me. That's outside of what a lab test or number on a paper want's us to believe. I can run a LC/MS/MS number let's say a 20, but my Free E is over the lab range...using one number in isolation may not be enough and we know low SHBG makes the E management difficult.

 

[TRTinNY]

Beside Erection issues, which come from, too, high estrogen...what makes you say you crashed your E. I mean physical symptoms...sore/achy joints is a usually clear low E symptom, much else of the low and high symptoms can mirror one another.

There's plenty here to work with though. I'm going with you're E is higher than you think it is. Test E2 LC/MS/MS, and "Estradiol, Free". I have all sorts of ED and sensitivity problems when my E is too high, for me. That's outside of what a lab test or number on a paper want's us to believe. I can run a LC/MS/MS number let's say a 20, but my Free E is over the lab range...using one number in isolation may not be enough and we know low SHBG makes the E management difficult.

I don't know if it is too high or too low. I haven't found a range where I'm just good. Whether I'm in the teens or in the 30s. I definitely get sore but also go to the gym. Nothing really out of the ordinary. As well, could I have other issues. Plus I also think that I over respond to anastrazole which is another problem. I'm just not sure what's up or down anymore.

 

[Vince Carter]

"as necessary" can be a boogeyman...you either need it or you don't, most guys have no idea how to work with "as necessary". Too, .125mg of Anastrozole is an extremely small dose and it's really unlikely to have upset the balance in some serious way.

What I would do is remove the DHEA...this can aromatase is most guys, easiest thing to do is remove something, one thing at a time and judge it. Don't change too much at one time and be consistent with your dosing and timing etc etc

 

[TRTinNY]

"as necessary" can be a boogeyman...you either need it or you don't, most guys have no idea how to work with "as necessary". Too, .125mg of Anastrozole is an extremely small dose and it's really unlikely to have upset the balance in some serious way.

What I would do is remove the DHEA...this can aromatase is most guys, easiest thing to do is remove something, one thing at a time and judge it. Don't change too much at one time and be consistent with your dosing and timing etc etc

As necessary is when my penis doesn't work.

 

[Vince]

Also your daily dose of testosterone is on the high side. Have you ever thought of a lower dose. Something like 16 mg daily.

 

[Vince Carter]

As necessary is when my penis doesn't work.

That's not a good barometer for taking a drug or judging Estrogen being high in the context of one time to the next.

 

[Vince Carter]

Also your daily dose of testosterone is on the high side. Have you ever thought of a lower dose. Something like 16 mg daily.

I was going to suggest this but he's got so much going on already.

 

[TRTinNY]

That's not a good barometer for taking a drug or judging Estrogen being high.

Truthfully I just need to get my ED issues under control and it is killing me that I haven't found the magic formula. I was in decent shape for a long time and now I'm not sure what to do or test. By the way I see Dr. Saya.

 

[Vince Carter]

Truthfully I just need to get my ED issues under control and it is killing me that I haven't found the magic formula. I was in decent shape for a long time and now I'm not sure what to do or test. By the way I see Dr. Saya.

Mental is a HUGE component...the mind is a powerful thing and can override all of it.

Test, Total
Free T
Estradiol LC/MS/MS
Estradiol, Free

...be consistent on everything so your labs can be a sound place to judge things on.

Try an increase from 5mg daily Cialis...the basic dose can be as much as 20mg.

Try adding Yohimbine HCL 5mg...this makes a real difference for me.

 

[TRTinNY]

Mental is a HUGE component...the mind is a powerful thing and can override all of it.

Test, Total
Free T
Estradiol LC/MS/MS
Estradiol, Free

...be consistent on everything so your labs can be a sound place to judge things on.

Try an increase from 5mg daily Cialis...the basic dose can be as much as 20mg.

Try adding Yohimbine HCL 5mg...this makes a real difference for me.

Should I talk to Dr. Saya about lowering my dose? What do you guys think are the risks of this.

 

[TRTinNY]

So I actually just got more test results. I took .125 anastrazole on Tuesday 7/16 after my blood work that day and my e2 was 30 but didn't know it until later that week. On Saturday 7/20 I got e2 tested again and it was 26 that day and I took another .125 not knowing the level was 26 until today. I had another e2 test this Tuesday 7/23 but don't have the results of that yet. Trying to understand how the anastrazole affects my levels.

 

[Vince]

I was going to suggest this but he's got so much going on already.

I would think if he lowered his dose, he could probably drop his AI completely. It may also take care of his ED issues.

 

[Systemlord]

I know my iron levels are low most likely from donating blood.

My e2 sensitive has been between 18 and 49 recently.

I smoke a pack a day of cigarettes.

Smoking will affect erections negatively, the main physiological mechanism that appears to be affected includes the nitric oxide signal transduction pathway.

Effects of cigarette smoking on erectile dysfunction

I believe you have more than one problem affecting you penile sensitivity, when iron levels are low you lose the metabolism boosting properties of thyroid hormones and reduce T4 to T3 conversion and increase reverse T3 levels.

Men with low SHBG usually cannot handle estrogen above ranges because Free E2 percentage is very high, this can mess with penile sensitivity. I also believe your usage of HCG is increasing estrogen then requiring you to block estrogen and seem unable to get the correct dosage.

I found it impossible to find the right AI dosage, it tipped too far in either direction and just became a nuisance. TRT in isolation without HCG or AI's is recommended unless you want to keep fighting to find the correct balance.

 

[TRTinNY]

Smoking will affect erections negatively, the main physiological mechanism that appears to be affected includes the nitric oxide signal transduction pathway.

Effects of cigarette smoking on erectile dysfunction

I believe you have more than one problem affecting you penile sensitivity, when iron levels are low you lose the metabolism boosting properties of thyroid hormones and reduce T4 to T3 conversion and increase reverse T3 levels.

Men with low SHBG usually cannot handle estrogen above ranges because Free E2 percentage is very high, this can mess with penile sensitivity. I also believe your usage of HCG is increasing estrogen then requiring you to block estrogen and seem unable to get the correct dosage.

I found it impossible to find the right AI dosage, it tipped too far in either direction and just became a nuisance. TRT in isolation without HCG or AI's is recommended unless you want to keep fighting to find the correct balance.

I got a prescription to have testosterone total, free, estradiol lc Ms, estradiol free

 

[TRTinNY]

Let me ask you guys something. Being that I do testosterone daily... Does it matter if I test before or after my shot?

 

[Gman86]

Let me ask you guys something. Being that I do testosterone daily... Does it matter if I test before or after my shot?

Rule of thumb is to test at trough, regardless of protocol. So I would just test before your injection. But with daily injections, there shouldn’t be too big of a difference. The degree of difference is going to depend on your SHBG and how fast you clear the testosterone. You’ll see a bigger difference if you’re a low SHBG guy, and less of a difference if you’re a high SHBG guy. What’s more important is that whichever you choose, you do it that same way every single time you get labs done. Consistency of when you draw labs is more important. But I would just keep things simple and test before the injection.

 

[Vince]

Let me ask you guys something. Being that I do testosterone daily... Does it matter if I test before or after my shot?

Even though I do daily injections, I do labs before I inject.

 

[S1W]

What are your TT/FT labs?

My first reaction was the same as Vince’s - 26mg/daily seems a lot higher than what most guys on daily use and that would be the first thing I’d address.

That and maybe get your health priorities straightened out...smoking a pack a day...

 

[TRTinNY]

What are your TT/FT labs?

My first reaction was the same as Vince’s - 26mg/daily seems a lot higher than what most guys on daily use and that would be the first thing I’d address.

That and maybe get your health priorities straightened out...smoking a pack a day...

This is the last time I had labs drawn in May for it