Endless ED Issues

[TRTinNY]

Hey guys...

Happy 2022!

Hoping to maybe get some more help or direction. Actually have a call scheduled with Dr. Saya who i see from time to time but was hoping maybe people can provide a direction for a conversation with him or suggestions for me.

I am relatively healthy at 41. I was tested for sleep apnea and i am negative. I am not a diabetic. i do smoke cigarettes (half a pack a day or so). I drink socially. I dont do drugs other than a rare occasion.

My RBC gets up into the mid 50s and then i donate blood every few months. My ferritin is always low but i was told that shouldnt be a cause of issue with ED.

I cannot get an erection without physical stimulation nor can I keep one without physical stimulation. Even getting a blow job unless it is rough, I will go soft. Sex and hands are the only thing that seems to work. I can get full erections. They just dont stay even with mental stimulation, watching porn etc.

The day after my blood test, i realized i was having a problem reaching orgasm with my girlfriend and my nipples were sensitive so i took .07 anastrazole which i rarely take. The next day it wasnt until the afternoon that I felt i was ready to go again and things seemed better but with a weaker erection.

I take 10mg of Cialis daily. I take 300mg of Wellbutrin XR. I take 5mg Crestor. I take 145mg of Fenofibrate. Both Crestor and Fenofibrate are due to family history. I take a daily Prilosec otherwise i end up with heartburn.

I also take 25mg DHEA, 30mg Pregnenalone, 125mcg D3, and 300mg CoQ10 all daily in the morning.

I am on Aimovig once a month and Botox every 3 months for migraines.

I inject daily. I have tried low dose testosterone at .09 daily which i didnt feel good and currently at .15 and dont feel much better but at least erections seem to be a bit better.

I just hate that i want to have sex all the time and i physically cant perform how i want to. I am way too young for this and havent found the magic bullet. Been dealing with this for about 5 or 6 years.

My most recent labs:

IRON, TOTAL 121 Reference Range: 50-180 mcg/dL
IRON BINDING CAPACITY 434 H Reference Range: 250-425 mcg/dL (calc)
% SATURATION 28 Reference Range: 20-48 % (calc)
FERRITIN 20 L Reference Range: 38-380 ng/mL

CHOLESTEROL, TOTAL 197 Reference Range: <200 mg/dL
HDL CHOLESTEROL 44 Reference Range: > OR = 40 mg/dL
TRIGLYCERIDES 131 Reference Range: <150 mg/dL
LDL-CHOLESTEROL 103 mg/dL (calc) Reference range: <100

WHITE BLOOD CELL COUNT 6.8 Reference Range: 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 6.80 H Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 17.9 H Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 54.7 H Reference Range: 38.5-50.0 %
MCV 80.4 Reference Range: 80.0-100.0 fL
MCH 26.3 L Reference Range: 27.0-33.0 pg
MCHC 32.7 Reference Range: 32.0-36.0 g/dL
RDW 14.1 Reference Range: 11.0-15.0 %
PLATELET COUNT 218 Reference Range: 140-400 Thousand/uL
MPV 11.9 Reference Range: 7.5-12.5 fL
ABSOLUTE NEUTROPHILS 4542 Reference Range: 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1489 Reference Range: 850-3900 cells/uL
ABSOLUTE MONOCYTES 673 Reference Range: 200-950 cells/uL
ABSOLUTE EOSINOPHILS 68 Reference Range: 15-500 cells/uL
ABSOLUTE BASOPHILS 27 Reference Range: 0-200 cells/uL
NEUTROPHILS 66.8 %
LYMPHOCYTES 21.9 %
MONOCYTES 9.9 %
EOSINOPHILS 1.0 %
BASOPHILS 0.4 %

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 97 Reference Range: 65-99 mg/dL
UREA NITROGEN (BUN) 18 Reference Range: 7-25 mg/dL
CREATININE 1.11 Reference Range: 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 82 Reference Range: > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 95 Reference Range: > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE Reference Range: 6-22 (calc)
SODIUM 138 Reference Range: 135-146 mmol/L
POTASSIUM 4.5 Reference Range: 3.5-5.3 mmol/L
CHLORIDE 103 Reference Range: 98-110 mmol/L
CARBON DIOXIDE 28 Reference Range: 20-32 mmol/L
CALCIUM 10.2 Reference Range: 8.6-10.3 mg/dL
PROTEIN, TOTAL 8.0 Reference Range: 6.1-8.1 g/dL
ALBUMIN 5.1 Reference Range: 3.6-5.1 g/dL
GLOBULIN 2.9 Reference Range: 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.8 Reference Range: 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.9 Reference Range: 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 41 Reference Range: 36-130 U/L
AST 23 Reference Range: 10-40 U/L
ALT 40 Reference Range: 9-46 U/L

PREGNENOLONE, LC/MS 63 Reference Range: 22-237 ng/dL
SEX HORMONE BINDING GLOBULIN 18 Reference Range: 10-50 nmol/L
HEMOGLOBIN A1c 5.5 Reference Range: <5.7 % of total Hgb
VITAMIN D,25-OH,TOTAL,IA 41 Reference Range: 30-100 ng/mL
TSH 1.09 Reference Range: 0.40-4.50 mIU/L
VITAMIN B12 575 Reference Range: 200-1100 pg/mL
PSA, TOTAL 0.28 Reference Range: < OR = 4.00 ng/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 49 H Reference Range: < OR = 29 pg/mL See Note 1
DHEA SULFATE 590 H Reference Range: 70-495 mcg/dL
TESTOSTERONE, TOTAL, MS 921 Reference Range: 250-1100 ng/dL
TESTOSTERONE, FREE 218.3 H Reference Range: 35.0-155.0 pg/mL

 

[TRTinNY]

Hey guys...

Happy 2022!

Hoping to maybe get some more help or direction. Actually have a call scheduled with Dr. Saya who i see from time to time but was hoping maybe people can provide a direction for a conversation with him or suggestions for me.

I am relatively healthy at 41. I was tested for sleep apnea and i am negative. I am not a diabetic. i do smoke cigarettes (half a pack a day or so). I drink socially. I dont do drugs other than a rare occasion.

My RBC gets up into the mid 50s and then i donate blood every few months. My ferritin is always low but i was told that shouldnt be a cause of issue with ED.

I cannot get an erection without physical stimulation nor can I keep one without physical stimulation. Even getting a blow job unless it is rough, I will go soft. Sex and hands are the only thing that seems to work. I can get full erections. They just dont stay even with mental stimulation, watching porn etc.

The day after my blood test, i realized i was having a problem reaching orgasm with my girlfriend and my nipples were sensitive so i took .07 anastrazole which i rarely take. The next day it wasnt until the afternoon that I felt i was ready to go again and things seemed better but with a weaker erection.

I take 10mg of Cialis daily. I take 300mg of Wellbutrin XR. I take 5mg Crestor. I take 145mg of Fenofibrate. Both Crestor and Fenofibrate are due to family history. I take a daily Prilosec otherwise i end up with heartburn.

I also take 25mg DHEA, 30mg Pregnenalone, 125mcg D3, and 300mg CoQ10 all daily in the morning.

I am on Aimovig once a month and Botox every 3 months for migraines.

I inject daily. I have tried low dose testosterone at .09 daily which i didnt feel good and currently at .15 and dont feel much better but at least erections seem to be a bit better.

I just hate that i want to have sex all the time and i physically cant perform how i want to. I am way too young for this and havent found the magic bullet. Been dealing with this for about 5 or 6 years.

My most recent labs:

IRON, TOTAL 121 Reference Range: 50-180 mcg/dL
IRON BINDING CAPACITY 434 H Reference Range: 250-425 mcg/dL (calc)
% SATURATION 28 Reference Range: 20-48 % (calc)
FERRITIN 20 L Reference Range: 38-380 ng/mL

CHOLESTEROL, TOTAL 197 Reference Range: <200 mg/dL
HDL CHOLESTEROL 44 Reference Range: > OR = 40 mg/dL
TRIGLYCERIDES 131 Reference Range: <150 mg/dL
LDL-CHOLESTEROL 103 mg/dL (calc) Reference range: <100

WHITE BLOOD CELL COUNT 6.8 Reference Range: 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 6.80 H Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 17.9 H Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 54.7 H Reference Range: 38.5-50.0 %
MCV 80.4 Reference Range: 80.0-100.0 fL
MCH 26.3 L Reference Range: 27.0-33.0 pg
MCHC 32.7 Reference Range: 32.0-36.0 g/dL
RDW 14.1 Reference Range: 11.0-15.0 %
PLATELET COUNT 218 Reference Range: 140-400 Thousand/uL
MPV 11.9 Reference Range: 7.5-12.5 fL
ABSOLUTE NEUTROPHILS 4542 Reference Range: 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1489 Reference Range: 850-3900 cells/uL
ABSOLUTE MONOCYTES 673 Reference Range: 200-950 cells/uL
ABSOLUTE EOSINOPHILS 68 Reference Range: 15-500 cells/uL
ABSOLUTE BASOPHILS 27 Reference Range: 0-200 cells/uL
NEUTROPHILS 66.8 %
LYMPHOCYTES 21.9 %
MONOCYTES 9.9 %
EOSINOPHILS 1.0 %
BASOPHILS 0.4 %

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 97 Reference Range: 65-99 mg/dL
UREA NITROGEN (BUN) 18 Reference Range: 7-25 mg/dL
CREATININE 1.11 Reference Range: 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 82 Reference Range: > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 95 Reference Range: > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE Reference Range: 6-22 (calc)
SODIUM 138 Reference Range: 135-146 mmol/L
POTASSIUM 4.5 Reference Range: 3.5-5.3 mmol/L
CHLORIDE 103 Reference Range: 98-110 mmol/L
CARBON DIOXIDE 28 Reference Range: 20-32 mmol/L
CALCIUM 10.2 Reference Range: 8.6-10.3 mg/dL
PROTEIN, TOTAL 8.0 Reference Range: 6.1-8.1 g/dL
ALBUMIN 5.1 Reference Range: 3.6-5.1 g/dL
GLOBULIN 2.9 Reference Range: 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.8 Reference Range: 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.9 Reference Range: 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 41 Reference Range: 36-130 U/L
AST 23 Reference Range: 10-40 U/L
ALT 40 Reference Range: 9-46 U/L

PREGNENOLONE, LC/MS 63 Reference Range: 22-237 ng/dL
SEX HORMONE BINDING GLOBULIN 18 Reference Range: 10-50 nmol/L
HEMOGLOBIN A1c 5.5 Reference Range: <5.7 % of total Hgb
VITAMIN D,25-OH,TOTAL,IA 41 Reference Range: 30-100 ng/mL
TSH 1.09 Reference Range: 0.40-4.50 mIU/L
VITAMIN B12 575 Reference Range: 200-1100 pg/mL
PSA, TOTAL 0.28 Reference Range: < OR = 4.00 ng/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 49 H Reference Range: < OR = 29 pg/mL See Note 1
DHEA SULFATE 590 H Reference Range: 70-495 mcg/dL
TESTOSTERONE, TOTAL, MS 921 Reference Range: 250-1100 ng/dL
TESTOSTERONE, FREE 218.3 H Reference Range: 35.0-155.0 pg/mL

Also... Almost every blood work I've had low prolactin. Didn't test this time.

 

[DixieWrecked]

Did you have these same issues prior to trt?

You described me on TRT. I require physical stimulation. It's like the mental part of arousal is missing. Before trt, I would definitely have an erection from watching porn or engaging with a girl. Now I NEED a blowjob to get ready for sex. I won't have a hard on from just kissing.

Your blood work looks good to me. Perhaps pregnenolone is low. Possibly estrogen too high. Free T too high. A few things you could tinker with at least but nothing is jumping out as outrageous

 

[TRTinNY]

Did you have these same issues prior to trt?

You described me on TRT. I require physical stimulation. It's like the mental part of arousal is missing. Before trt, I would definitely have an erection from watching porn or engaging with a girl. Now I NEED a blowjob to get ready for sex. I won't have a hard on from just kissing.

Your blood work looks good to me. Perhaps pregnenolone is low. Possibly estrogen too high. Free T too high. A few things you could tinker with at least but nothing is jumping out as outrageous

I had these problems before trt which is why I started in the first place. Literally consumes me at times. I wish I could stay hard and just enjoy a nice soft blow job. Needs to be a decent amount of pressure or it doesn't keep. No known cardiac issues either.

 

[DixieWrecked]

I had these problems before trt which is why I started in the first place. Literally consumes me at times. I wish I could stay hard and just enjoy a nice soft blow job. Needs to be a decent amount of pressure or it doesn't keep. No known cardiac issues either.

I know how you feel man. I hate how is always in the back of my mind.

 

[TRTinNY]

I know how you feel man. I hate how is always in the back of my mind.

Even Viagra doesn't do the trick. Sometimes it does but just as many I feel like it does nothing. Taken on empty stomach.

 

[Systemlord]

Smokers are at a higher risk for developing ED. The smoking can cause alterations in MCH and MCHC decreasing the ability to carry oxygen throughout the body.

Effect of Cigarette Smoking on Haematological Parameters in Healthy Population - PMC

Tobacco cigarette smoking is one of the major leading causes of death throughout the world. Smoking has both acute and chronic effect on haematological parameters. The aim of the present study was to assess the extent of adverse effects of cigarette ...

www.ncbi.nlm.nih.gov

 

[TRTinNY]

Idk

Smokers are at a higher risk for developing ED. The smoking can cause alterations in MCH and MCHC decreasing the ability to carry oxygen throughout the body.

Effect of Cigarette Smoking on Haematological Parameters in Healthy Population - PMC

Tobacco cigarette smoking is one of the major leading causes of death throughout the world. Smoking has both acute and chronic effect on haematological parameters. The aim of the present study was to assess the extent of adverse effects of cigarette ...

www.ncbi.nlm.nih.gov

I'm aware but I guess the question is would it be so bad at 41 that Cialis and Viagra together sometimes don't work?

 

[Systemlord]

I'm aware but I guess the question is would it be so bad at 41 that Cialis and Viagra together sometimes don't work?

Well your MCH is low and its not the low ferritin causing it, iron is normal. There's not much else that can be.

Everyone has a tolerance to alcohol, caffeine, and cigarette smoking. If I so much as take a shot of whiskey, I'm undone. A cup of coffee and I'm shaking like crazy 5 hours later.

Cigarette smoking destroys your DNA, causes ED and you're trying to fix it by taking Viagra and Cialis.

You must know that smoking is not healthy for you, so why don't you quit?

 

[TRTinNY]

Well your MCH is low and its not the low ferritin causing it, iron is normal. There's not much else that can be.

Everyone has a tolerance to alcohol, caffeine, and cigarette smoking. If I so much as take a shot of whiskey, I'm undone. A cup of coffee and I'm shaking like crazy 5 hours later.

Cigarette smoking destroys your DNA, causes ED and you're trying to fix it by taking Viagra and Cialis.

You must know that smoking is not healthy for you, so why don't you quit?

Because I'm an asshole and I quit for 6 months and nothing was better so I didn't attribute this to smoking.

 

[sammmy]

This is probably off topic but your lymphocyte count and % are close to the low end of normal. In my case this typically involves some kind of immune system activity and I usually feel sick.

 

[Nelson Vergel]

I take 10mg of Cialis daily. I take 300mg of Wellbutrin XR. I take 5mg Crestor. I take 145mg of Fenofibrate. Both Crestor and Fenofibrate are due to family history. I take a daily Prilosec otherwise i end up with heartburn.

What is your height and weight? Blood pressure?

How many times do you ejaculate per week?

How many times do you watch porn per week?

What do you mean that you can only get an erection with manual stimulation? Does this mean that you are wanting erections without manual stimulation?

Lipid lowering agents may have some ED associated issues.

Please, honest answers.

 

[TRTinNY]

What is your height and weight? Blood pressure?

How many times do you ejaculate per week?

How many times do you watch porn per week?

What do you mean that you can only get an erection with manual stimulation? Does this mean that you are wanting erections without manual stimulation?

Lipid lowering agents may have some ED associated issues.

Please, honest answers.

i am 6'2 228 Blood Pressure slightly elevated...like 140/90

Many times per week

on and off....sometimes 5 times a day and just as many days not at all. But i have erection issues watching porn too sometimes.

I cannot watch porn and get just mentally get myself hard. I usually dont get hard without manually stimulating myself and even that takes time.

 

[Nelson Vergel]

@TRTinNY

I think you are relatively in the upper quadrant of sexual performance, porn exposure and orgasmic frequency.

There is not much I can do to add any new "solutions" to your issue. Most of us would be lucky to have the number of orgasms you have.

I would try to decrease your porn consumption and even number of orgasms to be able to have "mental erections".

 

[TRTinNY]

I can't achieve an orgasm but have very little erection quality nor can I maintain

 

[sammmy]

Since you had the problem before TRT and it didn't improve with TRT, it doesn't seem related to testosterone.

Trouble with erection and orgasm point towards neurotransmitter issues or nervous system damage.

I would drop all the supplements/drugs that are not proven to give you benefit and see how it goes without them. When you take so many unnecessary compounds, it is extremely hard to pinpoint what benefits or side effects you have from them. Taking the smallest possible numbeer of supplements is always better.

I would drop:
* DHEA, Welbutrin, Pregnanolone (no clear or proven benefits of those)
* the 300mg CoQ10 (I have problems with orgasm too and every time I take a concentrated antioxidant in a huge dose, it gets worse. Orgasm, like most bodily processes needs oxidation to work. We can't exist "anti oxidized" to extreme.)
* Aimovig (a new drug acting on the nervous system with unknown side effects and low effectiveness for migranes, read that: Aimovig vs Salt for migranes)
* If your natural cholesterol levels are NOT high, do NOT take cholesterol drugs. They interfere with the whole body metabolism and do come with side effects.

 

[equel]

same here, mental arousal missing, was fine before TRT. Comes back in deca only but not on test

 

[Gman86]

same here, mental arousal missing, was fine before TRT. Comes back in deca only but not on test

That’s so interesting that it comes back on deca only. What dose of deca only did it return with? How was erectile function on deca only?

Have u tried deca and test together?

 

[equel]

300 and 600mg. Erections extremely powerful, iron rod.

Tried it with test, did not work at all, lol!

 

[Gman86]

300 and 600mg. Erections extremely powerful, iron rod.

Tried it with test, did not work at all, lol!

And libido was high on deca solo as well?

Any theories on why sexual function was better on deca solo than on test solo?