Good afternoon,
I've been on TRT for little over 3 years and have tried every protocol under the sun, without ANY success. I am now in a phase where I realize I might need professional help, so if anyone has any online doctors that they would recommend and are ok with me doing UGL, please let me know.
Regardless, if anyone has any input, please look at my labs below:
- Hemoglobin = 15.7 g/dL (normal)
- HbA1c = 4.4% (excellent)
- Glucose = 84 mg/dL (normal)
- Creatinine = 1.21 mg/dL (normal)
- Total Cholesterol = 143 mg/dL (good)
- HDL = 38 mg/dL (slightly low)
- LDL = 93 mg/dL (good)
- Triglycerides = 62 mg/dL (excellent)
- Vitamin D = 36.76 ng/mL (good)
- Estradiol = 47.4 pg/mL (high)
- Total Testosterone = 11.07 ng/mL (very high)
- Free Testosterone = 65.9 pg/mL (high)
- LH = <0.07 mUI/mL (very low/suppressed)
- FSH = 0.32 mUI/mL (very low/suppressed)
- Prolactin = 7.2 ng/mL (normal)
- SHBG = 34.5 nmol/L (normal)
- TSH = 1.79 μUI/mL (normal)
- PSA = 0.581 ng/mL (good)
This was on 120mg Test E a week split into two doses. It's important to mention that I do not feel any, and I mean any better on Test P daily, lower doses, higher doses, or even 4 month cold turkey quit, at least in regards to Libido and Erections. The only time I ever felt good was the first month of TRT (honeymoon, where I literally felt full of confidence, good EQ, etc.) Now I have no orgasms, soft erections, etc.
Thank you.
If these are your labs at true trough (lowest point) before your next injection and you are hitting a very high trough TT 1107 ng/dL with normal SHBG 34.5 nmol/L its a given that your trough FT will be high.
The only way to know where your FT truly sits would be testing it using the most accurate assay the gold standard Equilibrium Dialysis.
Otherwise you will need to use/rely on the calculated linear law-of-mass action Vermelen (cFTV) which will give a good approximation.
Seeing as you are from the Sweden chances are your FT was calculated as the gold standard ED is not widely available outside of the US.
If we calculate your FT using the Vermeulen method with a very high trough TT 1107 ng;dL, normal SHBG 34.5 nmol/L and Albumin 4.3 g/dL (default) then your trough cFTV 25.8 ng/dL would be high.
Keep in mind your peak TT and more importantly FT would be higher.
Always need to be mindful of your injection frequency/where trough FT sits.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.
Also going to be a big difference in peak--->trough on said protocol!
Many tend to overlook this and gun for a high-end/high trough FT only to end up struggling with sides especilly in the long run.
Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!
Even if you take those natty outliers in the 97.5th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot!
Not sure why you would have even considered trying higher dose as your trough FT was already high on 120 mg T/week split and driving it up further is. going to do jack s**t for libido let alone anyone suffering from ED.
As I have stated numerous times on the forum T is a threshold hormone!
Main point here being start low and go slow titrate the dose if need be until the threshold is crossed (bloodwork + symptoms).
Symptoms improved while at the same time minimizing/avoiding sides, keeping blood markers healthy and maintaining long-term health is key here.
Crossing the threshold turns the lights on but cranking the dimmer switch past that doesn't make them shine brighter. It's a ceiling effect, not a linear dose-response.
Especially when it comes to libido and erectile function.
The majority of symptoms will be improved once you achieve a healthy FT which for most would be aiming for a healthy/high-end trough 15-25 ng/dL.
Yes some will choose to run higher levels but the main benefit you are going to get here when driving up your FT sky-high is better gains in muscle/enhanced strength and recovery.
Plain and simple.
Every other symptom energy, mood, libido, erectile function let alone overall health (cardiovascular, brain, bone, tendons, immune system, lipids, and body composition) can easily be improved by achieving a healthy FT.
Even then I would put much more weight behind sleep, diet, exercise, thyroid/adrenals and stress (physical/mental) when it comes to energy, mood, libido, erectile function and overall health than supposedly needing a high/absurdly high FT.
This is a given!
Many men get caught up on T fixing any issues they have with libido or ED when both are multifactorial and complex.
Yes having healthy T levels are critical when it comes to libido but it is only one piece of the puzzle as there is much more involved here.
Eventually when you find that happy place you should have a healthy libido and normal erections if all your other health markers/lifestyle are in check!
The body was never meant to be amped up on T 24/7 steady-state!
Hammering the s**t out of your CNS and dopamine is the last thing you want to do here especially when it comes to libido.
Even then too many get caught up one that honeymoon phase when first starting therapy or tweaking their protocol (increasing dose of T).
The body will always adapt to its new set-point no matter how high you drive up your T as its a threshold hormone and there is a ceiling effect where more is not better and the increased libido and erections, euphoric type feeling will eventually wane more what we call into the norm.
You need to have realistic expectations especially when it comes to libido and erectile function.
Do not expect to maintain a stellar libido in the long-run as many other factors come into play here.
Getting caught up on that more T is better mentality is one of the biggest mistakes you can make.
Even then when tweaking a protocol whether increasing or decreasing dose the first 6 weeks mean nothing when looking at the bigger picture here.
You need to keep in mind that when first starting therapy or tweaking a protocol (doseT) it will take 4-6 weeks to reach steady-state when using esterified TC/TE and it is common for one to. experience ups/downs during the weeks leading up until blood levels have stabilized (4-6 weeks) as the body it trying to ADJUST.
Even then once blood levels have stabilized it will still take a few more months for the body to ADAPT to its new SET-POINT and this is the critical time period when one needs to gauge how they truly feel regarding relief/improvement of low-T symptoms and overall well-being.
Every protocol needs to be given a fighting chance as in 12 weeks to truly assess otherwise you will be chasing your tail endlessly!
If you never put in the time needed to truly gauge any changes made to your protocol then you are wasting your time.
Something else to keep in mind here is some men will fare better with libido when adding in hCG.
Can work wonders for some or cause grief for others.
Trial and error is the only way to see!
* Testosterone is a threshold hormone. Our bodies need a certain amount for normal functions, but beyond that, there is not necessarily any additional benefit
*The effects of testosterone on libido are incredibly mixed and complicated
Testosterone might not do as much for your libido as people think it does. Here's what this hormone does and doesn't do for your sex drive.
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As an expert on andrology and sexual dysfunctions, urologist Andrew Y. Sun, M.D., sees plenty of patients who’re struggling with low libido. And most are pretty sure they already know why: They must have low testosterone levels. Even if it turns out they don’t, “most of them still strongly believe that increasing their testosterone levels will improve their libido,” says Sun, who practices at Urology Partners of North Texas.
Sun’s...
