High DHT levels, erection strength, possible side effects, pregnenolone supplementation

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growing4skin

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I've been on TRT for 6 months now with varying results. My main question is about high DHT levels, erections, and any possible serious side effects.

My doctor, who is specializing in HRT for several years now, transitioned from being a surgeon to anti aging medicine. She has more experience with women than men, but is also very open minded and willing to listen and explore my own ideas about how therapy is going.

Before prescribing testosterone, she did extensive blood work, but the main hormone not tested was DHT. After 6 months of TRT I came in 200 points above the high range . I'm not worried about hair loss or BPH with the high DHT. I feel like I've read enough about it to be aware of the possible changes. I don't have any noticeable BPH symptoms.

Even though DHT is considered very good for enhancing male characteristics and behavior, can it cause weak erections or orgasms that come on suddenly with less build up than I had before? Are there any serious medical issues that can arise from high DHT? I haven't seen any listed on this forum.

From my tests, you can see my progesterone went from low normal pre TRT to very low @ 6 months. I'm considering taking a low dose sublingual pregnenolone tab (10 mg) to see if I can raise my progesterone levels and backfill the hormone pathway. Will this raise my DHT even further? Would this be of concern? I'm pretty conservative, but also experimental.

In the first few months of TRT I experienced noticeable shrinkage in my testicles and diminished sexual function. My doctor added Hcg. I think she could be more proactive about adding Hcg at the beginning.

I had 15 tests done at 6 months (two weeks ago) My thyroid is working well, but on the low end of Free T4 & Free T3. My cortisol is on the low end of normal and I'd like to see it a little higher. I have no major health concerns and a very healthy libido. But I've also experienced less firm erections and odd orgasms compared to before TRT. I get regular morning wood, and take a low 20mg dose of sildenafil to boost my confidence if I'm intimate with somebody. I am fully functional but still experience the odd orgasm while using sildenafil. I started to take the 20mg tab sublingually a month ago and the effects are awesome! It's just the boost I need without the discomfort I experience with a larger dose.

I'm going to have my first Gainswave treatment next week to see if it knocks open some of my blood vessels. I'm an RN and my doctor is going to do the treatment in exchange for my time helping with her Saturday clinics.

Any advice is greatly appreciated, including suggestions on a better area of the forum to post this question.

Here are a few of my test numbers:

Pre TRT:
Testosterone: 358 (193-740)
Free T: 8.2 ( 9-30 )
Non Sensitive E2: 28 (25-60)
DHEA-S: 297 (52-295)
Progesterone: 0.45 (0.2-1.4)

At 3 months of weekly IM shots of Test cap 200mg (no Hcg) I tested:

Testosterone: 1139 (350-890)
Sensitive E2: 27 (8-35)
Prolactin: 16.2 (4.0-15.2)

I changed to every 3rd day SQ Test cap 45mg (135 mg/week), every day SQ HCG 100 IU (700 IU/week) and had blood work 8 weeks later. I skipped my Test cyp which was due on the day before my blood work because I wanted to see my lowest T score. That was probably a mistake lab value wise. I've been feeling great for the most part on this regimen but would like to fine tune my sexual responsiveness.

Testosterone: 568 (350-890)
Free T: 108 ( 47-244)
Non Sensitive E2: 35 (10-42)
DHEA-S: 212 (70-310)
DHT: 922 (106-719)
Progesterone: < 0.10 (0.20-1.20) Is this drop adding to my sexual function issues?
Prolactin: 6.5 (2.1-17.7) Not sure if the Hcg lowered my prolactin?
 
Defy Medical TRT clinic doctor
I see a problem, your missing the most important lab value in order to design a protocol specifically for you, SHBG. It's the gold standard for sex hormone evaluation, this lab value tells you what type of protocol will work and which won't. Non-sensitive E2 test, forget it their designed for females. It can take 6-12 months for erections to fully resolve provided your E2 is right for you, you're not going to know what's right for you using the female E2 labs. There's no way to tell if E2 is low without the proper test. If E2 is low erections will suffer.

Not everyone feels good on HCG. Your T levels are mediocre.
 
Thanks for your replies Vince and Systemlord!

My PSA is low and I'll keep an eye on that.

My SHBG levels are:
Pre-TRT 43 (19-76)
Currently 36 (11-80)

I had an E2 sensitive test in Jan/18 after 3 months on TRT that was 27 (8-35). The latest round of tests were done through the hospital where I work and they had no clue what E2 sensitive was and they just did the typical E2 test. So I'll get another sensitive E2 done through DiscountLabs like the one I did in January. I'll also pull another T/Free T test at that time on a day were my trough will be more accurate. I have been wondering how lowering my weekly injected T and using the SubQ route would effect my levels so I'll just keep making slow changes and getting tested to see how it works.

Out of 15 tests done two weeks ago, the highest I'm paying out of pocket for a test is $10 (pretty darn good), with the exception of DHT, which the insurance company claims is medically unnecessary and will cost me $140 dollars. I'm getting a good idea of how to get testing done inexpensively where I can, and going to an online source like DiscountLabs when I need to.

Does anybody have suggestions about my low low progesterone labs and the idea of adding pregnenolone to the mix? I'll keep studying and being patient as I figure out my optimum TRT dosing regimen. I appreciate all the candid communication on this forum!
 
Your situation is unique, in order to keep SHBG from getting high and lowering your free T, you require moderately large doses of testosterone somewhat infrequently in order to keep good free T levels as higher SHBG will shrink free T levels. Free T is really want your body is responding to, total T is just a reservoir for free T. Your last lab result is rather low for someone who can hold onto testosterone well do to moderately higher SHBG, in your case lowering your dosage is going in the wrong direction.

You need a dosage increase, you need youthful levels in the 800-1000 ranges.
 
Beyond Testosterone Book by Nelson Vergel
I see. So you are saying that my every third day SQ injection of T can possibly cause higher production of SHBG, and that a once a week injection of T at a higher dose is better in the long run for creating a higher Free T count?

The reason I lowered my 200 mg/ 1x a week T dose was because my T level at trough was 1139 after 3 months. But we didn't measure Free T at that time. I felt uncomfortable having such a high level at my lowest point. But this is when I got onto the forums and started being more proactive to find out about how to manage my TRT. I think I'll go back to the weekly 200 mg IM shots and then measure my free T & SHBG to see where it sits. When I got onto Hcg and started reading up on it, I found Vergil's video showing how he injects Hcg & T together and thought I'd try it out.
 
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