Ideas for Fixing Chronic ED / Poor Sensitivity?

[mjones104]

Hi guys,

I’m 30 years old living in Canada and I have been on TRT for approximately three years. The primary issue that got me started on TRT was lack of libido, bad ED (including total absence of morning wood), and a “numb” feeling / no sensitivity in the genitals.

My initial bloodwork (September 2018) only included a few tests, with the below results:

• TSH: 1.61 (0.35 – 5.00 mIU/L)
• LH: 4.3 (1.7 – 8.6 IU/L)
• FSH: 2 (2 – 12 IU/L)
• Testosterone: 8 (7.6 – 31.4 nmol/L)
• Free testosterone: 162 (196 – 699 pmol/L)
• Estradiol (standard): 77 (<159 pmol/L)
• Prolactin: 13 (<18 ug/L)

After reviewing this bloodwork the urologist I’m seeing started me on 5G taro-testosterone 1% gel. In the initial weeks my libido came back and ED went away, but this only lasted a few weeks.

I found ExcelMale and switched over to cypionate injections in the hope they would give me a long-term solution. Over the years I’ve tweaked protocols but in the last ~12-18 months feel I’ve been quite dialed in with good levels. My mood has been good, I feel I’m enjoying the benefits of TRT except for the libido and ED issues. I still get minimal / no morning wood. Even using 50-100mg of Viagra only gives me mediocre erections for sex, and the sensitivity of my genitals is almost nothing when I do use Viagra.

I’ve been injecting 90 mg/week of test cypionate, which I split into two doses of 45 mg every 3.5 days. I don’t use an AI or HCG. Below I pasted a summary table of some key metrics from bloodwork to show how my levels have been tracking for the past year. I have also posted the complete labs in case there are any markers worth reviewing more closely. Note: my doctor refuses to give me the sensitive estradiol test, so these are all standard estradiol tests unfortunately.

Two questions I have are:

1. Does it matter that my Total T generally looks in the mid-range if my free-T is high? I’ve always assumed only free-T matters for managing symptoms but maybe I’m wrong and my total T is too low?
2. Does it make sense to try HCG given my remaining symptoms? I’m not sure if this will do anything for me since I also can’t tell if I was primary or secondary based on the initial bloodwork FSH and LH.

Any help or ideas would be much appreciated gents.

 

[M.J]

I was like you until I started b12 5000mcg daily sublingual.

now sex can be daily, at least the desire for sex is daily for sure.and I wasn’t deficient in b12. I am not sure I need cialis anymore. But I am still checking this issue.

 

[madman]

Hi guys,

I’m 30 years old living in Canada and I have been on TRT for approximately three years. The primary issue that got me started on TRT was lack of libido, bad ED (including total absence of morning wood), and a “numb” feeling / no sensitivity in the genitals.

My initial bloodwork (September 2018) only included a few tests, with the below results:

• TSH: 1.61 (0.35 – 5.00 mIU/L)
• LH: 4.3 (1.7 – 8.6 IU/L)
• FSH: 2 (2 – 12 IU/L)
• Testosterone: 8 (7.6 – 31.4 nmol/L)
• Free testosterone: 162 (196 – 699 pmol/L)
• Estradiol (standard): 77 (<159 pmol/L)
• Prolactin: 13 (<18 ug/L)

After reviewing this bloodwork the urologist I’m seeing started me on 5G taro-testosterone 1% gel. In the initial weeks my libido came back and ED went away, but this only lasted a few weeks.

I found ExcelMale and switched over to cypionate injections in the hope they would give me a long-term solution. Over the years I’ve tweaked protocols but in the last ~12-18 months feel I’ve been quite dialed in with good levels. My mood has been good, I feel I’m enjoying the benefits of TRT except for the libido and ED issues. I still get minimal / no morning wood. Even using 50-100mg of Viagra only gives me mediocre erections for sex, and the sensitivity of my genitals is almost nothing when I do use Viagra.

I’ve been injecting 90 mg/week of test cypionate, which I split into two doses of 45 mg every 3.5 days. I don’t use an AI or HCG. Below I pasted a summary table of some key metrics from bloodwork to show how my levels have been tracking for the past year. I have also posted the complete labs in case there are any markers worth reviewing more closely. Note: my doctor refuses to give me the sensitive estradiol test, so these are all standard estradiol tests unfortunately.

View attachment 17026

Two questions I have are:

1. Does it matter that my Total T generally looks in the mid-range if my free-T is high? I’ve always assumed only free-T matters for managing symptoms but maybe I’m wrong and my total T is too low?
2. Does it make sense to try HCG given my remaining symptoms? I’m not sure if this will do anything for me since I also can’t tell if I was primary or secondary based on the initial bloodwork FSH and LH.

Any help or ideas would be much appreciated gents.

Welcome!

I’m 30 years old living in Canada and I have been on TRT for approximately three years. The primary issue that got me started on TRT was lack of libido, bad ED (including total absence of morning wood), and a “numb” feeling / no sensitivity in the genitals.

My initial bloodwork (September 2018) only included a few tests, with the below results:

• TSH: 1.61 (0.35 – 5.00 mIU/L)
• LH: 4.3 (1.7 – 8.6 IU/L)
• FSH: 2 (2 – 12 IU/L)
• Testosterone: 8 (7.6 – 31.4 nmol/L)
• Free testosterone: 162 (196 – 699 pmol/L)
• Estradiol (standard): 77 (<159 pmol/L)
• Prolactin: 13 (<18 ug/L)

Definitely had a horribly low TT let alone FT would be in the gutter!

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You are missing an important blood marker SHBG which will have a significant impact on TT/FT let alone can dictate what injection frequency may suit you best.

Critical to know where your SHBG sits.

Men with highish/high SHBG may fair better when injecting less frequently as in once weekly or twice weekly (every 3.5 days).

Although it is not a given and comes down to the individual as many men with highish/high SHBG inject more frequently.

The downfall of injecting higher doses of T less frequently is there will be a big difference in peak--->trough and blood levels will not be as stable throughout the week which can have a negative impact on mood/energy/libido/erectile function due to the rollercoaster ride.

Injecting a lower dose more frequently will clip the peak--->trough let alone result in achieving more stable blood levels throughout the week.

Men with lowish/low SHBG tend to do better injecting a lower dose of T more frequently as in daily or EOD.

Keep in mind that men with lowish/low SHBG can get away with running a lower TT and still achieve a healthy let alone high FT.


After reviewing this bloodwork the urologist I’m seeing started me on 5G taro-testosterone 1% gel. In the initial weeks my libido came back and ED went away, but this only lasted a few weeks.

Although transdermal can be a good starting point when jumping on trt there are men who will continue to be poor responders due to absorption issues or in many cases not using a high enough dose of T seeing as most endos/uros rely on using big pharma transdermal T and the strength/potency is much less than what can be achieved using compounded transdermal T gels/creams.

Keep in mind that absorption using standard transdermal T application whether gel/cream is anywhere from 9-14%.

A common starting dose for Androgel was 50mg T/day which would be roughly 5 mg T/day and in most cases, men would only hit a mid-normal T level at best.

Most men would need the higher end dose of 100 mg T/day which would be roughly 10 mg T/day to achieve a high-end or in some cases very high T level.


I found ExcelMale and switched over to cypionate injections in the hope they would give me a long-term solution. Over the years I’ve tweaked protocols but in the last ~12-18 months feel I’ve been quite dialed in with good levels. My mood has been good, I feel I’m enjoying the benefits of TRT except for the libido and ED issues. I still get minimal / no morning wood. Even using 50-100mg of Viagra only gives me mediocre erections for sex, and the sensitivity of my genitals is almost nothing when I do use Viagra.

Not the least bit surprised that you jumped on injections.

Keep in mind when it comes to libido let alone ED they are multifactorial and there is much more involved than just having healthy hormones (TT, FT, estradiol, DHT, prolactin).

*Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.


My reply from a previous thread regarding ED/libido:

ED has multiple etiologies including vascular, neurologic, and endocrine disorders.

Underlying vascular health is critical!

Even when using PDE5is although effective for many most men have some degree of vascular/endothelial dysfunction.

Some men are poor responders and will end up needing to use intracavernosal injections to achieve/maintain an erection.

Having healthy testosterone levels is beneficial to one's libido/erectile function but it is far from the only thing that is required to achieve such.

Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.

Unfortunately, libido/ED is much more complex than simply having healthy testosterone levels.

Even then when it comes to trt and libido many tend to get caught up in thinking that it will be through the roof once they hop on trt and get to the point of so-called dialed in let alone cure any ED issues they may have.

When you find that happy place you should have a healthy libido not raging, savage, insane.

There are many men who will see an improvement in libido, others will continue to struggle, some may even end up worse off than before trt and some of the lucky ones will see a drastic improvement.

I think too many get caught up in expecting to feel great 24/7 once on trt as if testosterone is going to cure all that ails them.

Much more going on!


I’ve been injecting 90 mg/week of test cypionate, which I split into two doses of 45 mg every 3.5 days. I don’t use an AI or HCG. Below I pasted a summary table of some key metrics from bloodwork to show how my levels have been tracking for the past year. I have also posted the complete labs in case there are any markers worth reviewing more closely. Note: my doctor refuses to give me the sensitive estradiol test, so these are all standard estradiol tests unfortunately.

Looking over your labs I can see that your blood work was done at Dynacare.

Most men on trt are using 100-200 mg T/week whether injecting once weekly, twice weekly (every 3.5 days), M/W/F, EOD, or daily.

Even then many would never need the high-end dose to achieve a healthy, high let alone absurdly high FT.

Sure some may need the higher-end dose but it is far from common.

Most can easily achieve a healthy, high let alone in some cases absurdly high trough FT injecting 100-150mg T/week when split twice weekly (every 3.5 days), M/W/F, EOD let alone daily.

You are injecting 90 mg T/week split twice weekly (45 mg T every 3.5 days) and looking over your most recent labs on such protocol (dose T/injection frequency) has your trough TT 732 ng/dL (25.4nmol/L), trough FT 725 pmol/L (just over the top-end) and estradiol 161 pmol/L (just over the top-end).

Hard to say where your FT level truly sits as it was most likely done using the calculated method.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Unfortunately, such assays are not commonly used in Canada and many use/rely upon the calculated method as there are few doctors who use/rely upon the most accurate assays (ED/UF) as most of the general labs do not offer such and it would need to be requested by your treating physician through specific laboratories.

At least Canada no longer uses the piss poor direct immunoassay which is known to be inaccurate.

Unfortunately, such assays are used/relied upon heavily in the US and the sad fact of the matter is they have numerous labs which offer the most accurate assays(ED/UF).

Even then with a trough TT 732 ng/dL your trough FT would most likely be on the high end (28 ng/dL) if you have lowish/low SHBG and if your SHBG is highish/high then it would most likely be under mid-normal (22 ng/dL) which is far from what would be considered low.

FT 5-10ng/dL is considered low.

FT 16-31 ng/dL is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may need/choose to run higher levels.

Comes down to the individual.

When it comes to estradiol testing in Canada we only had access to the standard e2 up until a few years ago.

Even then as of now it is only available through Dynacare in the province of Ontario.

Most throughout Canada are still using/relying upon the standard e2 assay.

The downfall is that it tends to overestimate especially in cases where one has underlying inflammation.

Your trough estradiol is just over the top-end and that is using the standard assay and for all, we know it may very well be lower.

Keep in mind that if labs were done at true trough then your peak TT, FT, and estradiol levels will be even higher.


Two questions I have are:

1. Does it matter that my Total T generally looks in the mid-range if my free-T is high? I’ve always assumed only free-T matters for managing symptoms but maybe I’m wrong and my total T is too low?
2. Does it make sense to try HCG given my remaining symptoms? I’m not sure if this will do anything for me since I also can’t tell if I was primary or secondary based on the initial bloodwork FSH and LH.

1. Dynacare TT reference range is 7.6-31.4 nmol/L (220-905 ng/dL) and seeing as your trough TT 732 ng/dL then it would be closer to the higher-end for that specific assay.

Again although TT is important to know FT is what truly matters.

If you have lowish/low SHBG then with a trough TT 732 ng/dL your FT would be closer to the higher-end (28 ng/dL) and if your SHBG is highish/high then it would most likely be under mid-normal (24 ng/dL) which is far from what would be considered low.

Keep in mind peak levels will be higher.

Do you have room to increase your dose slightly and bring up your trough TT/FT.....sure?


2. You would be secondary.

If anything I would look into jumping on hCG (250-500IU) 2 x/week before increasing your T dose.

Keep in mind that such a dose will not only top up your T levels but will also drive up your estradiol.

In some men, this can be beneficial, and in others not so much as they may end up struggling with sides.

Comes down to the individual.

The main purpose of adding hCG to trt is to preserve/maintain fertility and prevent/minimize testicular atrophy.

The use of exogenous testosterone results in the suppression of ITT (intra-testicular testosterone) which is critical for sperm production.

The main goal when using hCG is to restore physiological ITT levels and in order to achieve such a minimum effective dose would be needed (125-500IU) and 250-500IU would seem to be the sweet spot.

My reply from a previous thread where the poster asked if hCG was needed:

Depends on the individual.....Is hCG needed?

*To preserve/maintain fertility then yes.

*To prevent/minimize testicular atrophy then yes.

*To enhance mood/libido than it is not a given as some may experience such effects whereas others may feel worse-off.

*To maintain upstream hormones and possibly prevent long-term consequences for health/well-being.....you be the judge!

What is the best dose of HCG? Dr Saya presents two case studies.

It depends on why someone’s using it. If you’re just trying to maintain testicular function for the purposes of fertility and to prevent atrophy if you ever decided to quit TRT, you don’t seem to need that much. 250-500iu’s a week split up into at least 2 injections seems fine for that. You can...

www.excelmale.com

 

[Gman86]

I was like you until I started b12 5000mcg daily sublingual.

now sex can be daily, at least the desire for sex is daily for sure.and I wasn’t deficient in b12. I am not sure I need cialis anymore. But I am still checking this issue.

What brand are u using again?

 

[mjones104]

I was like you until I started b12 5000mcg daily sublingual.

now sex can be daily, at least the desire for sex is daily for sure.and I wasn’t deficient in b12. I am not sure I need cialis anymore. But I am still checking this issue.

Thanks MJ for your suggestion. I am going to look into this as my October 2020 blood work actually shows my B12 below the reference range. I was at 214 pmol/L and the reference range was >220 pmol/L. Not sure why the doctor never added this to my panel again after October....

 

[M.J]

What brand are u using again?

i am doing now jarrow 5000mcg daily

 

[M.J]

Thanks MJ for your suggestion. I am going to look into this as my October 2020 blood work actually shows my B12 below the reference range. I was at 214 pmol/L and the reference range was >220 pmol/L. Not sure why the doctor never added this to my panel again after October....

at least for me it worked, i was maybe around 200 went all the way up to 400 through this time i had an aamzing libido then i stopped it , libido went offline,,, after 10 days started again and libido came back again.
i am still exploring this to see if it will stay or changes as b12 go higher or maybe even get better not sure. one thing for sure b12 defiantly switched my libido ON BIG TIME. 5000mcg daily

 

[Gman86]

i am doing now jarrow 5000mcg daily

U said it’s sublingual? Do u just let it dissolve first thing upon waking?

Can u link the specific product ur using? Looks like they have a few different ones.

 

[mjones104]

at least for me it worked, i was maybe around 200 went all the way up to 400 through this time i had an aamzing libido then i stopped it , libido went offline,,, after 10 days started again and libido came back again.
i am still exploring this to see if it will stay or changes as b12 go higher or maybe even get better not sure. one thing for sure b12 defiantly switched my libido ON BIG TIME. 5000mcg daily

I had a large B12 shot on Wednesday and am beginning to experience more sensation where it was previously lacking. The shot was nice to get levels up quickly but I will also add in sublingual now. Thanks for the suggestion

 

[M.J]

U said it’s sublingual? Do u just let it dissolve first thing upon waking?

Can u link the specific product ur using? Looks like they have a few different ones.

Yes b12 typical taking by letting it dissolve, however I had one brand which u just swallow it and it did work fine also.

 

[M.J]

I had a large B12 shot on Wednesday and am beginning to experience more sensation where it was previously lacking. The shot was nice to get levels up quickly but I will also add in sublingual now. Thanks for the suggestion

Most welcome,
How strong was it ? I noticed 5000mcg works great, I tried 500 felt something but more like 5%. Not like the 5000.

 

[Swilsondc]

Most welcome,
How strong was it ? I noticed 5000mcg works great, I tried 500 felt something but more like 5%. Not like the 5000.

Do you find the B12 helps more with your libido or the quality of your erection? Or both? I’ve gotten my libido about in check by tweaking my HCG dose but for the last several years my erections havent been too good no matter what my libido is. Cialis or Viagra work just fine but of course don’t fix the cause…. Whatever that might be.

 

[Gman86]

Do you find the B12 helps more with your libido or the quality of your erection? Or both? I’ve gotten my libido about in check by tweaking my HCG dose but for the last several years my erections havent been too good no matter what my libido is. Cialis or Viagra work just fine but of course don’t fix the cause…. Whatever that might be.

What HCG dose did u find works best for u?

 

[M.J]

Do you find the B12 helps more with your libido or the quality of your erection? Or both? I’ve gotten my libido about in check by tweaking my HCG dose but for the last several years my erections havent been too good no matter what my libido is. Cialis or Viagra work just fine but of course don’t fix the cause…. Whatever that might be.

I have noticed also improvement in libido once I lowered my hcg, for b12 I am not sure yet about erection but libido for sure it did help.
I am going through a transition in my protocol and can’t say much until I get stable.
Moving from weekly 75mg to eod 20mg

 

[xcpatr922]

In my case, B12 seems helping on stamina. I use a B12 cream though. I'm feeling very very fresh during the day.

 

[Gman86]

In my case, B12 seems helping on stamina. I use a B12 cream though. I'm feeling very very fresh during the day.

What’s ur B12 dose?

 

[xcpatr922]

I used B12 super cream (vita sciences) bought at amazon. Use 3 full pump. Not clear what's the equivalent dosage but literally much better absorption (can feel it) rather than capsule or pills.

 

[ajax31]

Among many other effects, I think vitamin B12 may be acting on the hypothalamic-pituitary-adrenal (HPA) axis in some way to stimulate cortisol. Just a hunch at this point. I need to do more reading and research.

BTW, you will feel like death warmed over if your serum cortisol is too low. Cortisol isn't the bad guy.

 

[mjones104]

Most welcome,
How strong was it ? I noticed 5000mcg works great, I tried 500 felt something but more like 5%. Not like the 5000.

I am finding the 5,000 mcg daily sublingual works great also

 

[Graham]

Yes b12 typical taking by letting it dissolve, however I had one brand which u just swallow it and it did work fine also.

View attachment 17128

I took this brand about 8 years ago. I remember reading back then this version actually worked better than the injectable.