Ongoing lack of libido, ED and PE despite T shots

[Janosch]

I continue having ongoing issues with lack of libido, ED and PE despite having been on Testosterone since February 2018. I have been injecting 75g twice a week and am taking 0.25mg of Anastrozole twice a week. I am 6'6" and 285lb. I would sure welcome any suggestions!

My labs (drawn 24 hrs prior to next injection) are as follows:

Total Testosterone 892.0 193-740
Free Testosterone 23.67 4.7-24.4
DIOH Testosterone 530.9 106-719
SHGB 24.18 10-80

Estradiol (Ultra) 23 10-42
Total Estrogens 46.4 19-69
Estrone 23.4 9-36

TSH 2.01 0.27-4.2
Free T4 1.50 0.71-1.7
Free T3 3.71 2.5-4.3
Reverse T To follow
Peroxidase IgG <3 <5.61
Thyroglobolin IgG <3 <4.11

DHEA 191.2 44.3-331
Progesterone 0.308 < 0.2
Prolactin 12.69 4.04-15.2

Iron 84.52 37-160
Ferritin 182.3 30-400
TIBC 403 245-400
UIBC 318
Transferrin 287.61 180-329

 

[Nashtide]

The TRT labs look pretty good. I'm not well versed enough to comment on the thyroid labs. How old are you and did you have ED and libido issues prior to TRT. Are you taking any other meds?

 

[MarkM]

Just from a numbers standpoint your labs look good although not quite at trough since labs were taken 24 hours prior to next injection. Would like to see the RT3 but the rest of thyroid looks okay and iron/ferritin levels are good so I am going to go out on a limb and say your RT3 is probably fine.

Your E2 is below mid range so not high by any means but not terribly low. Your SHBG and E2 are pretty close to each other which some say is good. I'm still trying to understand that correlation. Low E2 can cause libido issues and ED. You are taking a small dose of anastrozole which is pretty powerful stuff. Your body might be one that needs a little more E2. Do you know what your E2 was prior to TRT? Did you have libido and ED issues prior to TRT? Other medications?

If no medications are interfering and your libido and erection quality were good prior to TRT then I think I would drop the anastrozole altogether for a month and see how you feel. You can always restart it again if needed.

 

[Vince]

The only thing I could think of is cutting your AI in half .125 or stop it all together. Maybe if you had higher estradiol levels you would feel better.

 

[Janosch]

The TRT labs look pretty good. I'm not well versed enough to comment on the thyroid labs. How old are you and did you have ED and libido issues prior to TRT. Are you taking any other meds?

Nashtide, I am 52 and I am taking no other medication. Had PE issues for a long time, but no ED or lack of libido. Had a vasectomy in January 2017 and it seems that shortly thereafter I started having ED issues. I still had libido, but after I started taking testosterone shots my libido has been zero. Nothing in terms of ED, PE or libido has changed with a dose increase to testosterone an having shots twice a week from once a week.

 

[Janosch]

Just from a numbers standpoint your labs look good although not quite at trough since labs were taken 24 hours prior to next injection. Would like to see the RT3 but the rest of thyroid looks okay and iron/ferritin levels are good so I am going to go out on a limb and say your RT3 is probably fine.

Your E2 is below mid range so not high by any means but not terribly low. Your SHBG and E2 are pretty close to each other which some say is good. I'm still trying to understand that correlation. Low E2 can cause libido issues and ED. You are taking a small dose of anastrozole which is pretty powerful stuff. Your body might be one that needs a little more E2. Do you know what your E2 was prior to TRT? Did you have libido and ED issues prior to TRT? Other medications?

If no medications are interfering and your libido and erection quality were good prior to TRT then I think I would drop the anastrozole altogether for a month and see how you feel. You can always restart it again if needed.

Thanks for the feedback MarkM. I assume that if I had done the labs 24 hours later the overall T values would have been slightly lower, but still in very acceptable range?! Unfortunately I have to drive to a different city to draw labs. Unfortunately I don't have a pre T shot baseline on E2. I totally get the research of high and low E2 and how important it is to keep it in range. Perhaps I need a little more E2, so I might just take 0.25 mg once a week instead of twice or cut it out altogether and see how E2 looks in 6-8 weeks. Weird thing is though that libido did not disappear until I started T shots. At the time I did not take Anastrozole. Perhaps after I started giving T shots I began to convert T into E2 and I actually need even lower E2?! I don't know. No other medications. Libido and erections were good prior to starting T shots, but PE issues existed for long time.

 

[Janosch]

The only thing I could think of is cutting your AI in half .125 or stop it all together. Maybe if you had higher estradiol levels you would feel better.

Thanks Vince. Yes, perhaps. Like I had said to MarkM, I wonder if E2 was fine prior to T shots, but once I started those my body converted T to E2 and the increase in E2 zapped me of my libido and caused ED?! The only other correlation I could think of is that just prior to starting T shots I had a vasectomy, but I found no causal factors of vasectomy and ED, PE or libido...

 

[MarkM]

Well, you have a point........it is possible that you need to lower your E2. I tend to think that maybe it needs to come up some but everyone is different. If you attempt to lower your E2 more, be careful that you do not crash the E2 because that can be real uncomfortable. It is easy to bring E2 down if it gets high verse try to bring up E2 that gets too low.

You know what your doing at the moment isn't doing it for you so experiment a little bit. That is the only way you are going to change is if you change something. Best to change one thing at a time.

My readings/research point to normal and higher levels (to a point) of E2 support libido and erection quality and that low E2 adversely effects them. You can try both; stop the anastrozole and see how you feel and if not better, start it back up with a slight increase in anastrozole. I'm not sure you need to test each time, go by how you feel. How you feel is a better indicator than what a number says. Once you find a good spot where you libido has returned, test then so you know what that sweet spot number is.

Anastrozole has a half life of 48 to 50 hours so if you stop taking it, it will be out of your system in 10 days. Likewise, if you start taking it again, it will take 10 days to reach a steady state.

Please keep us posted on what, if any, you decide to do and how it is working for you.

Best wishes

 

[Janosch]

Well, you have a point........it is possible that you need to lower your E2. I tend to think that maybe it needs to come up some but everyone is different. If you attempt to lower your E2 more, be careful that you do not crash the E2 because that can be real uncomfortable. It is easy to bring E2 down if it gets high verse try to bring up E2 that gets too low.

You know what your doing at the moment isn't doing it for you so experiment a little bit. That is the only way you are going to change is if you change something. Best to change one thing at a time.

My readings/research point to normal and higher levels (to a point) of E2 support libido and erection quality and that low E2 adversely effects them. You can try both; stop the anastrozole and see how you feel and if not better, start it back up with a slight increase in anastrozole. I'm not sure you need to test each time, go by how you feel. How you feel is a better indicator than what a number says. Once you find a good spot where you libido has returned, test then so you know what that sweet spot number is.

Anastrozole has a half life of 48 to 50 hours so if you stop taking it, it will be out of your system in 10 days. Likewise, if you start taking it again, it will take 10 days to reach a steady state.

Please keep us posted on what, if any, you decide to do and how it is working for you.

Best wishes

Thanks again for the feedback and I think Ill cut dose of AI in half for two weeks and see how I feel. I might cut AI altogether afterwards and see.

 

[MarkM]

Thanks again for the feedback and I think Ill cut dose of AI in half for two weeks and see how I feel. I might cut AI altogether afterwards and see.

Good luck!

 

[Nashtide]

IMHO, I would start by cutting the AI in half while still taking it twice weekly. Are you taking HCG? If not, you may want to consider adding some. Let's take each problem separately. If your libido tanked right after starting TRT, then obviously it's related to something in your protocol. Most likely an E2 issue. So I would cut the dose of your AI as mentioned above. As far as ED goes I think it's the same problem and solution. Now, PE is interesting. I have not heard about TRT helping PE. I had what I would consider moderate PE for years. Not every time, but enough that it was a problem. I know this is going to sound ridiculous, but I tried a suggestion to use VERY vivid imagery where I imagined a sexual encounter in great detail which ended when I was ready. I literally haven't had an episode of PE since and that was 15 or so years ago.

 

[Janosch]

IMHO, I would start by cutting the AI in half while still taking it twice weekly. Are you taking HCG? If not, you may want to consider adding some. Let's take each problem separately. If your libido tanked right after starting TRT, then obviously it's related to something in your protocol. Most likely an E2 issue. So I would cut the dose of your AI as mentioned above. As far as ED goes I think it's the same problem and solution. Now, PE is interesting. I have not heard about TRT helping PE. I had what I would consider moderate PE for years. Not every time, but enough that it was a problem. I know this is going to sound ridiculous, but I tried a suggestion to use VERY vivid imagery where I imagined a sexual encounter in great detail which ended when I was ready. I literally haven't had an episode of PE since and that was 15 or so years ago.

Thanks for your reply! I only saw it just now. My Estradiol (LC/MS/MS) came out to be 23.0 pg/ml. That was while taking 0.25 mg twice a week. I have dropped the Anastrozole and will see if it will do anything. What might HCG do in men who are taking TRT? Is it supposed to increase testosterone production? My levels already seem to be pretty good (Total T=892; Free T=23.67). I'll give your PE suggestions some thought.

 

[Nelson Vergel]

Janosch

I think you will find THIS THREAD useful

 

[Janosch]

Janosch

I think you will find THIS THREAD useful

Thanks Nelson!

 

[Nelson Vergel]

You may need a jump start. Let go of the anastrozole for 2 weeks. If that does not work, add citrulline, HCG 500 IU twice per week and low dose (5 or 10 mg per day) Cialis for a month. Then decide if you want to stop Cialis, then HCG if you want. I believe that once one gets increased libido and erections, self confidence and some sort of "reset" happens in younger men with no medical conditions or taking other medications besides TRT.

 

[Janosch]

You may need a jump start. Let go of the anastrozole for 2 weeks. If that does not work, add citrulline, HCG 500 IU twice per week and low dose (5 or 10 mg per day) Cialis for a month. Then decide if you want to stop Cialis, then HCG if you want. I believe that once one gets increased libido and erections, self confidence and some sort of "reset" happens in younger men with no medical conditions or taking other medications besides TRT.

Thank you very much for taking the time to let me know about the information. I have since reviewed a few of your videos on the topic and articles and contacted my PCP to request a trial. He is a direct care physician and pretty open to learning, which is cool. It's almost been two weeks since I stopped the E2 blocker; without any changes. I have gotten myself pretty deep into the research of all of the possible factors that might contribute to ED issues, but although working in the health field, there is a limit to my understanding about pathophysiology. And it is getting old man!