Table of Contents
Hi everyone,
I've been reading here for a little over a year and I've found this site most educational. Thank you to Nelson for all the informative material on this website (I also enjoyed your book which I bought on Amazon) and for everyone else here who contributes information and shares their experience.
Background on me and my TRT journey
I'm 55 yo male, all my life I've enjoyed a high sex drive and high sexual function. My wife and I had problems conceiving children some 20+ years ago and my sperm was tested and turned out to have low quantity and very low motility so we were given the express path to IVF/ICSI. My Testosterone was tested then too and was on the low side of normal. My sexual dysfunction problems began three years ago after several months of taking an SSRI to alleviate stress of dealing with a life crisis
The SSRI crashed my libido and caused ED, but I wasn't too worried as I knew this to be temporary as I experienced similar symptoms before when I took an SSRI for several months and also when I took a Propecia for a month - but I rebounded very well both these times after I stopped taking the medication. However this time the symptoms of low libido and ED persisted after I got off the SSRI. I finally got tested and had Total Testosterone that was below the low normal range, as well as low LH & FSH, thus deducing secondary hypogonadism.
I tried both Nebido (Aveed) shots as well transdermal Testosterone but they were not able to provide me a stable level of Testosterone in the normal range. About a year ago I had a most helpful consultation with Dr. Crisler who pointed out that my low SHBG (around 17, which is the low side of normal) is causing the Testosterone to be flushed quickly out of my system. Dr. Crisler recommended me to go on bi weekly SUBQ injections of Testosterone, explaining that the slower release from the subq tissue would enable me to sustain a normal level of Testosterone. And indeed Dr. Crisler was right and when I switched to bi weekly Testosterone Enathate shots I was finally able to sustain a normal and stable level of Testosterone. Dr. Crisler also recommended taking DHEA and that indeed had a noticeable very positive effect on my libido, along with the HCG. For some reason I am still dependant on PDE5 inhibitors to overcome ED issues despite having for a year now normal Total Testosterone , managed E2 and high libido.
A couple of months ago I tried Clomid for two weeks (50mg three times a week) after a week of discontinuing the injections of T&HCG. However I had no response to the Clomid (LH remained low and my T and libido crashed) so I got off the Clomid and resumed the T&HCG therapy.
My current protocol
45mg SUBQ Testostone Enathate twice a week
500IU SUBQ HCG three times a week
0.25mg Anastrazole twice a week
50mg DHEA twice a day
With the above protocol I am able to sustain a level of Total Testosterone of 600-650 ng/dL. When I increased the above dosage I was able to increase my Total Testosterone levels. My E2 levels are around 50-55 pg/ml, and I prefer to keep them a little higher than the normal range since the sensitive LC/MS test is not available here and the CLlA test used here to measure E2 may erroneously elevate the results.
My Questions
1. What is the optimal level of Total Testosterone that low SHBG guys on TRT should be aiming for? It seems that most guys here on TRT aim for Total Testosterone in the upper fourth quadrant of the normal range. But If guys with low SHBG have a higher Free T, then it seems logical that we should aim for a lower range of Total Testosterone or perhaps aim for a certain range of Free Testosterone? Does anyone have any data on that? (I should note the labs of my health provider in my country only test for Free T when the total T is on the low end. Hence I need to rely on online calculators that compute Free T based on Total T, SHBG and Albumin).
2. Since I switched a year ago from transdermal T to injections I've seen an increase in my Hematocrit and Hemoglobin up to the high range of normal (Hematocrit as high as 52.5, Hemoglobin as high as 17.7). Thus I began donating blood every three months and I am reconsidering what level of Total Testosterone to aim for as mentioned in (1) above. I also wonder if there is any data on whether Exogenous Testosterone or HCG cause more polycythemia? As I am using a mix of Testosterone Enathate and HCG to generate my level of Testosterone, I can increase one at the expense of the other if one is more prone to inducing polycythemia.
3. Is there any data on how the use of SSRI may cause permanent alterations of Serotonin/Dopamine levels in the brain even after their use is discontinued? If indeed my Serotonin levels were altered and pose a problem for ED for example, is there any known and safe method to affect them with minimal side effects?
4. I am trying now daily Tadalafil at dosage of ~7mg/day and I'm experiencing some back and muscle pain. When I first began using Sildenafil l I experienced headaches but they eventually disappeared and all I feel now when I use Sildenafil is flushing in my face. Do the symptoms of back and muscle pain of Tadalafil typically disappear after persistent period of use of Tadalfil too?
