sensitivity issue can't solve

[BadassBlues]

I use a pretty low dose of DHEA (12.5 mg/day) and think I’m more sensitive to it than most men. I occasionally take 25 mg/day for more energy, but when I do I inevitably have less sleep that night, around 6 hours when I usually hit between 7-8.

Whenever I try pregnenolone my well-being always takes a hit around 4-5 days in and I never make it past 7. That’s on 25 mg/day though, so perhaps I’d do better on 10 and/or by pushing through and letting my body adjust. But I don’t really have any issues and have done it more experimentally to see if it would provide added benefits… but again I end up stopping around the one week mark. If you start at 10 you should minimize the likelihood of that situation though.

I absolutely cannot tolerate pregnenolone, it makes me feel like I am the walking dead. Dr. C was a major proponent of taking preg, so I tried several times with the same outcome.

 

[Dexter1001]

Lower your dose and stop the blockers, as being "over-tuned" on too much testosterone often numbs sensitivity by crushing your natural estrogen and neurosteroid balance.

 

[42HRT]

Lower your dose and stop the blockers, as being "over-tuned" on too much testosterone often numbs sensitivity by crushing your natural estrogen and neurosteroid balance.

I have lowered to around 80-85mg a week as I saw that as a potential factor as well.

 

[42HRT]

Being a D2 receptor agonist, Cabergoline starts working within a few hours. We are discussing an "Off Label" usage, so the parameters used for treating Prolactinomas and Parkinsons aren't the same. Peak plasma concentrations are between 1-2 hours; you will notice the effects very quickly. The half-life is around 70 hours (which is why the twice weekly protocol). The effects do get a little better the following days after initial dosing.

So, this being the case you could potentially use this on an "as needed" basis. Take it on Thursday for a weekend getaway, do 3 weeks on and take a week off, or 2 weeks on and 2 weeks off.

There are multiple options. The thing you want to do is give your D2 receptors a break so as to maintain normal function.

I got to where I was just using it on demand. The downside to Cabergoline (and all D2 receptor agonists) is the grogginess that they cause. Caber is definitely better than the rest, but it still has similar side effects.

@BadassBlues Would selgine be a safer drug long term? I know some don't get much of a libido kick off of it. But wonder what your thoughts are?

 

[FunkOdyssey]

I would suggest DHT is the answer here, as opposed to neurosteroids or anything else. Injections produce a skewed DHT/E2 ratio in most men, shifting away from DHT and towards E2 relative to their natural baseline. Provided the absolute E2 level is not excessive, DHT becomes the single hormone most relevant to penile sensitivity in my experience.

A couple drops of 20% DHT gel on the shaft are probably all you need. If you can't source pure DHT, you can just use some cream as suggested by others, which provides a huge DHT boost when applied to the scrotum.

 

[BadassBlues]

@BadassBlues Would selgine be a safer drug long term? I know some don't get much of a libido kick off of it. But wonder what your thoughts are?

To answer that you have to understand the different mechanism of action between the two drugs. Cabergoline is a D2 receptor agonist. D2 agonists exert direct influence on the receptors and mimics the effects of dopamine. Selegeline is an MAOI (Monoamine Oxidase Inhibitor) which at low doses inhibits the MAO-B enzyme that degrades dopamine.

Cabergoline: Simulates the effects of dopamine by stimulating D2 receptors.
Selegeline: Inhibits the degradation of dopamine to keep natural dopamine levels higher.

In my experience, I have found that Selegeline is more effective for older guys as dopamine levels decrease with age. A younger person taking Selegeline may not see any benefits due to naturally higher levels of dopamine. Selegeline does not stimulate the D2 receptors directly. This is why some guys report no libido bump.

As to long term safety, Selegeline is a much safer drug. Taking a D2 agonist long term has potential consequences

Long-Term Side Effects of Cabergoline​

Cabergoline is a medication primarily used to treat high levels of prolactin. While it can be effective, long-term use may lead to several serious side effects.

Serious Side Effects​

• Heart Valve Disease: Prolonged use can increase the risk of developing heart valve issues.
• Lung Fibrosis: This condition involves scarring of lung tissue, which can lead to breathing difficulties.
• Psychiatric Symptoms: Users may experience hallucinations or compulsive behaviors, such as increased gambling urges.

Common Side Effects​

In addition to serious risks, cabergoline can cause several common side effects, including:

• Nausea
• Dizziness
• Constipation

Monitoring and Precautions​

Due to these potential side effects, it is crucial for patients on cabergoline to have regular check-ups with their healthcare provider. Monitoring may include blood tests and assessments of heart health to ensure the medication is not causing adverse effects. If any severe symptoms arise, patients should contact their doctor immediately.

 

[Cataceous]

...
So he’s at 110 mg/week total (≈55 mg 2×/week), which is a very reasonable, even conservative TRT dose. That makes the “too much testosterone → desensitization” explanation much less likely.

The OP should know that Phil and I have an ongoing divergence of opinion on this issue, covered at length in other threads. The 110 mg TC/week gives an average of 11 mg testosterone per day, which is more than all but a very small fraction of men could make naturally. It defies common sense to say that taking around double average natural testosterone production puts the average man "in a mid–upper normal physiological range", unless you are measuring at a weekly trough and ignoring what goes on the rest of the week. The dose is certainly not conservative, and it could only be considered somewhat reasonable if lower doses had been tried first without success, after being given ample time to work.

Going by forum reports, a reduction in sensitivity is a side effect of TRT, even if not a common one. The reports thus far link it to the dose size, the suppression of the HPTA and the unnatural patterns of testosterone absorption.The lucky ones see improvements with only dose reductions, as seen in the quote above. I had to address all three issues in order to resolve this problem. By the way, I have also experimented with cabergoline in the past. It gave some minor and inconsistent benefits, but basically was just increasing complexity—the original treatment causes side effects, but rather than tackling the underlying issues you treat the side effects with additional treatments that offer their own side effects. Another example is using an aromatase inhibitor to counteract symptoms of high estradiol, when the high estradiol was simply a result of too much testosterone.

Some comments by AI on how testosterone that's high compared to our normal physiology affects dopamine signaling:

Chronic supraphysiological (or "excessive-for-the-individual") testosterone levels can initially enhance dopamine signaling in reward-related brain pathways but often lead to adaptive changes that blunt or alter it over time. This provides a plausible neurobiological mechanism for the commonly reported "honeymoon period" on TRT—where men feel euphoric, motivated, energetic, and improved in mood/libido shortly after starting higher-than-natural doses—followed by a return to baseline mood/motivation or even worse symptoms.​

 

[Phil Goodman]

The OP should know that Phil and I have an ongoing divergence of opinion on this issue, covered at length in other threads. The 110 mg TC/week gives an average of 11 mg testosterone per day, which is more than all but a very small fraction of men could make naturally. It defies common sense to say that taking around double average natural testosterone production puts the average man "in a mid–upper normal physiological range", unless you are measuring at a weekly trough and ignoring what goes on the rest of the week. The dose is certainly not conservative, and it could only be considered somewhat reasonable if lower doses had been tried first without success, after being given ample time to work.

Going by forum reports, a reduction in sensitivity is not a rare side effect of TRT. The reports thus far link it to the dose size, the suppression of the HPTA and the unnatural patterns of testosterone absorption.The lucky ones see improvements with only dose reductions, as seen in the quote above. I had to address all three issues in order to resolve this problem. By the way, I have also experimented with cabergoline in the past. It gave some minor and inconsistent benefits, but basically was just increasing complexity—the original treatment causes side effects, but rather than tackling the underlying issues you treat the side effects with additional treatments that offer their own side effects. Another example is using an aromatase inhibitor to counteract symptoms of high estradiol, when the high estradiol was simply a result of too much testosterone.

Some comments by AI on how testosterone that's high compared to our normal physiology affects dopamine signaling:

Chronic supraphysiological (or "excessive-for-the-individual") testosterone levels can initially enhance dopamine signaling in reward-related brain pathways but often lead to adaptive changes that blunt or alter it over time. This provides a plausible neurobiological mechanism for the commonly reported "honeymoon period" on TRT—where men feel euphoric, motivated, energetic, and improved in mood/libido shortly after starting higher-than-natural doses—followed by a return to baseline mood/motivation or even worse symptoms.​

Right, but the people providing guidelines that suggest hitting the mid-upper range are doing so while recommending to test at trough for injections. That has been standard practice for a long time, and that is what almost all of the studies to look for risk signals as well as benefits do. So a large part of our current understanding with regard to weighing the risk/reward ratio is based on that approach. You can argue it’s outdated, but it seems disingenuous to pull out one part of the recommendation (mid-upper levels) while tossing out the other part (testing at trough).

Feel free to move the discussion to the other thread if you'd like, but I tried to avoid the other things we’ve gone round and round about and stick strictly to responding to your claim here about trough levels.

 

[Cataceous]

Right, but the people providing guidelines that suggest hitting the mid-upper range are doing so while recommending to test at trough for injections. ... You can argue it’s outdated, but it seems disingenuous to pull out one part of the recommendation (mid-upper levels) while tossing out the other part (testing at trough).

The major medical societies do not explicitly recommend trough (pre-injection, nadir) measurements for titrating weekly testosterone cypionate (or enanthate) injections to mid-normal range serum levels. The Endocrine Society is explicit in recommending the opposite (mid-interval measurements), while the American Urological Association (AUA) is more ambiguous and does not mandate a specific timing.​

Is the AI wrong about this, or are you? Followup should be in this thread.

​

 

[Phil Goodman]

The major medical societies do not explicitly recommend trough (pre-injection, nadir) measurements for titrating weekly testosterone cypionate (or enanthate) injections to mid-normal range serum levels. The Endocrine Society is explicit in recommending the opposite (mid-interval measurements), while the American Urological Association (AUA) is more ambiguous and does not mandate a specific timing.​

Is the AI wrong about this, or are you? Followup should be in this thread.

​

Agreed, that aspect of the discussion should go to that thread.


And in the hopes of not derailing future threads, maybe it would be good if you don’t hyper fixate on the dosage aspects of my posts while disregarding everything else I type. I shared what I think is probably good insight and reasoning into what may be contributing to his problems in an attempt to help. But since my post suggested that 110 is a conservative dose(which wasn’t even from me, but from Chat GPT) you hone in on that again. Meanwhile Madman can regularly tell people who haven’t even started yet that 100 mg/week split into two doses is a good starting protocol and I don’t think I’ve ever seen you refute him.

But I think we both agree, it’s going to get old if every time one of us brings up dosage it derails a thread. When you first mentioned dosage in this thread I didn’t reply to you or argue, I simply provided OP with some other things to consider. So again, I think it would be better for everyone if that could occur without threads breaking down as a result of it.

 

[FunkOdyssey]

Meanwhile Madman can regularly tell people who haven’t even started yet that 100 mg/week split into two doses is a good starting protocol and I don’t think I’ve ever seen you refute him.

This is a fair point. Why does Madman get a free pass for his supraphysiologic dosage recommendations? He'll often suggest a range of 100-150 mg weekly... 150! The scandal!

I think it's time Cataceous take him to task! Just give me a warning first so I can make popcorn.

 

[Cataceous]

...
And in the hopes of not derailing future threads, maybe it would be good if you don’t hyper fixate on the dosage aspects of my posts while disregarding everything else I type. I shared what I think is probably good insight and reasoning into what may be contributing to his problems in an attempt to help.

Right, but the first thing your post did was downplay the most common and obvious cause of the problem, instead letting AI go off into esoteric explanations, which even if correct would likely also stem from non-physiological dosing. See Occam's razor. Or did the problem just happen to coincide with TRT?

... But I think we both agree, it’s going to get old if every time one of us brings up dosage it derails a thread. When you first mentioned dosage in this thread I didn’t reply to you or argue, I simply provided OP with some other things to consider. So again, I think it would be better for everyone if that could occur without threads breaking down as a result of it.

It's somewhat intractable, because whenever someone comes along with side effects that appear to be dose-related, and the dose is non-physiological in any respect, then I am going to suggest trying physiological dosing. Meanwhile you inject the opinion that 100+ mg TC/week is just fine, discouraging the changes I believe are most likely to help.

... Why does Madman get a free pass for his supraphysiologic dosage recommendations? He'll often suggest a range of 100-150 mg weekly... 150! The scandal! ...

You might infer that we've agreed to disagree on this point, at least with respect to what starting doses should be.

 

[Phil Goodman]

Right, but the first thing your post did was downplay the most common and obvious cause of the problem, instead letting AI go off into esoteric explanations, which even if correct would likely also stem from non-physiological dosing. See Occam's razor. Or did the problem just happen to coincide with TRT?

Source that that is the most common and obvious cause of the problem? Or are you just saying that because that’s what you always say?? I swear… someone could start a thread an say “I broke my pinky toe and want to know good ways to speed up recovery”… and your first response would be “what dose are you on?”, quickly followed by “clearly you need to lower your dose”.

They weren’t “isoteric explanations”. The reasoning behind every theory was well-explained and provided OP was some things that I’d say are valuable to consider. It even gave possible explanations for what could explain the various reactions to the different attempts of resolving the issue. Meanwhile you, again, just did what you always do. It’s like the old saying… when all you have is a hammer every problem is a nail. For you every problem is “dose too high” so your hammer is “lower your dose”.

It's somewhat intractable, because whenever someone comes along with side effects that appear to be dose-related, and the dose is non-physiological in any respect, then I am going to suggest trying physiological dosing. Meanwhile you inject the opinion that 100+ mg TC/week is just fine, discouraging the changes I believe are most likely to help.

See above. Also, I didn’t try to argue with you. I simply pointed out some other things to consider that could help the poster. Sorry if that bothers you so much. And again, i see other posters make suggestions about dosing that you clearly disagree with, but for some reason every single time i do it you start the discussion back up.

You might infer that we've agreed to disagree on this point, at least with respect to what starting doses should be.

You and I have have agreed to disagree as well. But apparently that doesn’t stop you from responding to my posts every time I mention it.

 

[BadassBlues]

We can go deep into the weeds, down the rabbit hole and perhaps to the moon on the subject of TRT. Just as Devil's advocate here, I just haven't found it to be that complicated if you stick to the basics. Yes... There are outliers that need to be addressed, but for the most part if you stay to the formula, things generally work out.

Pardon my oversimplification, but the vast majority of people reading this thread do not have the knowledge base that some of us have and are just looking for answers.

1. Get a comprehensive blood panel done with total T, free T, SHBG and E2 sensitive labs. You can do more, but this will get you started.

2. If warranted, based on labs, start at the lowest dose. My personal thoughts are to start at a dose between 75mg to 100 mg a week. Choose your injection protocol (I prefer biweekly).

3. Stay on the dose and protocol for 8 weeks, no changes. Retest (include DHT total and free) and compare lab results and how you feel. If free T isn't in upper range and you are still not "feeling it", bump your dose a little (5-10 mg). Give it another 8 weeks and retest. Also, take an honest assessment of any improvements.

4. Once your Free T is in range stay on the protocol and DON'T F""K with it. If you are still not feeling well, it likely isn't a testosterone issue. Your DHT should also be at top of range, if not than take the steps to correct that. One simple step is to apply T Gel to your perineum. I have found that once guys get their DHT levels where they need to be, everything falls into place.

5. Start on HCG and never, ever stop.

It really is that simple. There are hundreds of thousands of guys on TRT who are doing just fine. The ones who aren't are the ones who are searching forums for answers.

 

[BadassBlues]

This is a fair point. Why does Madman get a free pass for his supraphysiologic dosage recommendations? He'll often suggest a range of 100-150 mg weekly... 150! The scandal!

I think it's time Cataceous take him to task! Just give me a warning first so I can make popcorn.

Having been a mod, I can tell you that there is a very active "back channel". There is a shadow board that is only accessible to the moderators. Oh... to be a fly on the wall...

 

[Phil Goodman]

We can go deep into the weeds, down the rabbit hole and perhaps to the moon on the subject of TRT. Just as Devil's advocate here, I just haven't found it to be that complicated if you stick to the basics. Yes... There are outliers that need to be addressed, but for the most part if you stay to the formula, things generally work out.

Pardon my oversimplification, but the vast majority of people reading this thread do not have the knowledge base that some of us have and are just looking for answers.

1. Get a comprehensive blood panel done with total T, free T, SHBG and E2 sensitive labs. You can do more, but this will get you started.

2. If warranted, based on labs, start at the lowest dose. My personal thoughts are to start at a dose between 75mg to 100 mg a week. Choose your injection protocol (I prefer biweekly).

3. Stay on the dose and protocol for 8 weeks, no changes. Retest (include DHT total and free) and compare lab results and how you feel. If free T isn't in upper range and you are still not "feeling it", bump your dose a little (5-10 mg). Give it another 8 weeks and retest. Also, take an honest assessment of any improvements.

4. Once your Free T is in range stay on the protocol and DON'T F""K with it. If you are still not feeling well, it likely isn't a testosterone issue. Your DHT should also be at top of range, if not than take the steps to correct that. One simple step is to apply T Gel to your perineum. I have found that once guys get their DHT levels where they need to be, everything falls into place.

5. Start on HCG and never, ever stop.

It really is that simple. There are hundreds of thousands of guys on TRT who are doing just fine. The ones who aren't are the ones who are searching forums for answers.

I think that’s a great response and approach as well. And you’re right, a lot of times we seem to major in the minors when in actuality it’s best to just stick with the core principles that have worked for hundreds of thousands-millions of men. I’ve always been interested in anatomy and physiology as well as psychology and other aspects of the mental side of the house. So I could probably deep dive into all kinds of aspects on this topic, but for most men just looking to improve their situation who couldn’t care less about how things work and just want a good protocol, I think you pretty much nailed it.

 

[Cataceous]

Source that that is the most common and obvious cause of the problem? Or are you just saying that because that’s what you always say??

Maybe you forgot one of the first lines of this thread: "So the issue I am having is that penile sensitivity went in the tank after starting TRT and i feel I tried everything."

It is a known TRT-related symptom that is rare in the general population. When you hear hoofbeats, think horses, not zebras. Is it also a coincidence that testosterone levels can influence every other item on your list?

I swear… someone could start a thread an say “I broke my pinky toe and want to know good ways to speed up recovery”… and your first response would be “what dose are you on?”, quickly followed by “clearly you need to lower your dose”.

Is there a coherent argument hiding in there somewhere? Did you also miss the fact that men have ameliorated the sensitivity issue by making adjustments to their TRT, which included dose reductions?

They weren’t “isoteric explanations”. The reasoning behind every theory was well-explained and provided OP was some things that I’d say are valuable to consider. It even gave possible explanations for what could explain the various reactions to the different attempts of resolving the issue. Meanwhile you, again, just did what you always do. It’s like the old saying… when all you have is a hammer every problem is a nail. For you every problem is “dose too high” so your hammer is “lower your dose”.

Only in your unusual worldview is it improper to question taking in way more testosterone than you could ever produce naturally. More-is-better thinking leads to giving testosterone a free pass. But if a guy develops gynecomastia are you going to ignore the estradiol level and focus on other factors?

You and I have agreed to disagree as well. But apparently that doesn’t stop you from responding to my posts every time I mention it.

It takes two to tango.

 

[Phil Goodman]

Maybe you forgot one of the first lines of this thread: "So the issue I am having is that penile sensitivity went in the tank after starting TRT and i feel I tried everything."

Ok

It is a known TRT-related symptom that is rare in the general population. When you hear hoofbeats, think horses, not zebras. Is it also a coincidence that testosterone levels can influence every other item on your list?

And trt affects a LOT more than just testosterone. I know you’d like it to be as simple as “just lower your dose”, but there are many factors at play.

Is there a coherent argument hiding in there somewhere? Did you also miss the fact that men have ameliorated the sensitivity issue by making adjustments to their TRT, which included dose reductions?

I’d say as many or more have corrected the issue by adding HCG… which would also INCREASE their testosterone. It didnt fully resolve the issue for OP, but it did improve it. And again, there are plenty of other factors. But sure, you might be right and I have no problem with OP trying it to see if it helps. But there are other things that could as well. Again, sorry if having me point out other potential causes and avenues to explore upsets you so much.

Only in your unusual worldview is it improper to question taking in way more testosterone than you could ever produce naturally. More-is-better thinking leads to giving testosterone a free pass. But if a guy develops gynecomastia are you going to ignore the estradiol level and focus on other factors?

I don’t have a problem with you questioning it. I just get tired of you constantly jumping in any time I mention it. Or maybe you could just jump in and start arguing with Madman every time he tells someone that 50 mg twice per week is a great starting point. You know… for the sake of consistency.

It takes two to tango.

I agree to disagree with you. There, now maybe you won’t feel the need to respond to me every time I mention it.

 

[42HRT]

Thanks for all the responses. I know its not an estrogen issue.
I have tried many things.
Cabergoline is helping. However, low dopamine may not be the underlying cause.
I'll probably stay on it until my next urologist appointment. I do sorta like how i feel on it. I'm less anxious. Blood pressure came down. You feel calmer. With that said. Staying on long term may not be advised. I may come off of it and try selgine. The only thing I haven't tested is DHT. I mentioned to the urolgogist on this of trying some scrotum test gel to increase dht, or even proviron. She was ok with the test gel, but couldn't prescribe proviron. It has to be either DHT or neurotransmitter related at this point. I think ive ran through everything else