Started trt and now have ed.

[Diablo666]

Hi All,

New to forum. I started on TRT around 6 months ago. Started on 200mg every 2 weeks, but recently changed to 100mg weekly as per my doctors advice to avoid roller coaster effects.

Initially I noticed a GREAT improvement on my libido, energy, mental state, etc. but since a few weeks, for some reason, I noticed I started to have ED episodes with my wife, even when I had a high sex drive. Sometimes I could get a great erection, and 2-3 min after intercourse, then the ED starts, and then after that I lose my horniness. (like if I had ejaculated, but can assure that was not the case).

I told my endo, and he ordered tests. My readings were after 3 days of my shot:

850 Total T
256 Free T
19 SHBG

I have asked him to test my Estradiol, but he does not think that is neccesary (he did not prescribed arimidex or anything like that, just the Testosterone). I am not obese, but I am slightly overweight and have a little bit extra fat in my abdomen.

What could be happening here? Help? My suspicion is that I may have gotten high E2, but what else it could be? I am 31 years old and have secondary hypogonadism.

Appreciatte all the insights.

 

[ERO]

Your doctor is doing you no favors if he doesn't believe in the sensitive E2 test. Get your own at http://www.discountedlabs.com

 

[Vince]

It could be your estradiol levels or something else. If you post all your labs it my be easier for us to reply.

Why All Men Should be Tested with the Sensitive Estradiol Test

https://www.excelmale.com/forum/sho...d-be-Tested-with-the-Sensitive-Estradiol-Test

 

[Pacman]

Hi All,

New to forum. I started on TRT around 6 months ago. Started on 200mg every 2 weeks, but recently changed to 100mg weekly as per my doctors advice to avoid roller coaster effects.

Initially I noticed a GREAT improvement on my libido, energy, mental state, etc. but since a few weeks, for some reason, I noticed I started to have ED episodes with my wife, even when I had a high sex drive. Sometimes I could get a great erection, and 2-3 min after intercourse, then the ED starts, and then after that I lose my horniness. (like if I had ejaculated, but can assure that was not the case).

I told my endo, and he ordered tests. My readings were after 3 days of my shot:

850 Total T
256 Free T
19 SHBG

I have asked him to test my Estradiol, but he does not think that is neccesary (he did not prescribed arimidex or anything like that, just the Testosterone). I am not obese, but I am slightly overweight and have a little bit extra fat in my abdomen.

What could be happening here? Help? My suspicion is that I may have gotten high E2, but what else it could be? I am 31 years old and have secondary hypogonadism.

Appreciatte all the insights.

That's completely ridiculous that your doctor believes that testing estradiol level is unnecessary. I don't know if elevated estradiol levels is the culprit of your decreased sex drive/function, but of course you should get that tested!!! Get it checked regardless. Better to be safe than sorry, and you need a good general picture of the T vs. E ratios (you can "get away" with elevated E levels as long as your T levels are by ratio pretty high too).

I have gone through something similar to you, and it's totally frustrating.

I can tell you from the T aspect, shorter acting esters make you more horny more often than the longer ones, due to the rapid conversion to DHT. If you are on 100 mg/weekly, I imagine you are injecting either cypionate or enanthate, those are longer esters. Propionate and especially the topicals are really good for immediate DHT conversion.


There are obviously more aspects, but that's just my two cents.

Honestly, it does not sound like your doctor specializes in men's health. It might be worthwhile for you to look into a private clinic, such as Defy Medical that a lot of forum members here are a part of and are happy with. TRT is basically for life, so it may be a good idea to do it with a doctor/clinic that will work with your needs without deeming one blood test or another "unnecessary".

 

[Diablo666]

Thanks for all who have provided advice here. I really appreciate it.

I will follow your advice and test on my own. Any suggestions on which specific blood tests do I need? Is it just a standard estrogens test or specifically Estradiol? Thanks!

 

[ERO]

Thanks for all who have provided advice here. I really appreciate it.

I will follow your advice and test on my own. Any suggestions on which specific blood tests do I need? Is it just a standard estrogens test or specifically Estradiol? Thanks!

Sensitive E2 Test

 

[Dr Justin Saya MD]

In addition to the above salient points, lack of HCG inclusion and resultant testicular dormancy is another common cause at your stage of treatment.

 

[AbsoluteZ3R0]

I can tell you from the T aspect, shorter acting esters make you more horny more often than the longer ones, due to the rapid conversion to DHT. If you are on 100 mg/weekly, I imagine you are injecting either cypionate or enanthate, those are longer esters. Propionate and especially the topicals are really good for immediate DHT conversion.

I knew about the gels, but can you link me some information regarding propionate converting more readily to DHT? I have never heard this before.

 

[Diablo666]

In addition to the above salient points, lack of HCG inclusion and resultant testicular dormancy is another common cause at your stage of treatment.

Hi, I think based on the consensus on this forum and other similar forums. HCG and AI are other key elements in a good testosterone treatment, so just curious, anyone knows why the medical community and standard procedures are so behind (I assume this is well known for years already). For example, I was reading Merck Manuals and it does not even mention AI.. and the only reason they give for HCG is for infertility treatment.

So all in all, I agree 100% with the consensus, it makes sense, but just curious why the doctors or whoever write those manuals are so out of date.

 

[get2dichoppa]

In addition to the above salient points, lack of HCG inclusion and resultant testicular dormancy is another common cause at your stage of treatment.

Can you elaborate on this Doctor? My doctor is not willing to prescribe HCG, in fact he claims that if I do take it with my Test Cyp my body will build a tolerance to it and if I need to come off TRT for fertility in the future the HCG mono will not work bc my body is de-sensitized to it. Any truth to that?

 

[AbsoluteZ3R0]

Can you elaborate on this Doctor? My doctor is not willing to prescribe HCG, in fact he claims that if I do take it with my Test Cyp my body will build a tolerance to it and if I need to come off TRT for fertility in the future the HCG mono will not work bc my body is de-sensitized to it. Any truth to that?

In case Dr Saya doesn't get around to replying to you, high-dose HCG usage will desensitize the Leydig cells over time, but most trt patients don't take large enough doses for this to occur. HCG is an analog to LH (luteinizing hormone), which is one of the primary hormones released by your pituitary gland to stimulate testosterone production in the testicles. However, luteinizing hormone's purpose isn't only to stimulate testosterone production. There are actually LH receptors all throughout your body, including the penile tissue. This means that testosterone supplementation alone is usually not enough to experience full sexual benefits or improvements in well-being. Some men don't respond to HCG, but most feel better on it for this reason. HCG also helps fulfill other pathways not directly related to sex hormones that play a role in your body's hormonal function, and ultimately how you feel. Since testosterone supplementation shuts down natural LH production, HCG is introduced not only to maintain fertility, but to fulfill these now defunct pathways. If your doctor won't prescribe you HCG, there are ways to attain it online, and I also believe that Defy Medical offers HCG to patients receiving trt from other doctors who refuse to prescribe HCG. That said, you should also follow the advice of the other members and get your estradiol checked.

 

[Dr Justin Saya MD]

Can you elaborate on this Doctor? My doctor is not willing to prescribe HCG, in fact he claims that if I do take it with my Test Cyp my body will build a tolerance to it and if I need to come off TRT for fertility in the future the HCG mono will not work bc my body is de-sensitized to it. Any truth to that?

AbsoluteZ3ro did a pretty good job above elaborating. Desensitization to HCG at (relatively small) doses when used with TRT is a myth on par with the TRT-prostate cancer myth.

Besides, coming off TRT in the future wouldn't be HCG mono, but instead either clomid mono or a short course of HCG and then cloned mono (in other words, the clomid mono is the key component to a restart).

 

[CoastWatcher]

Hi, I think based on the consensus on this forum and other similar forums. HCG and AI are other key elements in a good testosterone treatment, so just curious, anyone knows why the medical community and standard procedures are so behind (I assume this is well known for years already). For example, I was reading Merck Manuals and it does not even mention AI.. and the only reason they give for HCG is for infertility treatment.

So all in all, I agree 100% with the consensus, it makes sense, but just curious why the doctors or whoever write those manuals are so out of date.

My own doctor has told me that the amount of time dedicated to androgen deficiencies in men when she was in residency and fellowship was paltry. Once in practice she wondered why, after sending her patients to big-name endocrinologists and urologists, few of her patients realized any benefits - nobody was getting better. She chose to sit down and educate herself on the way the hormone game is played. There are very few doctors who have either the time or the interest, largely because they don't realize what they don't know, to develop a knowledge base in this area. We, the men who need medical help, are the victims of this.

 

[Dr Justin Saya MD]

they don't realize what they don't know.

Very well said Coast.

Further, I always like to say physicians generally are "down on whatever they're not up on".

 

[Pacman]

Hi, I think based on the consensus on this forum and other similar forums. HCG and AI are other key elements in a good testosterone treatment

Not necessarily. For example, there is no reason to take an AI if your estrogen levels are in check. In fact, in such a case it could harm you by bringing your levels down too low if you estrogen levels are okay to begin with.

 

[CoastWatcher]

Not necessarily. For example, there is no reason to take an AI if your estrogen levels are in check. In fact, in such a case it could harm you by bringing your levels down too low if you estrogen levels are okay to begin with.

A very good point. An AI, absent symptoms and confirmed lab values indicating elevated e2, is a quick ticket to hormone hell. If anything, Excelmale has developed a reputation as being "anti-AI." That's probably an overstatement; let's say, we're very cautious when it comes to anastrozole. A good drug, often overprescribed.

Cautious is good in this aspect of androgen therapy.