Total T in Range but ED Problem

[emilix85]

Hi guys yesterday I took my blood tests 36yold male. I no longer have MW and I have ED problems. I'm not in trt and I have to evaluate what to do.
I have attached my complete results.

TT 600ng/dl
FT 25pg/ml
E2 32,7pg/ml
SHBG 37,9 nmol/l
Ferritin 110 ng/ml
Iron 68 ug/dl *
TSH 0,87 ui/ml (i use 100mcg of levotiroxine for hypothiroidism)
FT3 2,67 pg/ml
FT4 1,36 ng/dl
CORTISOL 12,11 ug/dl
Prolactin 9,5 ng/ml

I see that my iron and free t is low. My doctor says testosterone is more than fine and prescribed me iron.
Can lack of iron lower free and total testosterone levels?
Lift weights 4 times a week, 1,73cm x 75kg
Body fat 13%
Can give me some advice?

Thanks

 

[S1W]

If I'm interpreting the Free T ranges correctly, it appears that they give age specific ranges. It looks like you're towards the lower end of the range.

That said, ED can be a complex issue with physical and psychological causes.

- What is your relationship status - are you in a long-term relationship or are you dating?
- Prior to sex, are you somewhat anxious about ED or whether or not you will be able to perform?
- Do you ever have nocturnal erections during sleep?
- Have you ever injured your penis during sex?
- Have you ever experienced pain with an erection?
- Have you tried drugs like Cialis or Viagra?

 

[emilix85]

If I'm interpreting the Free T ranges correctly, it appears that they give age specific ranges. It looks like you're towards the lower end of the range.

That said, ED can be a complex issue with physical and psychological causes.

- What is your relationship status - are you in a long-term relationship or are you dating?
- Prior to sex, are you somewhat anxious about ED or whether or not you will be able to perform?
- Do you ever have nocturnal erections during sleep?
- Have you ever injured your penis during sex?
- Have you ever experienced pain with an erection?
- Have you tried drugs like Cialis or Viagra?

Yes the free T is in the lower range

- What is your relationship status - are you in a long-term relationship or are you dating?
11 years married
- Prior to sex, are you somewhat anxious about ED or whether or not you will be able to perform?
never always relaxed
- Do you ever have nocturnal erections during sleep?
until 1 year ago I had them constantly, now they are less frequent and no morning wood
- Have you ever injured your penis during sex?
no
- Have you ever experienced pain with an erection?
no
- Have you tried drugs like Cialis or Viagra?
never

 

[DixieWrecked]

Mark Bell talks about his experience with what you are going through too. Don't give up hope and keep your mind right.

 

[Systemlord]

My doctor says testosterone is more than fine

Your doctor can't know that your testosterone is fine by simply looking at a number, there is so much more to it than that. In today's world doctor's fixates on normal ranges and doesn't actually know much of anything about what constitutes a normal level for a particular person.

So many doctors get this male testosterone game wrong. You cannot just go to an ordinary doctor for male hormonal problems. You need to seek out the appropriate doctor and even then you need to be wary because some of these so called hormonal experts are in title only.

I recently had my Free T smack right in the middle of the ranges and had ED and didn't feel particularly well, I increased my dosage and now have erections every single day.

Those Free T levels are low for a 36 year old and am surprised ED is your only complaint!

 

[emilix85]

Your doctor can't know that your testosterone is fine by simply looking at a number, there is so much more to it than that. In today's world doctor's fixates on normal ranges and doesn't actually know much of anything about what constitutes a normal level for a particular person.

So many doctors get this male testosterone game wrong. You cannot just go to an ordinary doctor for male hormonal problems. You need to seek out the appropriate doctor and even then you need to be wary because some of these so called hormonal experts are in title only.

I recently had my Free T smack right in the middle of the ranges and had ED and didn't feel particularly well, I increased my dosage and now have erections every single day.

Those Free T levels are low for a 36 year old and am surprised ED is your only complaint!

Hi Systemlord I agree with you, but i have only one problem, in Italy no doctor prescribes me testosterone with these total testosterone values even if they are specialists!

Actually for a while I was really bad: insomnia, no pleasure of life, zero libido and ED .from blood tests it turned out that my thyroid was not good: high TSH, high Cortisol and Prolactin.

Since I started treatment with levothyroxine all this value are back to normal range and all symptoms have resolved, except ED and Free T.

I went to a specialist and my testicles are ok. I can not understand why the only value that has not returned to the norm is FreeT.

 

[Cataceous]

Unless your free testosterone was measured by an accurate method such as equilibrium dialysis or ultrafiltration you must not rely on it; the standard immunoassay-based tests are so poor they are effectively useless. If you do not have access to a good test then the next best thing is to look at your calculated values. Using a default value for albumin we see that your Vermeulen free testosterone is 12 ng/dL. This is within a healthy normal range of 10-20 ng/dL. Similarly, your Tru-T free T of 20 ng/dL is in the healthy range of 16-31 ng/dL. The one uncertainty here is your albumin. Your urine test suggests it could be elevated, which could push free testosterone a little lower. To find out you need to obtain a measurement of serum albumin. If your serum albumin is normal then it is less likely that low testosterone is your problem. If you're determined to pursue this avenue then I'd suggest a trial with Natesto or generic equivalent. This would give you a sample of higher testosterone without suppressing your own production.

 

[emilix85]

Unless your free testosterone was measured by an accurate method such as equilibrium dialysis or ultrafiltration you must not rely on it; the standard immunoassay-based tests are so poor they are effectively useless. If you do not have access to a good test then the next best thing is to look at your calculated values. Using a default value for albumin we see that your Vermeulen free testosterone is 12 ng/dL. This is within a healthy normal range of 10-20 ng/dL. Similarly, your Tru-T free T of 20 ng/dL is in the healthy range of 16-31 ng/dL. The one uncertainty here is your albumin. Your urine test suggests it could be elevated, which could push free testosterone a little lower. To find out you need to obtain a measurement of serum albumin. If your serum albumin is normal then it is less likely that low testosterone is your problem. If you're determined to pursue this avenue then I'd suggest a trial with Natesto or generic equivalent. This would give you a sample of higher testosterone without suppressing your own production.

Hi Cataceous thanks for reply! My Albumin Is 4,10 in normal range. Attach the file thanks

 

[Cataceous]

Hi Cataceous thanks for reply! My Albumin Is 4,10 in normal range. Attach the file thanks

This slightly increases free testosterone from the default albumin. Vermeulen calculated free T is 12.3 ng/dL, healthy range 10-20. Tru-T free T is 20.6 ng/dL, healthy range 16-31. With these methods in agreement I think your doctor is justified in turning the focus away from testosterone as a source of your difficulties. If other avenues are not successful then you could still come back to this with a trial of testosterone nasal gel, which would be the safest way to see if higher testosterone could be helpful.

Would you say your libido is normal now? If it is then perhaps the priority should be to rule out vascular issues. Your reaction to PDE5 inhibitors could give some indication. So you might start by having your doctor prescribe you some sildenafil or tadalafil. If these seem ineffective then look into a penile ultrasound.

Since you mentioned previous problems with prolactin and libido it's worth noting that some men, myself included, can have problems even with mid-range prolactin, around 10 ng/mL. It can also be a reflection of reduced dopamine activity. Therefore, another thing to try is to increase dopamine activity with supplements or medications. From another post: "On the mild side are L-tyrosine and NALT. More intense are things like wild green oat extract, macuna pruriens (L-Dopa), selegiline and cabergoline."

A further step is to try increasing acetylcholine. Possible supplements include alpha-GPC and huperzine A.

 

[emilix85]

This slightly increases free testosterone from the default albumin. Vermeulen calculated free T is 12.3 ng/dL, healthy range 10-20. Tru-T free T is 20.6 ng/dL, healthy range 16-31. With these methods in agreement I think your doctor is justified in turning the focus away from testosterone as a source of your difficulties. If other avenues are not successful then you could still come back to this with a trial of testosterone nasal gel, which would be the safest way to see if higher testosterone could be helpful.

Would you say your libido is normal now? If it is then perhaps the priority should be to rule out vascular issues. Your reaction to PDE5 inhibitors could give some indication. So you might start by having your doctor prescribe you some sildenafil or tadalafil. If these seem ineffective then look into a penile ultrasound.

Since you mentioned previous problems with prolactin and libido it's worth noting that some men, myself included, can have problems even with mid-range prolactin, around 10 ng/mL. It can also be a reflection of reduced dopamine activity. Therefore, another thing to try is to increase dopamine activity with supplements or medications. From another post: "On the mild side are L-tyrosine and NALT. More intense are things like wild green oat extract, macuna pruriens (L-Dopa), selegiline and cabergoline."

A further step is to try increasing acetylcholine. Possible supplements include alpha-GPC and huperzine A.

Thanks for your advice Cataceous! I try to explain it. Basically my problem is in the part of the initial excitement. Once excited and started sex I can stay even 1 hour. My problem I think is more than a delayed erection.

Practically to have sex I have to stimulate myself to have an erection. Then everything is fine. This excludes any physical problem. The fact that I rarely have morning erections makes me go more towards free testosterone

I would like to try natesto I have to see in italy if it is available. I have try to use macuna pruriens (L-Dopa) but nothing.

Thanks

 

[Cataceous]

One other thing you could look into is an alpha-1 receptor antagonist, such as doxazosin. It's hypothesized that as we get older there is an increase in sympathetic nervous system activity and a decrease in parasympathetic activity. Parasympathetic activity is necessary for erections, while sympathetic activity may be inhibitive. Doxazosin may be able to reduce the inhibitory action.

I have been experimenting with this, and the initial results are promising. Even a small dose of 0.25-0.5 mg doxazosin daily seems to promote spontaneous erections.

Further reading:

The Central Mechanisms of Sexual Function » Sexual Medicine » BUMC

Boston University

www.bumc.bu.edu

 

[Golfboy307]

Cat,

As always, thanks for posting this timely article. As I get older, I am struggling more and more with nervous side of this process, or "psychogenic" if you prefer. Any amount of performance anxiety or stress seems to shut down my erections very quickly. My Body Logic doctor has suggested an Alpha blocker for BP and also his reason. I need to take him up on this offer and try it.

Interesting paragraph about sympathetic CNS function being shut down during REM sleep. When my sleep is really good through the night (as opposed to the last couple of weeks), I have strong nocturnal erections. When I am awake and anxious from 3-6am, EQ is terrible.

Do doctors actually prescribe APO yet for sexual function?

Sorry don't mean to derail this thread.

 

[Cataceous]

...
Do doctors actually prescribe APO yet for sexual function?
...

I'm not sure about that. There may be a few doctors willing to go the official off-label route. But as conservative as most are I assume they'd prefer to nominally be treating blood pressure.

 

[Nelson Vergel]

If I'm interpreting the Free T ranges correctly, it appears that they give age specific ranges. It looks like you're towards the lower end of the range.

That said, ED can be a complex issue with physical and psychological causes.

- What is your relationship status - are you in a long-term relationship or are you dating?
- Prior to sex, are you somewhat anxious about ED or whether or not you will be able to perform?
- Do you ever have nocturnal erections during sleep?
- Have you ever injured your penis during sex?
- Have you ever experienced pain with an erection?
- Have you tried drugs like Cialis or Viagra?

I would add:

- Have you started a new medication or increased the dose on a current one?
- Do you have a lot of stress?
- How are you sleeping?
- Are you watching more porn than you used to?
- Do you get a good erection when you masturbate?
etc

So may factors that have nothing to do with hormones!

 

[Golfboy307]

As a guy in his mid 50's, I can attest to the sleep and stress comment above. They can wreak havoc on erection quality when you are older (and probably younger guys too).

Going through one of those periods right now!