TRT Newbie Frustrated but Hopeful

[Leesto]

First of all, thank you to Nelson and the members here for all the valuable information you have posted. Since discovering ExcelMale 1 month ago I have read thousands of posts and watched all of Nelson's videos and Gene's N.O. stack video. All have been educational.

Okay, before TRT I was:

- 62 year old male on hypertension and diabetes meds.
- About 15 pounds overweight.
- Complete ED not helped by viagra/cialis
- No NPT's or morning wood for 20 years.
- Could get a climax now and then but it was difficult, exhausting, and weak.
- poor libido (but not absent)
- low energy level, declining mood and declining physical stamina.
- Beginning to get achy joints.
- Total T = 205 (sorry I don't have other labs the doctor kept them)

4 months ago I started on TRT:

- Test Cyp 200: one IM injection per week
- HCG 2.5 ml on T day and 2.5 ml the next day
- Anastrozole .5 mg twice weekly


First 2 months I noticed nothing.

The third month I crashed:

- NO libido.
- Night sweats
- Hot flashes
- Sour mood
- Frustration/irritability
- Could not even get close to a climax under any circumstances.
- My Doc thought these signs were indicative of high E2.

In the 4th month I read lots of stuff here and so two weeks ago I did these things:

- Started Gene's NO stack
- Stopped taking Anastrozole
- Changed HCG injections to 2X per week evenly spaced rather than on consecutive days.

What happened since:

- After about 7 days the night sweats and hot flashes stopped.
- Mood is improving a bit
- blood test 8 days after stopping the AI (and two days after T Cyp injection) showed:
- Total T = 1427
- Free T = 36.4
- Estradiol (Sensitive) = 23.8
- Had one NPT. Not hard but somewhat enlarged vs completely flaccid.
- Was able to achieve one climax. Took a while and was difficult difficult but it happened and was a bit stronger and a bit more satisfying.
- Libido is still low but at least it is not completely absent.

On the plus side I have noticed since starting TRT:

- My body has leaned out. Even my wife comments that my body composition has changed. T-Shirts feel a bit more snug in the chest and arms but looser in the belly.
- I cut my diabetes meds in half
- I cut my hypertension meds in half

My main reason for starting TRT was ED and that is still with me. Still not helped by viagra (even 4x the normal dosage). I now know there are other health and quality of life benefits from TRT and I will stay on it because of them, but 4 months have not helped the ED.

I have read here about Cabergoline, PT-141, and Trimix but have not tried any of those yet. I am wondering if I should just stick with my current regimen and hope the ED gets fixed with time or if I should try one of those three ED remedies. As you can imagine, after 4 months of no improvement in the ED department I am getting impatient. I have a beautiful and understanding wife who is willing and ready but I've just got nothing happening down there.

Thanks in advance for any comments you may have. Sorry for the long post, but I am here to learn!

 

[CoastWatcher]

Welcome to Excelmale. We're glad you joined us.

Some points on labs. When posting please include reference ranges. All labs report differently; our comments will be more focused if we understand the ranges you and your doctor are working with. As to your missing labs, they belong to you. Federal law in the US permits you to ask for them, and requires your doctor to provide them.

*When we're these values drawn? Right before your next injection? That's the preferred time to pull blood as it gives a trough reading. If your total testosterone is a trough value, I can't imagine what your peak would be. Have you considered splitting your dose into two equivalent injections delivered 3.5 days apart?

*Was a CBC run? Hematocrit might be an issue with that high a testosterone level. If you don't know, it would be wise to run a CBC.

*ED frequently remains an issue even after success is achieved elsewhere. Many, perhaps most, of us rely on Cialis to seal the deal. Some use Trimix. Has Ciais/Viagra failed you?

*You mentioned Cabergoline - your prolactin is elevated?

We're glad you are here and glad you are becoming your own advocate in regard to your health (we've all had to learn how to do that). You realized an AI was not your friend...something your doctor should have been sharp enough to catch. With a bit more information we can help you focus your questions and offer some suggestions.

 

[Leesto]

Thank you CoastWatcher for taking the time to read and to reply. I know my post was kind of long! I'll try to answer your questions briefly.

1) Those values were drawn two days after injection.
2) Here are the ranges. I got these tests from Discount Labs through the links on this forum.




3) Have not run a CBC. Will suggest this to the Dr.
4) Don't know about my prolactin levels so I had a test done today. Should know the results in 5 days or so.
5) I have not spoken to the Doc about splitting the T dose but I have read about that protocol here on the forum and that appeals to me as well as possibly doing sub-Q instead of IM. Not sure what the Doc will think but I will ask.

Thanks for the info about the Federal requirement to release the labs to the patient! For some reason my Doc seems reluctant to give them to me. I will insist next time.

Thanks too for your comments about ED often remaining an issue. Cialis and Viagra don't work for me any more. I should probably not admit this but I tried as many as 4 viagras (total of 400 mg) and barely got a half erection. Even then it only lasted about 30 seconds. Not sure what the next steps should be to address the ED.

 

[ERO]

Tri-Mix works when Cialis and Viagra no longer work. Best source is often Defy Medical as many places charge a ridicules amount of $$$ for it. The fact that your doc doesn't want to share labs (that are yours, you paid for them) with you is a red-flag that he may not be the best doc for you as well.

 

[johndoesmith]

Thank you CoastWatcher for taking the time to read and to reply. I know my post was kind of long! I'll try to answer your questions briefly.

1) Those values were drawn two days after injection.
2) Here are the ranges. I got these tests from Discount Labs through the links on this forum.

View attachment 2762


3) Have not run a CBC. Will suggest this to the Dr.
4) Don't know about my prolactin levels so I had a test done today. Should know the results in 5 days or so.
5) I have not spoken to the Doc about splitting the T dose but I have read about that protocol here on the forum and that appeals to me as well as possibly doing sub-Q instead of IM. Not sure what the Doc will think but I will ask.

Thanks for the info about the Federal requirement to release the labs to the patient! For some reason my Doc seems reluctant to give them to me. I will insist next time.

Thanks too for your comments about ED often remaining an issue. Cialis and Viagra don't work for me any more. I should probably not admit this but I tried as many as 4 viagras (total of 400 mg) and barely got a half erection. Even then it only lasted about 30 seconds. Not sure what the next steps should be to address the ED.

Well if that's 2 days after injection, then you have crashed the hell out of your E2. You just experienced menopause basically. I lived it for who knows how long.

Another thing, testing 2 days after injection is fairly worthless for information, you want to get trough, day of injection but before injection.

You also need more than total, free and E2 ran. What amazes me is that your doc seems rather unfamiliar with TRT, but ran the correct test, that is VERY uncommon. A doctor even knowing there's a sensitive E2 test is a good sign usually that a doctor knows TRT but in this case, it seems rather confusing.

 

[Leesto]

Thank you johndoesmith. Sorry to hear you lived low E2 for so long. I hated it but didn't have the experience to figure it out till it got so miserable I couldn't stand it any longer. I am probably still low but the worst symptoms have lessened. Doc didn't run those recent tests - I did. I ordered them from Discount Labs because I read about the sensitive estradiol test here on Excel Male.

Thanks for the tips about testing at the trough!

I initially thought a Doc would manage the protocol well but am rapidly finding out that we must become knowledgeable about TRT and play a very active role in our own case management.

 

[Leesto]

Thanks Ero! I am beginning to see your point about my doc.

Thanks too for the tip about trimix from Defy. I'm hoping TRT does the trick once I get it dialed in but if not I am definitely going to try trimix or cabergoline or PT-141. Or maybe try them all eventually to see which one works for me and suits my lifestyle & budget.

 

[ERO]

PT-141 is somewhat problematic. The effect happens some hours after injection, you can only use it every so often, it doesn't work for everyone, etc. Definitely look into Cabergoline, but know that having your Prolactin too low can be as bad as too high. Caber is a strong drug as well - dosing should be something like 0.25 mg twice a week - so if your doc prescribes significantly more than that then you need to not walk but RUN from this guy.

Many of us here use Defy Medical and their tele-medicine model and they come highly recommended. Just food for thought.

 

[johndoesmith]

Thank you johndoesmith. Sorry to hear you lived low E2 for so long. I hated it but didn't have the experience to figure it out till it got so miserable I couldn't stand it any longer. I am probably still low but the worst symptoms have lessened. Doc didn't run those recent tests - I did. I ordered them from Discount Labs because I read about the sensitive estradiol test here on Excel Male.

Thanks for the tips about testing at the trough!

I initially thought a Doc would manage the protocol well but am rapidly finding out that we must become knowledgeable about TRT and play a very active role in our own case management.

I like your attitude! Seriously, it's refreshing, you're teachable, and lately on TRT forums it's been a PIA to get anyone to listen.

Low E2 will kill erections btw. Give it time.

Unfortunately you may have to watch over your own blood work as it doesn't seem your doc is going to. I highly recommend Defy medical. They are not like your doc now, and it takes the pressure off, as humans are not good at judging data objectively about themselves.

I appreciate your concern for me, and let me tell you, it was hell. I recognized your symptoms when you listed them, but assumed since you're on 200mg per week, you MUST have high E2, but the hot flashes stuck out a bit.

Let me ask you, did the hot flashes itch really really intensely? Did you find yourself urinating a lot and really thirsty? almost feeling like anhedonic?

 

[Leesto]

Johndoesmith yes the hot flashes were very itchy and prickly. You nailed it. I had thirst and urge to urinate but not quite as strong as you described. The night sweats were insane. Maybe that's why I didn't urinate so much because I had lost so much water in the sweat. Sheets and blankets and pillows were saturated.

Thx for your encouragement. Wish I had started off with Defy.

 

[Leesto]

Thanks much ERO. I appreciate the info about caber and pt-141. Also the info about Defy.

I had a draw today for prolactin so will await that test result before making a decision about caber.

I appreciate the knowledge and experience of you guys on the forum.

 

[johndoesmith]

Johndoesmith yes the hot flashes were very itchy and prickly. You nailed it. I had thirst and urge to urinate but not quite as strong as you described. The night sweats were insane. Maybe that's why I didn't urinate so much because I had lost so much water in the sweat. Sheets and blankets and pillows were saturated.

Thx for your encouragement. Wish I had started off with Defy.

It's amazing, only certain guys get these exact symptoms. The hot flashes caused by anxiety or heat were so itchy. Like a million needles with itching so bad and urgent I almost couldn't move my arm fast enough to scratch. I'd wake up so thirsty I'd drink until my stomach hurt, then run lights and sirens to the bathroom.

The anhedonia was bad, like I wished I'd get run over by a truck, couldn't understand why people wanted to live. I felt nothing. Just itchy, anxious, and thirsty.

This was how I felt and I'm 22. I had doctors congratulate me on my perfect hormones. Glad someone else relates.

 

[Leesto]

All I can say is WOW! ! !

 

[lowe2sucks]

It's amazing, only certain guys get these exact symptoms. The hot flashes caused by anxiety or heat were so itchy. Like a million needles with itching so bad and urgent I almost couldn't move my arm fast enough to scratch. I'd wake up so thirsty I'd drink until my stomach hurt, then run lights and sirens to the bathroom.

The anhedonia was bad, like I wished I'd get run over by a truck, couldn't understand why people wanted to live. I felt nothing. Just itchy, anxious, and thirsty.

This was how I felt and I'm 22. I had doctors congratulate me on my perfect hormones. Glad someone else relates.

is this how you felt with low e2? i felt like this with low e2

 

[johndoesmith]

is this how you felt with low e2? i felt like this with low e2

That's honestly the short explanation of it, I left out some. It was worse at times. I also didn't mention the sexual symptoms from low e2. Although I cared much less about the sexual symptoms, because the other ones were all the time, and honestly I really never realized the thirst, hot flashes and urination were abnormal until they went away.

I thought this was normal:/ so when older folks told me how lucky I was to be 21, I wanted to gouge their eyes out. How dare you tell me THIS is the best life gets.

 

[lowe2sucks]

oh man I totally understand you.. i feel like this a bit over a year now

 

[Leesto]

Yes lowe2sucks: low E2.

The doc thought those signs were high E2 but I'm learning here on the forum and also learning the hard way that low E2 can be highly symptomatic and miserable. Similar to a woman going through menopause but all the worst symptoms of menopause happening at once. At least that's what I experienced. It lasted about 6 weeks. Ugh!

Once I stopped taking Anastrozole it took a week for the worst symptoms to lessen. Two weeks later I'm still not right but hopefully on the path back toward a good balance.

 

[johndoesmith]

Yes lowe2sucks: low E2.

The doc thought those signs were high E2 but I'm learning here on the forum and also learning the hard way that low E2 can be highly symptomatic and miserable. Similar to a woman going through menopause but all the worst symptoms of menopause happening at once. At least that's what I experienced. It lasted about 6 weeks. Ugh!

Once I stopped taking Anastrozole it took a week for the worst symptoms to lessen. Two weeks later I'm still not right but hopefully on the path back toward a good balance.

There are a few symptoms that are almost exclusively associated with high or low estradiol.

Low: joint pain, no emotions, frequent urination and thirst, and maybe loss of penile sensitivity

high: bloating, sensitive nipples, being really emotional, and water retention.

The other symptoms, anxiety, depression, low libido, ED, fatigue, and night sweats can be from either high or low depending on the guy.

Basically, you need to learn YOUR symptoms of high or low. Some guys never get the misery of low E2 like we did.

 

[Leesto]

That's valuable information. I have looked everywhere for accurate symptoms of high and low E2 but there seems to be much more speculation and conjecture than factual information. Plus, as I have read here, it is possible that the T/E2 ratio is more important than absolute serum levels. Who knows. There seems to be a lot more fear out there of high E2 than low but I suspect that is a holdover from past conceptions which persist in the absence of clear facts.

I am now inclined to take Nelson's approach to E2 which (correct me if I am wrong) is basically don't use an AI unless you get clear symptoms of high E2 as well as labs showing high E2. I even read that he is suspect of most of the symptoms frequently attributed to high E2 other than gynecomastia. There is simply a lack of good research in this area.

Until there is more research to guide us I suppose we will have to do as you suggest and each of us learn our own symptoms of high and low E2. That probably means going through some tough times along the way but we'll learn from it.

I, for one, don't ever want to go low again!

 

[johndoesmith]

That's valuable information. I have looked everywhere for accurate symptoms of high and low E2 but there seems to be much more speculation and conjecture than factual information. Plus, as I have read here, it is possible that the T/E2 ratio is more important than absolute serum levels. Who knows. There seems to be a lot more fear out there of high E2 than low but I suspect that is a holdover from past conceptions which persist in the absence of clear facts.

I am now inclined to take Nelson's approach to E2 which (correct me if I am wrong) is basically don't use an AI unless you get clear symptoms of high E2 as well as labs showing high E2. I even read that he is suspect of most of the symptoms frequently attributed to high E2 other than gynecomastia. There is simply a lack of good research in this area.

Until there is more research to guide us I suppose we will have to do as you suggest and each of us learn our own symptoms of high and low E2. That probably means going through some tough times along the way but we'll learn from it.

I, for one, don't ever want to go low again!

Well, the reason is because the symptoms are individual to the person. you might get joint pain, and I don't, but I get serious depression.

http://dosagemayvary.com/high-estrogen-vs-low-estrogen-symptoms-for-men/

That's a list of potential symptoms, you don't need to have all of them.

The ones I listed that are exclusive, are from my observations from guys who post labs and symptoms. Very rarely do people report joint pain with high E2, or bloating with low E2. Looking into E2's mechanism of action, it makes sense why.

T/E2 ratio is a theory, but I have seen on steroid user forums, guys with a total test of 3000 still have high E2 symptoms at 60 pg/ml. It's a guide, and it doesn't take into consideration SHBG, or assay method. No one thing should guide you with E2, it's a combination of symptoms and labs.

I do agree with nelson, AI should be avoided at all costs, and only in the case of symptoms and high labs.