Help - Premature Ejaculation and lab results

[medic3644]

Hey all,

I have been on TRT now for around 5 years and never had too many problems besides the occasional ED from my e2 levels being off that required some Cialis. I am 34y/o 6'5" 230lb male that works out frequently and has visible abs. Since December of 2020 year I have acquired premature ejaculation. It doesn't matter if I have some ED present or not, if its the umpteenth time of the day, if Cialis or viagra is present or not; when I get fully erect I can only last around a minute tops. This is much different from my experience because I used to be able to last as long as I'd like or it would be difficult at times for me to cum since I began TRT. I spoke to my TRT doc in January of 2020 and she raised my prescribed dose from 75mg x2 per of Test Cyp with .375mg Anastrozole week to 100mg x2 per week Test cyp with .5mg Anastrozole. This will be my second posted labs below, but came back off of the charts so she backed things back off to the previous dose. I did however feel somewhat better with this amount but my patience was nonexistent and I still had frequent PE. Now, i am still complaining about said symptoms and been researching the site looking for answers because what my provider is doing obviously isn't working. I would really appreciate some help with this. Below are my most recent lab results:

10/4/21 75mg Test cyp x2 per week with .375mg Anastrozole each dose
TESTOSTERONE, FREE (DIALYSIS) AND TOTAL (MS) TESTOSTERONE, TOTAL, MS:
1034 250-1100 ng/dL
TESTOSTERONE, FREE:
223.8 H 35.0-155.0 pg/mL

TSH: 0.86 0.40-4.50 mIU/L EN
T4, FREE: 1.0 0.8-1.8 ng/dL EN
T3, FREE: 4.1 2.3-4.2 pg/mL EN

DIHYDROTESTOSTERONE, LC/MS/MS: 126 12-65 ng/dL
PROLACTIN: 8.1 2.0-18.0 ng/mL EN
SEX HORMONE BINDING EN GLOBULIN: 28 10-50 nmol/L
ESTRADIOL,ULTRASENSITIVE, LC/MS: 30


5/21/21 100mg Test cyp x2 per week with .5mg Anastrozole each dose
Total T: 1410
SHBG: 26
Free T: 326pg/ml
Bioavailable T: 614ng/dl
E2 ultrasensitive: 16
PSA: 1.1


1/10/21 .75mg Test cyp x2 per week with .375mg Anastrazole each dose
ENDOCRINE EVALUATION
PROGESTERONE 0.84 0.28 - 1.22 ng/mL
ESTRADIOL (E2) 20.7 0.0 - 39.9 pg/mL
DHEA-SULFATE 366.3 34.5 - 568.9 ug/dl
TESTOSTERONE, TOTAL 841 280 - 1100 ng/dl
SEX HORMONE BIND GLOBULIN 21 14 - 95 nmol/L
TESTOSTERONE, FREE 22.9 4.3 - 24.0 ng/dl

Any ideas what I should do? My TSH seems low, T3 high and DHT really high in the recent tests. Thanks in advance!

 

[DorianGray]

It seems reasonable to backtrack your labs and performance going back to last year. What is different in the labs from then? Too high DHT and Free T perhaps?

 

[medic3644]

Unfortunately I currently only have results from 2018 and yes it confirms the Free T but DHT wasn't tested.

Thyroid Panel With TSH
TSH 1.080 0.450-4.500 uIU/mL 01
Thyroxine (T4) 7.9 4.5-12.0 ug/dL 01
T3 Uptake 29 24-39 % 01
Free Thyroxine Index 2.3 1.2-4.9 01

Testosterone, Free/Tot Equilib
Testosterone, Serum 550 348-1197 ng/dL 01
Testosterone, Free 18.86 5.00-21.00 ng/dL 02
% Free Testosterone 3.43 1.50-4.20 %

I'm going to my TRT doc tomorrow so I'll get more results then.

 

[sammmy]

She treated premature ejaculation with raising your testosterone? LOL

The obvious thing to do is to drop testosterone to 2x50mg per week and ditch the anastrozole. Evaluate how you feel on that for 2 months and if everything is ok, you don't need anastrozole. You should be guided by symptoms, not that your estradiol should be this or that lab level.

 

[Gman86]

How’s ur libido? Is it really high?

 

[medic3644]

She treated premature ejaculation with raising your testosterone? LOL

The obvious thing to do is to drop testosterone to 2x50mg per week and ditch the anastrozole. Evaluate how you feel on that for 2 months and if everything is ok, you don't need anastrozole. You should be guided by symptoms, not that your estradiol should be this or that lab level.

Yeah she isn't the best. Last time I called in for my refill there was a delay due to her issues with her medical license. I think youre right with the dosing. I have always had a problem with E2 control, so it makes sense to drop it overall.

How’s ur libido? Is it really high?

Unfortunately no and whatever is there is deterred by my anxiety. His performance is so hit or miss for the past year which has caused me to lose a lot of confidence. I will have days where I wake up with killer morning erections which used to point to days of glory. Now its quite the opposite as it doesn't signify anything. My erections are so hit or miss. Even on cialis. Intense foreplay will hit 30 mins after we woke up and not a single reaction from my penis and when he finally responds 20mins later, I only last 30 seconds or less. Its wreaked havoc

 

[madman]

ddddHey all,

I have been on TRT now for around 5 years and never had too many problems besides the occasional ED from my e2 levels being off that required some Cialis. I am 34y/o 6'5" 230lb male that works out frequently and has visible abs. Since December of 2020 year I have acquired premature ejaculation. It doesn't matter if I have some ED present or not, if its the umpteenth time of the day, if Cialis or viagra is present or not; when I get fully erect I can only last around a minute tops. This is much different from my experience because I used to be able to last as long as I'd like or it would be difficult at times for me to cum since I began TRT. I spoke to my TRT doc in January of 2020 and she raised my prescribed dose from 75mg x2 per of Test Cyp with .375mg Anastrozole week to 100mg x2 per week Test cyp with .5mg Anastrozole. This will be my second posted labs below, but came back off of the charts so she backed things back off to the previous dose. I did however feel somewhat better with this amount but my patience was nonexistent and I still had frequent PE. Now, i am still complaining about said symptoms and been researching the site looking for answers because what my provider is doing obviously isn't working. I would really appreciate some help with this. Below are my most recent lab results:

10/4/21 75mg Test cyp x2 per week with .375mg Anastrozole each dose
TESTOSTERONE, FREE (DIALYSIS) AND TOTAL (MS) TESTOSTERONE, TOTAL, MS:
1034 250-1100 ng/dL
TESTOSTERONE, FREE:
223.8 H 35.0-155.0 pg/mL

TSH: 0.86 0.40-4.50 mIU/L EN
T4, FREE: 1.0 0.8-1.8 ng/dL EN
T3, FREE: 4.1 2.3-4.2 pg/mL EN

DIHYDROTESTOSTERONE, LC/MS/MS: 126 12-65 ng/dL
PROLACTIN: 8.1 2.0-18.0 ng/mL EN
SEX HORMONE BINDING EN GLOBULIN: 28 10-50 nmol/L
ESTRADIOL,ULTRASENSITIVE, LC/MS: 30


5/21/21 100mg Test cyp x2 per week with .5mg Anastrozole each dose
Total T: 1410
SHBG: 26
Free T: 326pg/ml
Bioavailable T: 614ng/dl
E2 ultrasensitive: 16
PSA: 1.1


1/10/21 .75mg Test cyp x2 per week with .375mg Anastrazole each dose
ENDOCRINE EVALUATION
PROGESTERONE 0.84 0.28 - 1.22 ng/mL
ESTRADIOL (E2) 20.7 0.0 - 39.9 pg/mL
DHEA-SULFATE 366.3 34.5 - 568.9 ug/dl
TESTOSTERONE, TOTAL 841 280 - 1100 ng/dl
SEX HORMONE BIND GLOBULIN 21 14 - 95 nmol/L
TESTOSTERONE, FREE 22.9 4.3 - 24.0 ng/dl

Any ideas what I should do? My TSH seems low, T3 high and DHT really high in the recent tests. Thanks in advance!

Since December of 2020 year I have acquired premature ejaculation. It doesn't matter if I have some ED present or not, if its the umpteenth time of the day, if Cialis or viagra is present or not; when I get fully erect I can only last around a minute tops. This is much different from my experience because I used to be able to last as long as I'd like or it would be difficult at times for me to cum since I began TRT.

Would be nice to see your labs from 2019.

Looking over your reply from post #3.

Unfortunately I currently only have results from 2018 and yes it confirms the Free T but DHT wasn't tested.

Thyroid Panel With TSH
TSH 1.080 0.450-4.500 uIU/mL 01
Thyroxine (T4) 7.9 4.5-12.0 ug/dL 01
T3 Uptake 29 24-39 % 01
Free Thyroxine Index 2.3 1.2-4.9 01

Testosterone, Free/Tot Equilib
Testosterone, Serum 550 348-1197 ng/dL 01
Testosterone, Free 18.86 5.00-21.00 ng/dL 02
% Free Testosterone 3.43 1.50-4.20 %

I'm going to my TRT doc tomorrow so I'll get more results then.

How did you feel overall regarding energy/mood/libido/erectile function?

Were labs done at the trough?

Not sure what your protocol (dose T/injection frequency) was but if these are labs at trough you can clearly see that your trough TT 550 ng/dL is far from high and your trough FT 18.00 ng/dL is healthy but far from what would be considered high.

Keep in mind that peak TT/FT/estradiol levels would be higher.

No idea where your estradiol sat. as you never posted.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng.dL (top-end) is healthy.

Most men will do well with FT 20-30 ng/dL range and many tend to fair better on the higher end.

Some may need/choose to run even higher levels.

Comes down to the individual.

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

SHBG is also a critical blood marker as not only will it have a significant impact on TT/FT but can also dictate what injection frequency may suit you best.

Where did your SHBG sit when you had these labs done?

Knowing where your trough FT sits is critical.

Unfortunately, most are using/relying upon inaccurate assays when testing FT.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard EquilibriumDialysis or Ultrafiltration (next best).

Luckily you had your FT tested using one of the most accurate assays Equilibrium Ultrafiltration (Labcorp reference range 5.00-21.00 ng/dL).

Again your trough TT 550 ng/dL is far from what would be considered high let alone your FT is healthy but far from high.

These are labs from 2018.

When you first started trt up until December 2020 you stated that there were no issues other than the occasional ED.

Were you running average tough TT/FT levels most of the time up until recently?

If we compare your labs from 2018 to the most recent 2021 then you did a complete 360.




I spoke to my TRT doc in January of 2020 and she raised my prescribed dose from 75mg x2 per of Test Cyp with .375mg Anastrozole week to 100mg x2 per week Test cyp with .5mg Anastrozole. This will be my second posted labs below, but came back off of the charts so she backed things back off to the previous dose. I did however feel somewhat better with this amount but my patience was nonexistent and I still had frequent PE. Now, i am still complaining about said symptoms and been researching the site looking for answers because what my provider is doing obviously isn't working. I would really appreciate some help with this. Below are my most recent lab results:

10/4/21 75mg Test cyp x2 per week with .375mg Anastrozole each dose
TESTOSTERONE, FREE (DIALYSIS) AND TOTAL (MS) TESTOSTERONE, TOTAL, MS:
1034 250-1100 ng/dL
TESTOSTERONE, FREE:
223.8 H 35.0-155.0 pg/mL

TSH: 0.86 0.40-4.50 mIU/L EN
T4, FREE: 1.0 0.8-1.8 ng/dL EN
T3, FREE: 4.1 2.3-4.2 pg/mL EN

DIHYDROTESTOSTERONE, LC/MS/MS: 126 12-65 ng/dL
PROLACTIN: 8.1 2.0-18.0 ng/mL EN
SEX HORMONE BINDING EN GLOBULIN: 28 10-50 nmol/L
ESTRADIOL,ULTRASENSITIVE, LC/MS: 30


5/21/21 100mg Test cyp x2 per week with .5mg Anastrozole each dose
Total T: 1410
SHBG: 26
Free T: 326pg/ml
Bioavailable T: 614ng/dl
E2 ultrasensitive: 16
PSA: 1.1


1/10/21 .75mg Test cyp x2 per week with .375mg Anastrazole each dose
ENDOCRINE EVALUATION
PROGESTERONE 0.84 0.28 - 1.22 ng/mL
ESTRADIOL (E2) 20.7 0.0 - 39.9 pg/mL
DHEA-SULFATE 366.3 34.5 - 568.9 ug/dl
TESTOSTERONE, TOTAL 841 280 - 1100 ng/dl
SEX HORMONE BIND GLOBULIN 21 14 - 95 nmol/L
TESTOSTERONE, FREE 22.9 4.3 - 24.0 ng/dl




Jan.10
150 mg T/week split (75 mg every 3.5 days) + AI you are hitting a higher-end trough TT 841 ng/dL and seeing as your SHBG is only 21 nmol/L then your trough FT would most likely be high (low 30 ng/dL).

Estradiol sitting around 20 (not sure what assay was used) as you are trying to manage the high estradiol with the use of an AI due to running a high FT level.

Keep in mind that your peak TT/FT/estradiol levels will be higher.

Although you had your FT tested judging by the reference range you most likely did not use an accurate assay.


May.21
Why your doctor upped your weekly T dose from 150 mg T split (75mg every 3.5 days)--->200 mg split (100 mg every 3.5 days) is beyond me!

Let alone upped your AI dose and now your estradiol is only 16 which is low compared to the absurdly high trough TT/FT level you are hitting.

You were already most likely hitting a high-end trough (30+ng/dL) on 150 mg T.

Going from 150mg T/week--->200 is a whopping jump and as you can see your trough TT 1410ng/dL is absurdly high let alone with an SHBG of only 26 nmol/L than your trough FT is very high and would most likely be through the roof as in 50+ ng/dL.

Your FT was tested using one of the most accurate assays Equilibrium Dialysis (Quest Diagnostics (reference range 35-155 pg/mL).

These are absurdly high trough TT/FT levels especially on 2X/week injection protocol meaning that your peak TT, FT, and estradiol would be even higher!

You stated that your patience was non-existent.....most likely was due to the absurd trough FT level.

Healthy levels of T and its metabolites (estradiol/DHT) will have a positive impact on energy, mood, libido, erectile function, recovery, body composition, lipids, insulin sensitivity, cardiovascular health, immune system, and bone health.

Keep in mind that testosterone has a tonic effect on the CNS.

Too high an FT level can easily make one feel amped up let alone have a negative impact on mood/sleep/erections/libido.

Some men will not do well running high FT levels which can lead to numerous issues in some.

Excess FT levels can result in acne/oily skin (genetically prone), accelerated balding (genetically prone), drive down HDL, increased RBCs/hemoglobin/hematocrit (common), overstimulation of the CNS (common), bloating/water retention due to androgens effects on the retention of electrolytes (common).

Let alone many end up trying to manage estradiol with the use of an aromatase inhibitor.

Even than excess steady-state FT levels may very well have a negative impact on neurotransmitters (dopamine/serotonin).


Oct.4
150 mg T/week split (75 mg every 3.5 days) + AI you are hitting a high-end trough TT 1034 ng/dL and seeing as your SHBG is only 28 nmol/L then your trough FT would most likely be very high (almost 40 ng/dL).

Your FT was tested using one of the most accurate assays Equilibrium Dialysis (Quest Diagnostics (reference range 35-155 pg/mL).

Keep in mind that your peak TT/FT/estradiol levels will be higher.

Again your estradiol sitting around 30 as you are still trying to manage the high estradiol with the use of an AI due to running a high FT level.

Even then when it comes to libido let alone ED they are multifactorial and there is much more involved than just having healthy hormones (TT, FT, estradiol, DHT, prolactin).

*Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.


My reply from a previous thread regarding ED/libido:

ED has multiple etiologies including vascular, neurologic, and endocrine disorders.

Underlying vascular health is critical!

Even when using PDE5is although effective for many most men have some degree of vascular/endothelial dysfunction.

Some men are poor responders and will end up needing to use intracavernosal injections to achieve/maintain an erection.

Having healthy testosterone levels is beneficial to one's libido/erectile function but it is far from the only thing that is required to achieve such.

Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.

Unfortunately, libido/ED is much more complex than simply having healthy testosterone levels.

Even then when it comes to trt and libido many tend to get caught up in thinking that it will be through the roof once they hop on trt and get to the point of so-called dialed in let alone cure any ED issues they may have.

When you find that happy place you should have a healthy libido not raging, savage, insane.

There are many men who will see an improvement in libido, others will continue to struggle, some may even end up worse off than before trt and some of the lucky ones will see a drastic improvement.

I think too many get caught up in expecting to feel great 24/7 once on trt as if testosterone is going to cure all that ails them.

Much more going on!

What stands out clear as day is that you have been running high/very high trough FT levels on your protocols since Jan.2021 let alone are trying to manage elevated estradiol with the use of an AI.

Would you fair better lowering your overall weekly dose, injecting lower doses of T more frequently, and running a lower trough FT while at the same time avoiding the avoiding use of an AI.....it is hard to say as there may very well be more to the picture.

You stated.....I have been on TRT now for around 5 years and never had too many problems besides the occasional ED from my e2 levels being off that required some Cialis.

Seems to me you felt good overall the first 4 years and blamed the high estradiol for the occasional ED which was managed with the use of a PDE5i.

From the labs posted in 2018, you were running a much lower trough TT/FT level let alone sounds like you never touched an AI.

Other than the labs from 2018 we have no idea what protocols you were running (dose T/injection frequency) during the first 4 years let alone where your trough TT, FT, and estradiol levels sat.

You only posted your most recent protocols 2021 which clearly show that your trough TT/FT levels are high/very high let alone you are managing your elevated estradiol with the use of an AI on every protocol.

Even then when it comes to libido/ED or even PE it is not so cut and dry.

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[medic3644]

"..."

Thank you so much for your reply! In regards to the changes, or 360 as you put it; I made it a point last year to get my health dialed in because I had made it a last priority for years. I used to miss injections frequently, doses of anastrozole and for the majority of the time only injecting once per week. It wasn't until January of last year that I began injecting every 3.5 days and attempting to dose the anastrozole on schedule but it seems as you pointed out, that I may have caused more problems by doing so LOL. Obviously my more consistent injections and high dose have raised my Free T up too, since my Free T at trough is still high.

Here are my previous labs:

1/10/20
Total T: 842
Free T: 22.1
SHBG: 24
DHT: 67
DHEA: 312
E2: 30.2
PSA: .860
This was when i first started the 75mg x2 per week with the anastrozole and it was at trough. It seemed to work well in regards to my erections as they improved but my mood and patience were terrible last year but I thought it was just the pandemic. I still had some ED but it was less frequent and the low dose cialis would work for what it felt like 5 days. Then December '20 hit and nothing has been the same. Cialis is hit or miss. I've tried Viagra now with the same results.

7/25/19
Total T: 1279
Free T: 42.1
SHBG: 17
E2: 25.2
PSA: 1.040
This was also 200mg/wk w/1mg anastrozole but was also inconsistent and I have no idea where this test landed in regard to peak/trough.


I discussed dropping the dose with her today as well as dropping the anastrozole completely and she is on board. I feel like with everyones responses so far, that is the next logical step. She also recommended that i begin taking Zinc and vitamin D3 daily and adding Nandrolone in if things do not improve.

 

[Systemlord]

Now its quite the opposite as it doesn't signify anything. My erections are so hit or miss.

You know as we age our bodies change, maybe the 2x weekly dosing is no longer adequate and what you need are more steady hormones.