Worsening Symptoms, "Dead Penis"

[Strengthandlibido]

Learn from our mistakes. If you make frequent protocol changes then you can end up chasing your tail, never really figuring out what causes what. Reiterating previous advice: with the current protocol you want to ensure you've restored HPTA function and have peak testosterone at healthy levels. Then give it some time—at least another month or two.

Making sure HPTA function is restored: you mean another few weeks with the nasal gel alone?

 

[Cataceous]

Making sure HPTA function is restored: you mean another few weeks with the nasal gel alone?

Yes, measure LH to ensure it's not still suppressed, and testosterone at a peak, about an hour after a dose of the nasal gel. As you have normal SHBG, you're looking for total testosterone to be at least 600-700 ng/dL to achieve normal free testosterone.

...
I've wondered(and played with the idea), since subq has a half life of 240 hours and a slower uptake, ...

This half-life is for the Xyosted product. Typical formulations of cypionate or enanthate would be more like half that, around five days.

 

[Strengthandlibido]

Yes, measure LH to ensure it's not still suppressed, and testosterone at a peak, about an hour after a dose of the nasal gel. As you have normal SHBG, you're looking for total testosterone to be at least 600-700 ng/dL to achieve normal free testosterone.

Thanks. I'm still not sure about nasal gel monotherapy though. In order to pursue that, I'd have to ignore Defy again for several months, and I'm not sure if I should keep doing that.

This absence of feeling in my nether regions has me both panicky and depressed. It feels like I've lost one of my senses, like my sense of touch. I can't believe how much worse that situation is compared to before I started injecting.

 

[Strengthandlibido]

I just got blood work back...

TESTOSTERONE, TOTAL, MALES (ADULT), IA 294 250-827 ng/dL EN
ALBUMIN 4.4 3.6-5.1 g/dL EN SEX HORMONE BINDING GLOBULIN 21 10-50 nmol/L EN
TESTOSTERONE, FREE EN TESTOSTERONE, FREE 52.9 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 106.4 L 110.0-575.0 ng/dL

The blood was drawn exactly one hour of my morning nasal application. Total T = 294, 250-827 ng/dL, lower than my initial number of 312. Looks like I'm ready to try the injections + hCG now.

10mg/day doesn't work for me either. The low dose daily thing is not for everyone.

For whatever reason, TRT is basically ineffective for me until it gets my levels to at least the upper part of the range.

Also, I've had very good success with scrotal cream.

This is going to be a looooong ride so set your expectations accordingly. It's a game of trial and error that will likely take years to figure out just what works for you.

My $0.02:

- Do the 100mg/week for at least 6 weeks. I'd just do E3.5D (Mon AM, Thur PM) to keep it simple but perhaps Defy told you MWF for a reason... After 6 weeks, evaluate how you feel, get labs.
- Then add in the HCG. Wait another 5 weeks or so. Evaluate how you feel, get labs, see if it made a positive/negative/any difference for you.
- Avoid using the AI at this point. Not everyone needs them and I don't think they should be included at the very beginning of a protocol. Add in as symptoms/labs indicate at some point in the future.

I was thinking of just adding the hCG now since Defy already prescribed it, as I was seeing some atrophy already on the 10 mg/day. I do like the idea of injecting the test just twice per week from here on. The hCG prescription was 500 iu, twice/week. I believe Dr. Chrisler recommended doing the hCG the day after the cypionate (someone correct me if I'm wrong). So I could do Sunday/Wednesday for the test cyp and Monday/Thursday for the hCG.

 

[Cataceous]

That's a pretty disappointing testosterone level for the nasal gel. I'm wondering if that's more generally reflective of the Empower product, because it's low compared to what's reported in the Natesto studies. If your natural production is still suppressed then 300 ng/dL wouldn't actually be such a bad rise from baseline. But this scenario doesn't seem so likely. Hard to know without measuring testosterone at trough and/or looking at LH.

 

[Strengthandlibido]

That's a pretty disappointing testosterone level for the nasal gel. I'm wondering if that's more generally reflective of the Empower product, because it's low compared to what's reported in the Natesto studies. If your natural production is still suppressed then 300 ng/dL wouldn't actually be such a bad rise from baseline. But this scenario doesn't seem so likely. Hard to know without measuring testosterone at trough and/or looking at LH.

And my SHBG went down to 21.5 nmol/L from 31.5 nmol/L while testosterone is essentially unchanged.

Since hCG supply is being disrupted, Defy agreed to switching me over to enclomiphene as part of a clinical study. So I'll be doing test cypionate at 60 mg/3.5 days along with enclomiphene at 25 mg every day.

Update: Dead penis no more? Libido surging this evening. Getting aroused and actually flirting/sexting with a woman for the first time in months. Maybe bigger doses less frequently is the way to go for me.

 

[Cataceous]

And my SHBG went down to 21.5 nmol/L from 31.5 nmol/L while testosterone is essentially unchanged.

Since hCG supply is being disrupted, Defy agreed to switching me over to enclomiphene as part of a clinical study. So I'll be doing test cypionate at 60 mg/3.5 days along with enclomiphene at 25 mg every day.

Update: Dead penis no more? Libido surging this evening. Getting aroused and actually flirting/sexting with a woman for the first time in months. Maybe bigger doses less frequently is the way to go for me.

Lower SHBG with the same total testosterone means an improvement in free testosterone, though it's still lowish.

Did Defy provide any details about this clinical study on enclomiphene? Expectations? Dr. Saya is the one who reported seeing little HPTA activity in most guys coming to him on TRT/clomiphene protocols. I wonder if they are expecting something different with enclomiphene, or just wanting to get some more definitive results in response to other clinics promoting enclomiphene as a replacement for hCG.

Keep reporting your results. It would be great if larger fluctuations helped you. But it is common to have a honeymoon period with a protocol change.

 

[Kuhlsnu]

For what it's worth, I've taken enclomiphene for 4-5 months as I noticed I just felt better on it but was not running HCG simultaneously. My testicles were more full but certainly not at their baseline size, but my HDL and LDL kept getting worse. After some research, I found that these are strongly correlated. So I've stopped the enclomiphene, and I will hunt the pharmacies for HCG until I figure out why my SHBG is so low, and then I'll come off TRT.

 

[Strengthandlibido]

Lower SHBG with the same total testosterone means an improvement in free testosterone, though it's still lowish.

Did Defy provide any details about this clinical study on enclomiphene? Expectations? Dr. Saya is the one who reported seeing little HPTA activity in most guys coming to him on TRT/clomiphene protocols. I wonder if they are expecting something different with enclomiphene, or just wanting to get some more definitive results in response to other clinics promoting enclomiphene as a replacement for hCG.

Keep reporting your results. It would be great if larger fluctuations helped you. But it is common to have a honeymoon period with a protocol change.

Yep, this may just be honeymooning. Everything I read has me anticipating this libido will wear off in a few weeks. But with the bigger dose, everything is suddenly working: penile sensitivity, erection strength, morning erections, and actual libido. I wish it could be as simple as taking a week off every few weeks to keep this going.

They mentioned seeing good LH numbers with clomid/enclomiphene. I think you're right about replacing the hCG for clients. That's what this midway call was all about.

For what it's worth, I've taken enclomiphene for 4-5 months as I noticed I just felt better on it but was not running HCG simultaneously. My testicles were more full but certainly not at their baseline size, but my HDL and LDL kept getting worse. After some research, I found that these are strongly correlated. So I've stopped the enclomiphene, and I will hunt the pharmacies for HCG until I figure out why my SHBG is so low, and then I'll come off TRT.

That's disappointing and a bit distressing. Doesn't seem worth the tradeoff.

 

[DixieWrecked]

Yep, this may just be honeymooning. Everything I read has me anticipating this libido will wear off in a few weeks. But with the bigger dose, everything is suddenly working: penile sensitivity, erection strength, morning erections, and actual libido. I wish it could be as simple as taking a week off every few weeks to keep this going.

They mentioned seeing good LH numbers with clomid/enclomiphene. I think you're right about replacing the hCG for clients. That's what this midway call was all about.

That's disappointing and a bit distressing. Doesn't seem worth the tradeoff.

Keep us posted man! I hope it continues and I think it is possible that it may. With anything in life there has to be ups and downs to feel something. Would ice cream taste good if you only ate ice cream?

 

[madman]

Yep, this may just be honeymooning. Everything I read has me anticipating this libido will wear off in a few weeks. But with the bigger dose, everything is suddenly working: penile sensitivity, erection strength, morning erections, and actual libido. I wish it could be as simple as taking a week off every few weeks to keep this going.

They mentioned seeing good LH numbers with clomid/enclomiphene. I think you're right about replacing the hCG for clients. That's what this midway call was all about.

That's disappointing and a bit distressing. Doesn't seem worth the tradeoff.

You just went from a piss poor response using Empowers version of Natesto.

Jumping on 120 mg/week T split (60 mg every 3.5 days) is going to be a huge difference.

You were running around with a dismal TT/FT level and just started injections.

Hormones will be in flux over the following weeks until blood levels stabilize and as you very well know T levels will be rising/increased dopamine, ARs lighting up and it is almost a given that one will experience what we call the honeymoon period (strong increase in libido/nocturnal and daytime erections, euphoric feeling).

Unfortunately, this is temporary and short-lived as the body will eventually adapt.

That intense drive in libido/erections let alone euphoric feeling wane.

Once you achieve steady-state (4-6 weeks when using TC/TE) it will still take time for the body to adapt to the new set-point.

This will become the new norm.

Need to give the protocol 12 weeks to gauge how you truly feel overall regarding low-t symptoms.

Hopefully, you end up with a healthy libido let alone improvements in erectile function/strength.

Get back to us in 8-12 weeks!

Not trying to steal your thunder but as I have stated numerous times on the forum

ED usually has a multifactorial etiology.

The causes of erectile dysfunction let alone decreased libido are complex and multifactorial.

Not as simple as just having healthy hormones (testosterone/free testosterone, estradiol, dihydrotestosterone, prolactin).

Too many caught upon that higher T = raging libido/titanium erections.

Much more going on when it comes to libido/ED than just testosterone!

 

[Nelson Vergel]

But if I do continue, maybe I should just take Defy's dosing advice for both the T cypionate and hCG..?

That is what I would do. Plus 5-10 mg of tadalafil per night if you can tolerate it.

If you don't respond to this, then I would assume there is an emotional/stress/relationship/etc factor involved.

Are you getting erections during your sleep cycle? How about when you masturbate? How frequently do you masturbate and orgasm per week? Any dopamine depleting things that you have not mentioned?

 

[Strengthandlibido]

That is what I would do. Plus 5-10 mg of tadalafil per night if you can tolerate it.

If you don't respond to this, then I would assume there is an emotional/stress/relationship/etc factor involved.

Are you getting erections during your sleep cycle? How about when you masturbate? How frequently do you masturbate and orgasm per week? Any dopamine depleting things that you have not mentioned?

I do get nighttime erections, but was having zero urge to masturbate for several weeks. Things just started to turn around last night after a couple of spaced-apart injections at higher doses. I'm sure my dopamine and norepinephrine systems are a bit jacked from a few misspent years of living the party life, but nothing I'm doing now to deplete dopamine, except maybe my sugar intake. I'm also hyperthyroid, on methimazole, along with Abilify and Wellbutrin for a mood disorder. I also messed with blasting and cruising and self TRT for a few years as I hit middle age. I've been hypogonadal for a while, since I stopped using, but only in the past year as I turned 45 did my libido go to absolute zero.

 

[Nelson Vergel]

Thanks for replying.

I would like to remind everyone on this forum to always ask questions before you start giving suggestions. It never fails to potentially find factors that can explain the issue being discussed.

. I'm also hyperthyroid, on methimazole, along with Abilify and Wellbutrin for a mood disorder.

How long have you been on each, if you don't mind asking? How are you sleeping?

 

[Strengthandlibido]

Thanks for replying.

I would like to remind everyone on this forum to always ask questions before you start giving suggestions. It never fails to potentially find factors that can explain the issue being discussed.


How long have you been on each, if you don't mind asking? How are you sleeping?

It's been a few years on methimazole, and maybe a year on the other two. I sleep well, but I get up after about four hours, every night, no matter what time I go initially fall asleep. But I'm always able to get back to sleep for a few more hours.

 

[Strengthandlibido]

Update: I don't know if the existential, geopolitical stress or what, but my libido has almost completely dried up again. Looks like that surge was just a random one. Let's hope it comes back with a few weeks at the higher, less frequent dose and enclomiphene. @Cataceous, Defy has me doing labs for LH and FSH after about six weeks, so it seems they're looking for the effects 25 mg of enclomiphene a day has on those two levels. I'm now worried about the effect on my cholesterol, but I'm willing to give it a go for just a few weeks.

 

[MIP1950]

Update: I don't know if the existential, geopolitical stress or what, but my libido has almost completely dried up again. Looks like that surge was just a random one. Let's hope it comes back with a few weeks at the higher, less frequent dose and enclomiphene. @Cataceous, Defy has me doing labs for LH and FSH after about six weeks, so it seems they're looking for the effects 25 mg of enclomiphene a day has on those two levels. I'm now worried about the effect on my cholesterol, but I'm willing to give it a go for just a few weeks.

How's your thyroid function, though I know that even people with mood disorders and 'normal' lab values, sometimes respond to thyroid augmentation.

 

[Strengthandlibido]

How's your thyroid function, though I know that even people with mood disorders and 'normal' lab values, sometimes respond to thyroid augmentation.

I see my endo next week. My numbers were good last time,
TSH 1.07 UIU/ML, 0.400-4.100,
Free T3 2.8 PG/ML, 2.2-4.2,
Free T4 1.32 NG/DL, 0.80-1.90
but I think I've developed a bit of goiter, even though I'm up to 60 mg/day of methimazole, which is a lot. I have nodules and was going to have surgery to remove my thyroid entirely, but I chickened out and decided to try to manage it with medication. May be time to reconsider.

 

[Strengthandlibido]

I found this anecdotal gem about adding clomid to TRT in a thread about why clomid doesn't work while on TRT.

Clomid & Testosterone: Why they don't work together - By Mike Gaiso

Lots of interesting talking points!! Here's my angle on it ... The whole purpose of administering HCG or Clomid is for the benefit of LH. Men diagnosed with Secondary Hypogonadism can achieve benefit of testicular well being, and in other areas of the body where LH receptor sites are present...

www.excelmale.com

"I did 50 mg for 2 days to jump start, and have been doing 25mg a day for 2 weeks. To downsize the possibility of the placebo effect, all i expected from the clomid was hopefully to gain my testicles back, and hopefully another little boost to my test for libido, mood, workout,etc. What has happened is a HUGE increase in my libido and my mood. Nothing in the gym yet (time proportional i know). I do feel 20 again. Before 2 weeks ago, i maybe woke up with wood once every 2 months. For the past 5-10 days, its every morning. I am wanting sex every single night too, rather than 2x a week, which was still a huge improvement for me while just on test."

 

[Strengthandlibido]

I just got back some labs and got reminded that exogenous testosterone beats up kidneys. I posted about it here.

My TSH went from <0.01 UIU/ML, 0.400-4.1000 on 2/12/2021 to >100.000 UIU/ML almost exactly a year later on 2/15/2021.

02/12/2021
TSH REFLEX TO FREE T4 <0.010 UIU/ML, 0.400-4.100, Low
FREE T4 (THYROXINE) 2.21 NG/DL, 0.80-1.90, HIGH

11/06/2021
TSH, THIRD GENERATION 1.070 UIU/ML, 0.400-4.100
FREE T4 (THYROXINE) 1.32 NG/DL, 0.80-1.90
FREE T3 2.8 PG/ML, 2.2-4.2

02/15/2022
TSH, THIRD GENERATION >100.000 UIU/ML, 0.400-4.100 ABOVE HIGH NORMAL
FREE T4 (THYROXINE) <0.11 NG/DL, 0.80-1.90 BELOW LOW NORMAL

The top and bottom labs are almost to the day a year apart. I was extremely hyperthyroid a year ago with almost unreadable levels of TSH to extremely hypothyroid now with levels too high to be read accurately. I apparently went too high on my methimazole. I've been developing a goiter lately, too.

My endocrinologist was highly annoyed that I chose to go to a private clinic. She said that with my thyroid situation, no one should be prescribing me testosterone because thyroid status affects testosterone levels so much. But she said it's ultimately my choice. Between my kidneys and my thyroid, I think it may be best to discontinue treatment entirely after all. My problems with low test might have been thyroid-related all along.