Soooo confused about what to do about ED

[RickD]

Im 61, 205, good health. Not interested in bodybuilding just want to be 20 again...lol... OK, who doesn't.

I've been on TRT at .45mg twice a week Subq for over a year and my typical low T symptoms have improved tremendously, concentration, agility, strength, muscle mass. Of course here in Canada you have to be basically dead before they'll prescribe TRT but I get it from a friend.

BUT I'm now having ED problems! Could it be Estrogen? Do I need an AI? Viagra and Cialis barely make a difference.

Here's my latest full workup, any advice is greatly appreciated.

Rick

 

[Joe Sixpack]

Im 61, 205, good health. Not interested in bodybuilding just want to be 20 again...lol... OK, who doesn't.

I've been on TRT at .45mg twice a week Subq for over a year and my typical low T symptoms have improved tremendously, concentration, agility, strength, muscle mass. Of course here in Canada you have to be basically dead before they'll prescribe TRT but I get it from a friend.

BUT I'm now having ED problems! Could it be Estrogen? Do I need an AI? Viagra and Cialis barely make a difference.

Here's my latest full workup, any advice is greatly appreciated.

Rick

The Estrogen looks high, but it is not clear to me that you got the sensitive test. The standard test can sometimes give invalid high readings. So you wouldn't want to take an anti E drug based on an inappropriate lab.

Aside from that I'd be very concerned about the elevated GGT, creatinine, C-reactive protein and the sub par glomerular filtration rate. Your test also flagged a few blood markers as out of range. I don't know much about the blood markers, but I would be asking a doctor about them. I do know that an elevated GGT is not something to ignore.

Are these new to you or have you already been aware of them.

 

[Cataceous]

Your testosterone level is reasonable for twice-weekly injections. Your peak serum level could be around 800 ng/dL (28 nMol/L) if your absorption is typical. Unfortunately you don't seem to have a result for SHBG, which would give some indication of your free testosterone. Estradiol at 64 pg/mL might be high, but chances are this was the standard immunoassay test. This test is known to have cross-reactivity with C-reactive protein, and yours is a little high, which leaves uncertainly about your actual estradiol level until there's confirmation with a test using mass spectrometry. ED can have a lot of different causes, so I wouldn't be too quick to blame estradiol. And you shouldn't even consider an AI until you can get accurate measurements of estradiol. Another worthwhile test is prolactin. This can creep up under TRT and cause problems for some.

 

[RickD]

The Estrogen looks high, but it is not clear to me that you got the sensitive test. The standard test can sometimes give invalid high readings. So you wouldn't want to take an anti E drug based on an inappropriate lab.

Aside from that I'd be very concerned about the elevated GGT, creatinine, C-reactive protein and the sub par glomerular filtration rate. Your test also flagged a few blood markers as out of range. I don't know much about the blood markers, but I would be asking a doctor about them. I do know that an elevated GGT is not something to ignore.

Are these new to you or have you already been aware of them

Never had any issues with bloodwork till I went on TRT but the EGFR has been the same for most of the time since I went on TRT. I know that I don't drink enough water (well hardly any...lol) and I'm working on correcting that last few weeks.

Biggest problem is getting a doctor to actually help me. I went to 7 doctors over a year and a half (3 were endocrinologists, some I waited a year to see) and each and every one said basically the same thing. "Based on your symptoms combined with your tests, you really do likely need TRT. However your tests are just above the legal criteria for me to prescribe it in Canada, I'd lose my license".

The last one (the one I waited a year to see), a little asian woman endocrinologist said the same thing but added "Go to a big gym, find the biggest guy with the biggest muscles and ask him where to get it" I asked "how much should I take?". She replied "Ask the guy you get it from, I'm so rarely able to prescibe it, I have almost no experience" so that's basically what I did.

 

[RickD]

Your testosterone level is reasonable for twice-weekly injections. Your peak serum level could be around 800 ng/dL (28 nMol/L) if your absorption is typical. Unfortunately you don't seem to have a result for SHBG, which would give some indication of your free testosterone. Estradiol at 64 pg/mL might be high, but chances are this was the standard immunoassay test. This test is known to have cross-reactivity with C-reactive protein, and yours is a little high, which leaves uncertainly about your actual estradiol level until there's confirmation with a test using mass spectrometry. ED can have a lot of different causes, so I wouldn't be too quick to blame estradiol. And you shouldn't even consider an AI until you can get accurate measurements of estradiol. Another worthwhile test is prolactin. This can creep up under TRT and cause problems for some.

I will get bloodwork done this week and include SHBG and see if I can get the sensitive Estradiol done.

 

[Gman86]

How’s ur libido?

 

[DixieWrecked]

This is unfortunately not uncommon with TRT. Some people react amazing to it and for some guys it causes ED. If you find a solution please post it. Seems like lowering the dose helps some guys.

I'm going to give no-fap a try and give up porno. I've heard good things. The more I obsess over my dick the more stressed I get And the worse things go.

 

[DragonRider]

I would guess it's your estrogen level. I have the same issue and I can't do anything even with max doses of cialis and viagra. Unfortunately, my libido is through the roof and always has been, so that only adds to the frustration.

 

[madman]

Im 61, 205, good health. Not interested in bodybuilding just want to be 20 again...lol... OK, who doesn't.

I've been on TRT at .45mg twice a week Subq for over a year and my typical low T symptoms have improved tremendously, concentration, agility, strength, muscle mass. Of course here in Canada you have to be basically dead before they'll prescribe TRT but I get it from a friend.

BUT I'm now having ED problems! Could it be Estrogen? Do I need an AI? Viagra and Cialis barely make a difference.

Here's my latest full workup, any advice is greatly appreciated.

Rick

To be honest you should have posted labs right away as we have no clue where your TT/FT/e2/SHBG let alone other blood markers sit as of now as your results are from Jan 5/2021.....over 2 months ago.

Even then looking over your results from 2 months ago you left out 2 key tests.....FT and SHBG!

I am sure I have responded to some of your previous threads as you are a fellow canuck.

Again 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.

It is critical to know where your FT sits on such protocol (dose T/injection frequency).

As Sixpack stated some of your blood markers are out of range and you need to look into this.

You stated that you are injecting .45mg twice a week?

You mean 90 mg T/week split into twice-weekly injections (45 mg every 3.5 days) as most would use the decimal point when meaning .45 ml (strength test could be 100 mg/mL or 200 mg/mL).

When was blood work done.....trough?

Your TT 18.8 nmol/L (544 ng/dL) is far from high.

Need to know where your FT sits!

Your estradiol is absurdly high for a less than robust TT 544 ng/dL.

With a TT 1200 ng/dL my e2 is much lower than yours.

I have used the standard immunoassay in the past and fortunately, the estradiol sensitive (LC/MS-MS) has been available in my province (Ontario) through Dynacare for the past few years.

Mind you yours was tested using the standard immunoassay and although it is very high as was stated earlier your CRP is slightly elevated (but far from high) which can skew results on the standard immunoassay.

Unfortunately the estradiol sensitive (LC/MS-MS) is only available through Dynacare in Ontario and not in your province.

Getting treated for low-t in Canada can be difficult for many and you need to keep in mind that it is far from a dead-end street.