Should I try Testosterone

Tinman said:

I have been on this site for several years and really appreciate all the info and opinions. Posted once several years ago about how “Gene’s Stack” helped me with some sexual function issues. I think increasing NO has helped my overall health in the years since. But the sexual issues have lingered and I've strongly considered TRT for years. I am pretty healthy and overall feel pretty good. Mood and energy is good, eat pretty healthy and workout 4-5 days per week. Play basketball twice a week and mix in weight training and yoga other days. My most recent numbers are…

57 years old
190 lbs

453 ng/dL total t
65.5 pg/dL free t
30 nmol/L shbg
132.2 ng/dL bio available t

My current doctor will not consider TRT at those numbers. But I recently met and talked to some guys locally who highly recommend I get on it. They suggested pellets or injections. From my research I would like to start with cream and see how it goes from there.

I have read many suggestions to newbies and people on the fence like me but curious to get opinions and suggestions from some of you about my specific numbers and situation.

Thank you in advance for your feedback.

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Need to post reference ranges/assay used especially for free testosterone.

You need to test your FT using what would be considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG in order to know where your FT level truly sits.

This is critical!

Even then without knowing what assay was used as sammmy stated you can easily calculate it using your TT, SHBG and Albumin.

This can be done online for free using the linear law-of-mass action cFTV.

If we take your not so stellar TT 453 ng/dL, normal SHBG 30 nmol/L and Albumin 4.3 g/dL (default) then your cFTV would be 9.94 ng/dL which is not low but it is under where a healthy young male would sit which would be 13-15 ng/dL.






Even then no one cared to mention that cFTV tends to overestimate FT.

As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!


*Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].


What is critical here is that you are hitting a cFT 9.94 ng/dL so if you had it tested using the most accurate assay (Equilibrium Dialysis) it would most likely be even lower as in 6-7 ng/dL which is low/bottom-end as most healthy young males would be hitting a FT 12 ng/dL.

Again just to put this in perspective most healthy young males would be hitting a FT 12 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low-mid 20s whether cFTV or standardized ED assay would be high!

Again everyone needs to hammer it in their heads that a TROUGH FT 30 ng/dL is absurdly high.

We are talking TROUGH here too not peak!

Everyone so caught up on thinking they need to be hitting these high/absurdly high troughs to have this so called stellar libido!

Libido let alone erectile function are much more complex!

Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

Have realistic expectations especially when it comes to libido and erectile function

Now getting back to your FT also keep in mind that anyone with a TT 8-12 nmol/L or FT that falls between 5-10 ng/dL would be considered in the grey zone where many men can still experience low-T symptoms at such levels.

This is stated in some of the numerous testosterone therapy guidelines!

Any doctor in the know who is well versed in testosterone therapy that dealt with a patient that had a TT which fell in what would be considered the grey zone or better yet FT <10 ng/dL (100 pg/mL) along with symptoms of low testosterone would treat you.

Dr. Morgentaler who is considered the father of testosterone has treated 1000s of men over decades has stated numerous times that he would treat a man with a FT <10 ng/dL that was experiencing symptoms of low-T!

He would be considered top tier when it comes to (research/clinical experience) in the field!

If I were in your shoes seeing as your FT would easily be <10 ng/dL if tested using the most accurate assay (Equilibrium Dialysis) and I was experiencing symptoms of low-T then I would seek out a doctor well versed when it comes to treating low-T!

Final point that needs to be made here is I would not get too caught up on polymorphism of the AR/CAG repeat length (short/long) as testing for such is not available to the average joe let alone having a longer CAG repeat length is far from common!









*We established mFT reference ranges for healthy men aged 18 to 69 years




We present 95% mFT age-stratified reference ranges



*The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years






*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies


* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1).


Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.





Again!

Yes there is such a thing as AR DDS (distribution, density, sensitivity/polymorphisms).

When it comes to sensitivity of the AR, polymorphism of the AR/CAG repeat length (long/short) tread lightly when you speak on such especially those pushing that everyone and their brother needing to run these very high/absurdly high trough FT levels 30-60 ng/dL in order to experience the beneficial effects of T!

Yes we are talking TROUGH f**king levels here!

Key point here having a CAG repeat length >24 is far from common!


* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]





* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16.





*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In humans, the AR gene comes in many forms, called alleles. The best-studied alleles are those involving a CAG repeat sequence that encodes a polyglutamine tract near the amino end of the androgen receptor. This CAG repeat has different lengths for different people. In humans, the number of AR CAG repeats ranges from as few as 9 to as many as 36, but population averages are typically between 17 and 24 (Chamberlain et al., 1994; Hsiao et al., 1999; Irvine et al., 2000; La Spada et al., 1991). Individuals with higher numbers of AR CAG repeats will normally have diminished testosterone action on cellular functioning, effectively making males with high AR CAG repeats less masculine regarding most sexually dimorphic traits when compared to males with fewer AR CAG repeats (Loehlin et al., 2004; Simanainen et al., 2011)

* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16. Five countries had averages in the 17.00s; they were Swaziland (17.00), Zambia (17.00), Sierra Leone (17.30), Nigeria (17.58), and Senegal (17.90). Five countries had averages of 23.00 or higher; they were Lithuania (23.00), Mongolia (23.00), Ireland (23.07), Thailand (23.10), and Romania (23.16).









AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment




Highly cited paper here!

Eye opener for many!










Libido starts in the brain.

Neurotransmitters have a big impact especially dopamine.

There is a fine balance here when it comes to the dopamine system!

This is key here..... dopamine circuits are powerfully regulated by androgens!


*dopamine circuits are powerfully regulated by androgens

*androgens as potent modulators of prefrontal cortical operations and of closely related, functionally critical measures of prefrontal dopamine level or tone

*androgens dynamically control meso prefrontal dopamine systems and impact prefrontal states of hypo- and hyper-dopaminergia

*dopamine-dependent prefrontal operations appear to universally follow inverted U shaped functions

* androgens maintain a lifelong capacity to bidirectionally modulate prefrontal dopamine tone

*By targeting enzymes and signaling molecules associated with androgenic metabolites of testosterone (Fig 1), these studies more directly implicate androgens in modulating prefrontal function. They also show that both supranormal androgen stimulation and androgen deficiency negatively affects prefrontal operations (Fig 2A). This inverted U- shaped function is similar to that described for functional meso prefrontal dopamine settings (Cools R and D'Esposito M, 2011; Cools R et al.,2019; Floresco SB, 2013; Floresco SB and Magyar O, 2006)

*The data also demonstrate an inverted U-shaped function that describes these dopamine effects. According to this function, prefrontal dopamine levels— often referred to as prefrontal dopamine tone- that are either higher or lower than a functionally optimal set point are detrimental to behavior and circuit function (Fig 2B).




Look over the threads in post #3

*The male sexual response cycle is complex and the exact role of testosterone in mediating libido, arousal, erection, ejaculation, and orgasm is multifactorial

*This hormone isn’t the only biological factor with clear, substantial power over our libidos





*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!

*Studies have shown that once T drops below a threshold of roughly 230 ng/dL, men can begin to experience ED.





* ED only occurs with very low testosterone levels

Testosterone Replacement Therapy​

Low testosterone levels can decrease sex drive and lead to weak erections, though this is rarely the sole cause of erectile dysfunction. Over time, the hormone deficiency can cause penile tissues to atrophy, making erections even more difficult. The condition is easily treatable with testosterone replacement therapy, which can also improve the effectiveness of oral medications. But it’s important to work alongside a doctor to monitor the condition.





*Testosterone replacement therapy can improve several aspects of sexual life, including erection, only in hypogonadal subjects but its contribution alone is clinically effective only in milder forms of erectile dysfunction





CONCLUSIONS AND FUTURE RESEARCH

The literature presented herein illustrates that T mediates erectile function, but it is imperative to note that T is not necessary for satisfactory erections. Two small prospective studies found that erectile responses to visual erotic stimuli were equivalent between hypogonadal men and healthy controls [61, 62]. However, nocturnal penile tumescence and spontaneous daytime erections were diminished in hypogonadal men. This points to the observation that motivation and interest through sexual stimuli can overcome deficiencies in the physiology of the erectile response brought upon by hypogonadism.

Several questions remain despite the robust literature that exists. In the physiology realm, certain pathways may present an opportunity for novel drug targets. For example, the study that examined castration-induced upregulation of sphingosine-1- phosphate and consequent contraction of rat CCSM showed that administering an S1P receptor antagonist reinstated CCSM relaxation [33]. From the structural aspect, corporal cavernosal fibrosis is associated with T deprivation but few studies have assessed the restorative effects of T on animal models of PD.

Clinically, the optimal population of men with ED who will benefit most from TRT is unclear. There were inconsistent results on the impact of age on treatment efficacy and while multiple RCTs have focused on just older men, a parallel large study on younger men is still lacking. The threshold of ED and T deficiency severity for which TRT is efficacious, the dosing of TRT, the timing for initiating combination therapy, and the duration of the treatment have yet to be outlined in clinical guidelines. Presumably, TRT monotherapy could be first-line for patients with severe T deficiency but milder forms of ED (with PDE5i as salvage therapy if the response is poor), whereas combination TRT and PDE5i would be first-line for those with severe T deficiency and severe ED.









Conclusions

In conclusion, this review summarizes the endogenous androgen neuroendocrine system and describes studies evaluating the role of T in human sexual desire and function. Limitations of this review include study inclusion criteria, which did not analyze studies published in languages other than English. Future systematic reviews should be conducted to further analyze the current literature in a regimented manner. Sexual desire is a sequela of complex multifactorial interactions among various biopsychosocial influences.

Both animal and human studies have solidified the role of androgens in the neuroendocrine pathways that regulate sexual desire, and this association has been validated in numerous clinical studies. The strong relationship between T and sexual desire underlies the clinical foundation of TRT in hypogonadal men, with data suggesting increased efficacy in a dose-dependent manner and with the superiority of gel over patch application.





*It is important to recognize that, whatever outcome is considered, the effects of TRT are clearly evident only in the presence of hypogonadal status (ie, total T < 12 nmol/L), whereas the positive effects of TRT are no longer confirmed for higher T levels. In addition, TRT alone can be effective in restoring only milder forms of ED, whereas combined therapy with other drugs is required when more severe vascular damage is present





Conclusion


Both animal and human studies support an association between hypogonadism and ED. Animal studies first elucidated testosterone’s role in maintaining the proper synthesis and/or release of enzymes as well as tissue structure and function in the corpora cavernosa. When low testosterone is present in both animals and humans, erectile function is compromised as a result, which can be improved with testosterone replacement.

Testosterone monotherapy in hypogonadal men without significant comorbidities can improve erectile function in those struggling with ED. Combination therapy with testosterone and PDE-5 inhibitors can lead to improvement in erectile function for hypogonadal men with medical comorbidities who do not respond to monotherapy. Based on the evidence, it is important to screen all men with ED for hypogonadism, especially those with a history of inadequate response to PDE-5 inhibitors, so that the appropriate treatment plan is implemented. Further studies are crucial to better understand the nuances of testosterone treatment for patients with different degrees of hypogonadism and to optimize sexual outcomes in hypogonadal men with ED.





Erectile Dysfunction

Erectile dysfunction (ED) is defined as, “an impairment in the arousal phase of [the male] sexual response” with “consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.”20

The prevalence of ED has been widely reported by a variety of sources. Approximately 20 percent of adult men are reported to have ED.21

ED is typically classified as psychogenic or organic.22 The pathogenesis of ED is multifactorial and can involve multiple underlying disturbances, including vasculogenic, neurogenic, hormonal, and/or medication-induced.

Although most men with ED do not have hypogonadism, ED has been shown to be related to low T levels in some cases. It has been postulated that T may exert local effects to mediate erections based on studies demonstrating fluctuations in serum and corporal T levels during erection.23 Studies have shown that once T drops below a threshold of roughly 230 ng/dL, men can begin to experience ED.21 This is particularly relevant for men undergoing ADT, for whom ED is a well-established potential side effect. Further research is being undertaken to better understand the mechanisms by which hypogonadism affects erectile function.
Low Libido

Meta-analyses investigating the effect of TRT on male sexual function have demonstrated variable improvements in libido. In these studies, TRT led to reported improvements specifically in hypogonadal men, with no change in libido for eugonadal men.32 Furthermore, the benefits of TRT were found to be greater in men with lower baseline levels of T (< 288 ng/dL).35 Although the literature suggests that TRT can improve libido in hypogonadal men, some studies have shown no significant difference in sexual satisfaction after TRT.36




Erectile Dysfunction

In hypogonadal men, TRT has been shown to improve responses to PDE5 inhibitors (PDE5i) for ED.37 Several randomized controlled trials and systematic reviews of hypogonadal men with ED have shown that PDE5i therapy in conjunction with TRT is more effective in improving ED than PDE5i therapy or TRT alone.24,28 Therefore, the AUA recommends that urologists inform hypogonadal men with ED that PDE5i therapy may be augmented by TRT.24

While TRT in hypogonadal men may optimize the efficacy of other ED treatments by restoring normal T levels, there is not adequate data to support combining TRT with other ED treatments.

Similarly, TRT is not recommended as a monotherapy for ED.30

I have read a lot of these arguments over the years and a lot of them are the reason I haven’t tried TRT yet. Still deciding but just a little more info….I have used Cialis and Viagra (along with increasing n/o with food and supplements) and both work pretty well for me. I have also taken macuna Pruriens and p5p for dopamine. Seems to help some as well but always hoping for a little more….
I should probably get a new doctor like recommended but hard to find them without paying out of pocket. I have great insurance but can’t find a doctor with the right experience…..might try the new oral like Kyzatrex before cream?

Tinman said:

I have been on this site for several years and really appreciate all the info and opinions. Posted once several years ago about how “Gene’s Stack” helped me with some sexual function issues. I think increasing NO has helped my overall health in the years since. But the sexual issues have lingered and I've strongly considered TRT for years. I am pretty healthy and overall feel pretty good. Mood and energy is good, eat pretty healthy and workout 4-5 days per week. Play basketball twice a week and mix in weight training and yoga other days. My most recent numbers are…

57 years old
190 lbs

453 ng/dL total t
65.5 pg/dL free t
30 nmol/L shbg
132.2 ng/dL bio available t

My current doctor will not consider TRT at those numbers. But I recently met and talked to some guys locally who highly recommend I get on it. They suggested pellets or injections. From my research I would like to start with cream and see how it goes from there.

I have read many suggestions to newbies and people on the fence like me but curious to get opinions and suggestions from some of you about my specific numbers and situation.

Thank you in advance for your feedback.

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I’m 58 185lbs. and started Trt late last year due to low T at 152 total. I’m in remission from Hodgkin’s lymphoma and was down to 150lbs. My doctor started me on Androgel and it worked for several months, but I was never able to get my total T above 358 and the pre-Trt symptoms returned. My endocrinologist started me on injections of test cypionate three months ago and that’s when everything changed for the better! My muscle mass, libido, mood, cognition, have all skyrocketed and I’ve never felt better in my life. I needlessly suffered for way too long due to my ignorance and needle phobia.
I’m telling you my Brother, being “pretty healthy” and feeling “pretty good “ is really not adequate when you can be completely healthy and feel absolutely amazing through lifestyle changes and today’s modern medicine!
I encourage you to find a doctor that is knowledgeable and can get you the care that you deserve at a reasonable cost.
My life changed dramatically after getting a terminal illness diagnosis and Trt has been a Godsend…

Tinman said:

I have read a lot of these arguments over the years and a lot of them are the reason I haven’t tried TRT yet. Still deciding but just a little more info….I have used Cialis and Viagra (along with increasing n/o with food and supplements) and both work pretty well for me. I have also taken macuna Pruriens and p5p for dopamine. Seems to help some as well but always hoping for a little more….
I should probably get a new doctor like recommended but hard to find them without paying out of pocket. I have great insurance but can’t find a doctor with the right experience…..might try the new oral like Kyzatrex before cream?

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What are the issues you are hoping to resolve? If you are able to fix your ED issues with cialis and viagra then there must be other things you are still wanting to improve beyond that.

Tinman said:

I have read a lot of these arguments over the years and a lot of them are the reason I haven’t tried TRT yet. Still deciding but just a little more info….I have used Cialis and Viagra (along with increasing n/o with food and supplements) and both work pretty well for me. I have also taken macuna Pruriens and p5p for dopamine. Seems to help some as well but always hoping for a little more….
I should probably get a new doctor like recommended but hard to find them without paying out of pocket. I have great insurance but can’t find a doctor with the right experience…..might try the new oral like Kyzatrex before cream?

Click to expand...

No responsible doctor will prescribe you TRT because you simply don't have the symptoms of hypogonadism (your energy and mood are good) and your testosterone is low normal. Erection problems are caused by a much wider group of diseases than just low T (and it must be much lower than yours).

The ones "advising" you here to do TRT are citing their own story before TRT, which has nothing in common with yours. Most of them didn't read carefully your story, they are too busy with their own LOL

For your erectile problems, I would check first if you have arteriosclerosis, diabetes, nerve damage with a neurologist (they are not very helpful for sexual problems), and then a Dopler ultrasound of the penis to see if there is a structural defect (vein leackage).

If all that is fine, then go ahead and try TRT. It is highly likely you will be underwhelmed from "getting on the juice". All fantasies of a sudden man superpower will evaporate in a few months on proper TRT. It is miraculous for really hypogonadal people and just blah for people with normal T.

sammmy said:

No responsible doctor will prescribe you TRT because you simply don't have the symptoms of hypogonadism (your energy and mood are good) and your testosterone is low normal. Erection problems are caused by a much wider group of diseases than just low T (and it must be much lower than yours).

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He reported mild ED. And madman suggested to measure FT precisely. I'm not convinced that TRT would not help. On the other hand I'm not convinced that TRT would help.

sammmy said:

The ones "advising" you here to do TRT are citing their own story before TRT, which has nothing in common with yours.

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I agree.

sammmy said:

Most of them didn't read carefully your story, they are too busy with their own LOL

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Still I believe they mean well.

sammmy said:

For your erectile problems, I would check first if you have arteriosclerosis, diabetes, nerve damage with a neurologist (they are not very helpful for sexual problems), and then a Dopler ultrasound of the penis to see if there is a structural defect (vein leackage).

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Excluding/checking every other cause, in theory the best approach.

sammmy said:

If all that is fine, then go ahead and try TRT. It is highly likely you will be underwhelmed from "getting on the juice". All fantasies of a sudden man superpower will evaporate in a few months on proper TRT. It is miraculous for really hypogonadal people and just blah for people with normal T.

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I feel you. If I had only mild ED and the wellbeing and performance he described I would prefer the simple and cheap option of a pde5 inhibitor.
Being aware of the symptoms of hypogonadism is very useful, and checking the T levels regularly is useful too.

Almost forgot to mention the option of clomid to boost T levels and check the effect on mild ED.

sammmy said:

No responsible doctor will prescribe you TRT because you simply don't have the symptoms of hypogonadism (your energy and mood are good) and your testosterone is low normal. Erection problems are caused by a much wider group of diseases than just low T (and it must be much lower than yours).

The ones "advising" you here to do TRT are citing their own story before TRT, which has nothing in common with yours. Most of them didn't read carefully your story, they are too busy with their own LOL

For your erectile problems, I would check first if you have arteriosclerosis, diabetes, nerve damage with a neurologist (they are not very helpful for sexual problems), and then a Dopler ultrasound of the penis to see if there is a structural defect (vein leackage).

If all that is fine, then go ahead and try TRT. It is highly likely you will be underwhelmed from "getting on the juice". All fantasies of a sudden man superpower will evaporate in a few months on proper TRT. It is miraculous for really hypogonadal people and just blah for people with normal T.

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Says the guy who cited a “study” of ELEVEN people where they artificially crashed test levels, provided trt at two different doses, then followed up after 30 days and made a blanket conclusion.



A conclusion that goes against many of the other studies shared in this thread I would add. And as mentioned above, he has mild ED which trt can help with….despite how often you scream that his levels aren’t low when they are definitely on the lower end of the range. It appears you want things to be very cut and dry, but unfortunately the real world isn’t that simple.

I'm still waiting for the "many" people "here and there" that allegedly had normal T levels and cured erection problems with TRT LOL

Unfortunately, I agree in this case with all urologists and endocrinologists. It's not that they are "outdated" but they know the research, and have the real world experience trying to treat such people with TRT. The reality is that it's unlikely to work, the rest is fantasies from broscience land.

It always amazes me on this forum how the actual story of the OP is not being understood or analyzed, nor an attempt is made to look for the actual problem but instantly everyone jumps on the TRT as a panacea for everything and hormones as an explanation for anything. In medicine this doesn't work. Unless you pinpoint the root cause, treating it with random overhyped "solutions" is unlikely to work.

sammmy said:

I'm still waiting for the "many" people "here and there" that allegedly had normal T levels and cured erection problems with TRT LOL

Unfortunately, I agree in this case with all urologists and endocrinologists. It's not that they are "outdated" but they know the research, and have the real world experience trying to treat such people with TRT. The reality is that it's unlikely to work, the rest is fantasies from broscience land.

It always amazes me on this forum how the actual story of the OP is not being understood or analyzed, nor an attempt is made to look for the actual problem but instantly everyone jumps on the TRT as a panacea for everything and hormones as an explanation for anything. In medicine this doesn't work. Unless you pinpoint the root cause, treating it with random overhyped "solutions" is unlikely to work.

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A few things here…

I didn’t say trt will “cure” ed issues, I said there are people who have had what you would call normal test levels that started trt and saw improvements to libido and erection quality. You can count me as an example in that group. Libido and erection quality weren’t even an issue for me before I started and weren’t deciding factors when I considered whether or not to start. Yet both saw improvement. And despite your claim that libido boost will be very short-lived, I’ve been on trt for over 3 years and it’s still higher than what was already a good baseline when I started. Plenty of studies were shared in this thread that indicate people with what would call normal test levels can see erection improvement with trt. Yes, it may not be as big of an improvement as what is seen in people with lower levels, but that wasn’t your claim. That isn’t “bro science” no matter how many times you call it that.

Secondly, you were the first person in the thread to suggest to OP that he could start trt. Not sure why you’re so upset that others did the same, or shared their success stories. I do agree with your approach that he start with cialis or viagra though. But now we found out that he has tried those and they both worked pretty good, so there must be other things he is wanting to improve. And it’s quite possible trt could help him, again, regardless of how much you want to call it “broscience”. Like you said, maybe he could try it for a few months and see how he feels.

Drive your serum FT let alone DHT through the roof, far from a given that this would lead to stellar erections let alone a raging libido!

Same could be said when it comes to individuals genetically predisposed to MPB as sensitivity/saturation point of the AR to DHT is what truly matters not high serum DHT!

One does not need to have high serum DHT to experience such!

Threshold/saturation point AR (skin, prostate, erectile/corpora cavernosal tissue) is what's key here!

Pure broscience that driving up ones FT let alone DHT high/absurdly high will have one running around with titanium erections and a raging libido to boot!

LOL!

Again everyone so caught up on thinking they need to be hitting these high/absurdly high trough FT levels let alone high/absurdly high DHT to have this so called stellar libido/titanium erections!

Libido let alone erectile function are much more complex!

Again having a healthy FT/DHT is only one piece of the puzzle as libido let alone ED are multifactorial.

Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your DHT/trough FT.

Have realistic expectations especially when it comes to libido and erectile function!




*There is a complex relationship between ED and serum testosterone levels

*Further support for the androgen-dependent extent of erectile function includes a threshold testosterone value of 200 ng/dL for regular nocturnal erections

*Arteriogenic ED, which accounts for a majority of cases

*The pathologic mechanism underlying arteriogenic ED is likely multifactorial, including 1 or more of the following, as suggested by Musicki and colleagues41 in a 2015 review: (1) endothelial dysfunction, (2) smooth muscle alterations, (3) autonomic dysregulation (discussed later), (4) hypogonadism (see endocrine section), and (5) metabolic defects

*Alterations of vascular smooth muscle content and function have been suggested as contributing factors to ED





*ED often is the end result of multiple pathophysiologic processes

*Arteriogenic ED, which accounts for a majority of cases, has been strongly linked to the following conditions: hypertension, hyperlipidemia, tobacco use, metabolic syndrome/obesity, sedentary lifestyle, diabetes, and pelvic radiation.33–38 Doppler ultrasound has been used to correlate decreased peak systolic velocity of the cavernosal arteries with underlying vascular disease and risk of cardiovascular events.39,40

*The pathologic mechanism underlying arteriogenic ED is likely multifactorial, including 1 or more of the following, as suggested by Musicki and colleagues41 in a 2015 review: (1) endothelial dysfunction, (2) smooth muscle alterations, (3) autonomic dysregulation (discussed later), (4) hypogonadism (see endocrine section), and (5) metabolic defects

*Alterations of vascular smooth muscle content and function have been suggested as contributing factors to ED

*There is a complex relationship between ED and serum testosterone levels

*Further support for the androgen-dependent extent of erectile function includes a threshold testosterone value of 200 ng/dL for regular nocturnal erections

*Studies have demonstrated that testosterone and DHT stimulate nNOS gene expression and increase NO in the corpora during erections.72,74 Van den Broeck and colleagues75 confirmed dose-dependent relaxation of human corpora cavernosal tissue with increasing testosterone and DHT

*Hyperprolactinemia results in reproductive as well as sexual dysfunction. Symptoms associated with hyperprolactinemia include loss of libido, ED, galactorrhea, gynecomastia, and infertility. These symptoms typically occur only at severely elevated levels (>35 ng/mL or 735 mU/L).76

*Hyperthyroidism or hypothyroidism also may be associated with ED.

*A direct effect of thyroxine may also be at play in thyroid hormone ED because both alpha and beta thyroxine receptors have been shown to be present in endothelial and smooth muscle cells from human corpora cavernosa.82

*Psychogenic ED may not be a primary etiology in most cases but it is a contributing factor in virtually all cases

*The degree to which ED is psychogenic versus physiologic is difficult to parse out; isolated psychogenic ED is considered a diagnosis of exclusion clinically.

I kind of feel like @sammmy and @madman are constructing strawmen then arguing against them. Who said he should drive free t through the roof, or that if he does it would resolve all of his issues? From what I read in this thread it appeared everyone agrees sexuality is a complex phenomenon with lots of different factors. Trt can and often does help with this, but obviously there are other things people need to consider when seeking to resolve issues in those realms.

Phil Goodman said:

I kind of feel like @sammmy and @madman are constructing strawmen then arguing against them. Who said he should drive free t through the roof, or that if he does it would resolve all of his issues? From what I read in this thread it appeared everyone agrees sexuality is a complex phenomenon with lots of different factors. Trt can and often does help with this, but obviously there are other things people need to consider when seeking to resolve issues in those realms.

Click to expand...

Yes no one stated such but these are things that need to be pointed out as many of the misinformed are brainwashed into thinking that jumping on T or better yet driving ones FT let alone DHT through the roof will cure all which ails them especially when it comes to libido let alone ED!

Nonsense littered in numerous threads on here!

Again everyone needs to keep in mind that although testosterone metabolites estradiol and DHT play a critical role in libido/erections that there is much more involved than just testosterone, estradiol, dihydrotestosterone, prolactin.

Although having healthy hormones is essential the shitkicker here is that libido/ED is multifactorial!

Most of those sheep lurking on here let alone polluting all those so called men's health/HRT forums would be preaching that more T is better mentality!

Going to stomp this out quick on here.

madman said:

Yes no one stated such but these are things that need to be pointed out as many of the misinformed are brainwashed into thinking that driving ones FT let alone DHT through the roof will cure all which ails them especially when it comes to libido let alone ED!

Nonsense litterd in numerous threads on here!

Click to expand...

Fair enough, and I pretty much always enjoy and appreciate the depth of your posts. If you think it’s bad here, you should see some of the other places online! The attention to detail and nuance along with depth of information here is one of the reasons I frequent this place instead of some of the others.