ED issues with TRT absolutely lost and local doctors dont seem to have any answers.

Long story but thought overview would be best. Major health issue 2020 with oesophageal bleed which was put down to long term steroid use. Nearly died, double blood transfusion and was told to not take any PCT as my body would recover in time (was 35 at the time) over a year later and no recovery so TRT company started me on TRT. Absolute nightmare ever since, various dosage alterations, different TRT companies and ED plus low libido etc still as bad as before it started. Been on low dose, high dose, various esters and nothing seems to work for more than a few weeks then crashes again. Pretty sure it’s something to do with oestrogen levels and AI use not sitting well with my body, seems even low dose fortnightly can crash things. Last blood tests (attached) came back and TRT doc said I should feel great on those numbers. No sex drive, brain fog and ED issues still major problem. Can’t remember my last morning erection and need high dose viagra 200mg to do anything and even that’s only 7/10 at best. Thought I’d reach out and see if anyone at all has any ideas or input at this stage? Tempted to just taper off and accept defeat but at 39 and the mrs blaming herself that’s going to be a disaster also.

Anyone not responded to TRT at all or had major issues finding any balance? Or anyone else really struggled with oestrogen management?

NHS endocrinologist has said to stop listening to TRT company as they promote bad protocol and said 250mg of sustanon once every 3 weeks is all they would suggest. Urology have said nothing physically wrong so must be hormonal.

Really wish I hadn’t started and feel completely lost at this stage

Spartan1985 said:

Major health issue 2020 with oesophageal bleed which was put down to long term steroid use. Nearly died

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Spartan1985 said:

Been on low dose, high dose, various esters and nothing seems to work for more than a few weeks

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Steroid abuse can cause damage to various processes in your body that can take years to recovery.

Your tolerance to androgens is probably the issue here due to abusing steroids.

I don't think TRT alone is going to fix your issues.

Spartan1985 said:

Anyone not responded to TRT at all or had major issues finding any balance?

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TRT unbalance me. I was on TRT for 8-9 years, never felt right beyond 3 weeks, steady states was the end of feeling balanced and normal. I always felt symptoms of iron overload.

My health problems years ago was mainly the type 2 diabetes causing my issues, if my success now is any indication.

Now I'm off TRT for almost 3 months and haven't felt this good in more than 30 years.

Things just keep getting better.

Systemlord said:

Steroid abuse can cause damage to various processes in your body that can take years to recovery.

Your tolerance to androgens is probably the issue here due to abusing steroids.

I don't think TRT alone is going to fix your issues.

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Thanks for taking the time to reply. In your opinion would you say TRT would still be part of the recovery or any ideas on alternative options? Tempted to taper off and use long PCT to try restart to normal at this stage just to see how that feels in comparison

Systemlord said:

TRT unbalance me. I was on TRT for 8-9 years, never felt right beyond 3 weeks, steady states was the end of feeling balanced and normal. I always felt symptoms of iron overload.

My health problems years ago was mainly the type 2 diabetes causing my issues, if my success now is any indication.

Now I'm off TRT for almost 3 months and haven't felt this good in more than 30 years.

Things just keep getting better.

My HPTA recovery log: I have reversed my type 2 diabetes (SHBG 31/glucose 80) and may have never had hypogonadism!!

I’ve made the decision to come off TRT and restore my natural hormone production and reverse my diabetes. I’ve identified my problems on TRT and they are as follows, Testosterone suppresses hepcidin, which is a peptide hormone that regulates iron absorption. When hepcidin is suppressed more iron...

www.excelmale.com

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That’s around how long I get a lift for when I alter dose, swap ester or change oestrogen management approach then symptoms return. Not sure if that’s a placebo or my body just gets used to the change and reverts back to previous damaged state

Spartan1985 said:

That’s around how long I get a lift for when I alter dose, swap ester or change oestrogen management approach then symptoms return. Not sure if that’s a placebo or my body just gets used to the change and reverts back to previous damaged state

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Spartan1985 said:

Thanks for taking the time to reply. In your opinion would you say TRT would still be part of the recovery or any ideas on alternative options?

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As long as you don’t push things too hard, overdose, TRT can be apart of the recovery process. Remember, if your body’s recovering from excess androgens, that’s the last thing you want to do.

First TRT company started me on 0.7mg sustanon 250mg/ml every 7 days, then went to 0.8mg every 7days. They tried dropping to 0.5mg every 5days but oestrogen seems harder to control on sustanon. Currently running 120mg of twice weekly injections 60mg every 3days. That’s what I was running when blood test results attached were taken on trough day. Do you think the oestrogen to free T ratio is wrong in any way? Another doctor said run a higher dose T, let the oestrogen come up but use tamoxifen rather than AI. Totally punch drunk with all this now

You said you tried different esters, doses and additional compounds (like AI), can you give us a chronological list of all your tried and the doses, to get a feel for what you've been doing? Overall it doesn't seem like your T:E2 ratio is off.

Thanks for the reply. At this stage I couldn’t provide a full exact list but an overview would be as follows.

Sustanon as described 0.7ml of 250mg/ml every 7days
Sustanon 0.8ml of 250mg/ml every 7days
Sustanon 0.5ml 250mg/ml every 5 days. At this stage 250iu hcg twice weekly introduced and half a tab of anastrazole which flattened oestrogen and killed all progress.

They swapped me to test prop at 30mg every other day 150iu hcg no AI. Worked on for around a month the all symptoms returned. Oestrogen response seemed minimal with prop as opposed to sustanon so TRT doc suggested going higher dose just to see how I reacted. Upto 50mg EOD 150iu hcg no AI. Libido responded well, training responded well but ED still an issue. Manageable with Sildenafil or vardenifil though although at much higher than normal dose.

Bloods came back way too high for legit trt company who said obviously I was way outwith their normal range they can take people too test level wise so would need to try different approach.

Test E next with high dose of 90mg twice weekly to start 250iu hcg with Aromasin introduced half a tablet every 3rd injection. Again couple of weeks to a month or so then libido crash, Ed issues, brain fog, penile atrophy. Same loop as before.

TRT doc said he was out of options and didn’t know how to proceed. Suggested maybe speaking to a doctor in Greece regarding risk management to using higher than prescribed dose safely as that’s when I felt the best.

Second opinion from new TRT provider, asked if fertility was necessary which it isn’t as a father of 3 so he said reducing overall test load by dropping hcg may reduce need for AI. Introduce 25-50mg ED of proviron with 180mg per week (90mg twice weekly shot of Test E) and see how this goes. This probably led to the best reduction of symptoms to date however 2-3months later same issues return low libido, ED, brain fog, irritability etc.

Back to TRT doc who said let’s reduce all dosages and remove proviron to see what low dose TRT with fortnightly AI at half a tab of aromasin (I seem to tolerate this better than an Anastrozole which just flattens me for around a month) get the figure back to a normal range and see how it feels.

That’s what the recent attached blood results were, at this stage he is a little lost. Doesn’t agree with saturated androgen receptors as I suggested that but as I didn’t take mega high dose test cycles although very long cycles doesn’t believe I would have blocked androgen receptors. Said he had worked with various bodybuilders who had taken mega high dose long cycles and who could still find some success with TRT.

He said there must be something else physically causing the issues im having and test won’t fix them.

At this stage is it even worth continuing trying? I know people take a year or two sometimes longer to dial in protocol but is it usually this turbulent?

Should I just taper off and run long PCT and accept whatever happens at the end of that?

Just give up and run high dose test prop and enjoy the highs while accepting the inevitable crashes along the way.

Absolutely lost at this stage. NHS endocrinologist said all TRT companies are over selling their products and said come off, let system crash for 6months then go see them for a test. If low then get 1ml of 250mg/ml sustanon every 2-3weeks no AI no hcg.

Honestly I think you're just messing with too many things at the same time. From one change to another you switch ester, dose, HCG, no HCG, AI, no AI, etc., it's hard to figure out what's going on when so many things change. It would also be good to check your DHT on injections to see if it's too low. I think you "crashed" in many cases, because you lowered E2 too much, it usually takes 2-4 weeks to saturate, so it might reduce it enough in the beginning to feel good, but then it goes further and crashes E2. It's also possible that your doses have been too high thus the reason for your E2 issues. Just from what you've written I'd take something like 120-140 mg/week of Test Prop without anything else, no HCG, no AI. I'd run this for a while and see how you feel and if E2 symptoms return again.

ziegen said:

Honestly I think you're just messing with too many things at the same time. From one change to another you switch ester, dose, HCG, no HCG, AI, no AI, etc., it's hard to figure out what's going on when so many things change. It would also be good to check your DHT on injections to see if it's too low. I think you "crashed" in many cases, because you lowered E2 too much, it usually takes 2-4 weeks to saturate, so it might reduce it enough in the beginning to feel good, but then it goes further and crashes E2. It's also possible that your doses have been too high thus the reason for your E2 issues. Just from what you've written I'd take something like 120-140 mg/week of Test Prop without anything else, no HCG, no AI. I'd run this for a while and see how you feel and if E2 symptoms return again.

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I think it probably reads much worse than it was as the changes were over around 2.5years but the point stands as felt that way myself with the changes the TRT doc was making. Think when I didn’t respond as expected he was a bit lost to be honest. Interested in what you mean about check DHT I assume that’s blood work? Haven’t seen that result in any test I’ve had so I’m assuming I would have to find a lab that tests for that?

I’d defo agree with the crashes that’s exactly how it feels repeatedly. I’d say he started fairly high dose then tapered down and seems even at relatively low dose I still get repeated crashes.

At the moment only running about that dose of test E with very intermittent use of 1/2 tab of aromasin every 3rd or 4th jab and still feel the same. Could try swapping to test prop and drop the AI altogether to see where it goes. I appreciate you taking the time to read and respond been feeling pretty out of options and deflated with the whole thing

Spartan1985 said:

I think it probably reads much worse than it was as the changes were over around 2.5years but the point stands as felt that way myself with the changes the TRT doc was making. Think when I didn’t respond as expected he was a bit lost to be honest. Interested in what you mean about check DHT I assume that’s blood work? Haven’t seen that result in any test I’ve had so I’m assuming I would have to find a lab that tests for that?

I’d defo agree with the crashes that’s exactly how it feels repeatedly. I’d say he started fairly high dose then tapered down and seems even at relatively low dose I still get repeated crashes.

At the moment only running about that dose of test E with very intermittent use of 1/2 tab of aromasin every 3rd or 4th jab and still feel the same. Could try swapping to test prop and drop the AI altogether to see where it goes. I appreciate you taking the time to read and respond been feeling pretty out of options and deflated with the whole thing

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The problem is that TRT is very individual, I'm sure that what you've done would have helped many people, but it doesn't work for you specifically. In this case the doctors are lost as why doesn't it work for you as it does for others? I'm the same way and in our cases we have to think and experiment for ourselves and do it in some systematic fashion.
I'd suggest stopping Test E and 1 week after the last injection starting Test P. Do Test P at 122.5mg/week (17.5mg per day) every morning and be consistent with the timing. After another week Test E should be mostly out of your system and Test P should be saturated. This is a somewhat lower dose compared to what you've been given and along with frequent injections E2 should definitely be lower. I wouldn't expect any crashes as longer esters or supporting substances (AIs, Proviron) start to show its effectiveness after 3 weeks or so, which kind of fits with your crashes. Here you should be quite stable 2 weeks after stopping Test E, it would be odd to suddenly crash. If you crash I'd do a blood test immediately to see what the state is and what could be wrong before continuing.
DHT is a hormone that gets converted from T. On injections it's known to have a lower conversion than being natural. It's mildly anti estrogenic and has a lot of other benefits, including emotional and sexual. Would be worth checking this hormone to see if it's low compared to total T. I'm on self administered TRT so I just go to my local lab when I want to and pay for the hormonal test out of pocket. I can tell them what exactly I want tested. In my case I go to Synlab which is a well known private blood test provider in Europe. Not sure if it's available in your town.

Thank you for taking the time to explain that. I’m happy to try that approach so will get some P ordered and follow the advice you have been kind enough to provide. It makes a lot of sense, will need to try learn self administered delt injections though if doing daily as my mrs and I work different shifts and she’s been my injection provider to date. 1inch needle into delt should be ok? I would have to contact the blood test provider and ask if that’s possible for them to test for that during next set of bloods. Will order a blood test kit anyway so it’s on hand in case of crash after the 3 weeks or so. I’m glad you may see some sort of pattern to what’s being going on and I’m not a total lost cause. Yeah I didn’t mean to sound disrespectful to the 2 TRT docs to date but think my reaction and their tight guidelines made figuring my reaction out a little difficult for them.

Will post results on the above in around 4 weeks or so allowing for Test P ordering and E clearance time of a week.

Genuinely appreciate you taking the time to write such a detailed response, you have no idea how much help that is for me right now. Have a great weekend

Hey Spartan I don't know if you read a lot of threads on this forum or not, but a lot of members here are getting excellent results on injecting as low as 10mg a day of test prop, test enanthate, or test cypionate by IM. I would stongly recommend daily injections. Its such a game changer for a lot of guys. I myself was doing 12mg daily of test enathate for 3 months and I did not have any problems. I just recently switch up my protocol again and Im now doing 10mg of test cypionate per day because 12mg of test per day made my total and free test go above the range value. With about a year of experimenting, I found that test enanthate seems to work the best for me so far, but I want to give test cypionate a go for awhile to see if its any better for me or not. If your worried about injecting test everyday by IM, then you could inject every day by SQ, although IM is the better choice

RotnGun said:

Hey Spartan I don't know if you read a lot of threads on this forum or not, but a lot of members here are getting excellent results on injecting as low as 10mg a day of test prop, test enanthate, or test cypionate by IM. I would stongly recommend daily injections. Its such a game changer for a lot of guys. I myself was doing 12mg daily of test enathate for 3 months and I did not have any problems. I just recently switch up my protocol again and Im now doing 10mg of test cypionate per day because 12mg of test per day made my total and free test go above the range value. With about a year of experimenting, I found that test enanthate seems to work the best for me so far, but I want to give test cypionate a go for awhile to see if its any better for me or not. If your worried about injecting test everyday by IM, then you could inject every day by SQ, although IM is the better choice

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Hi, thanks for the reply. Yeah that’s the next thing I’m going to try as not an approach tried so far and had some great info provided by another member. Order some test P (which seems to have had best results so far for me) going to wait a week after last shot of E then 17.5mg daily. Yeah daily injections will mean having to do it myself as usually my mrs does it but with our shift pattern I’ll be learning to do it myself. Going to try IM into delts each morning as flexibility wise literally couldn’t successfully inject the glute. Thanks for the reply, feeling a little more optimistic hearing other guys have had success this road. Hoping it’s the result that’s been evading me so far, fingers crossed anyway

Spartan1985 said:

Hi, thanks for the reply. Yeah that’s the next thing I’m going to try as not an approach tried so far and had some great info provided by another member. Order some test P (which seems to have had best results so far for me) going to wait a week after last shot of E then 17.5mg daily. Yeah daily injections will mean having to do it myself as usually my mrs does it but with our shift pattern I’ll be learning to do it myself. Going to try IM into delts each morning as flexibility wise literally couldn’t successfully inject the glute. Thanks for the reply, feeling a little more optimistic hearing other guys have had success this road. Hoping it’s the result that’s been evading me so far, fingers crossed anyway

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Personally, if I were you, I would first try out 12mg of test prop per day, injecting morning time/or upon awakening along with 75iu of HCG per day. Keep at this protocol for 2 months and then get blood test done. Depending how you feel and what your blood test are, you can easily adjust the dosage up or down from 12mg a day, but keeping the HCG dose the same. When I was on test prop at 10mg a day and HCG at 75iu per day, my total test was was 790ng/dL and free test was 17.6ng/dL and estradiol at 29pg/mL after 12 hours of injection, which are really good numbers

RotnGun said:

Personally, if I were you, I would first try out 12mg of test prop per day, injecting morning time/or upon awakening along with 75iu of HCG per day. Keep at this protocol for 2 months and then get blood test done. Depending how you feel and what your blood test are, you can easily adjust the dosage up or down from 12mg a day, but keeping the HCG dose the same. When I was on test prop at 10mg a day and HCG at 75iu per day, my total test was was 790ng/dL and free test was 17.6ng/dL and estradiol at 29pg/mL after 12 hours of injection, which are really good numbers

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Seems logical, can I ask why you suggest such a high dosage over the week of hcg? (Compared to what I’ve been prescribed over the last year) I’m going to try what Ziegen recommended with slightly higher Prop dose with no hcg at all to start as so far the issues seem to come from E2 so from my limited understanding his protocol should have less e2 spike and see if I need to adapt from there. If I don’t get any relief from symptoms with that I’ll try lower dose Prop with some hcg and see how I react to that. Do you defo think 75iu per day is needed? I have no fertility requirements as already have 3 kids and honestly couldn’t cope with a 4th lol

I don't think it makes sense in using HCG if you're having Estradiol issues, as HCG is known to increase it to a good degree. You should find what works for by using the least amount of substances, adding other substances should be done after you stabilized the protocol you currently run. Also HCG doesn't need to be injected everyday, 2-3x a week is fine, because of its half life. 75 IU/day (525 IU/week) also isn't a too high of a dose, I'd say the typical weekly dose is 500-1000 IU.
Test P is great for many reasons and one of them is quick symptom relief and saturation, you should have stable blood levels after 1 week. This means you can very quickly adjust your protocol, which is great if you're experimenting on how your body works and reacts. However I'd still do regular blood tests to see where you stand with some dose. While it's not bad to try out a lower dose, the reality is that if your trough is at 500 with 120mg/week, then with 84mg/week your dose might be too low and you'd feel bad. Nothing wrong with trying it out anyway, but having some data at least explains what's going on and sets some expectations. Personally I did regular blood tests during my experimentation, but I mostly tested just total T and E2, as this was enough to tell me what's going on, and to keep the costs of tests as low as possible.

If your interested here is my own thread about my experimentation with a bunch of updates: Test P improved TRT, libido still at 0 – what next?

ziegen said:

I don't think it makes sense in using HCG if you're having Estradiol issues, as HCG is known to increase it to a good degree. You should find what works for by using the least amount of substances, adding other substances should be done after you stabilized the protocol you currently run. Also HCG doesn't need to be injected everyday, 2-3x a week is fine, because of its half life. 75 IU/day (525 IU/week) also isn't a too high of a dose, I'd say the typical weekly dose is 500-1000 IU.
Test P is great for many reasons and one of them is quick symptom relief and saturation, you should have stable blood levels after 1 week. This means you can very quickly adjust your protocol, which is great if you're experimenting on how your body works and reacts. However I'd still do regular blood tests to see where you stand with some dose. While it's not bad to try out a lower dose, the reality is that if your trough is at 500 with 120mg/week, then with 84mg/week your dose might be too low and you'd feel bad. Nothing wrong with trying it out anyway, but having some data at least explains what's going on and sets some expectations. Personally I did regular blood tests during my experimentation, but I mostly tested just total T and E2, as this was enough to tell me what's going on, and to keep the costs of tests as low as possible.

If your interested here is my own thread about my experimentation with a bunch of updates: Test P improved TRT, libido still at 0 – what next?

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Might want to tell the guy to tread lightly when it comes to driving up your FT too high off the hop!

Better yet the complexity involved when it comes to libido and erectile function!

Everyone so caught up on T, DHT and estradiol LMFAO!

Much more involved than just having healthy hormones!









*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





Much more to the story when it comes to testosterones impact on libido/erectile function!


*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!

ziegen said:

I don't think it makes sense in using HCG if you're having Estradiol issues, as HCG is known to increase it to a good degree. You should find what works for by using the least amount of substances, adding other substances should be done after you stabilized the protocol you currently run. Also HCG doesn't need to be injected everyday, 2-3x a week is fine, because of its half life. 75 IU/day (525 IU/week) also isn't a too high of a dose, I'd say the typical weekly dose is 500-1000 IU.
Test P is great for many reasons and one of them is quick symptom relief and saturation, you should have stable blood levels after 1 week. This means you can very quickly adjust your protocol, which is great if you're experimenting on how your body works and reacts. However I'd still do regular blood tests to see where you stand with some dose. While it's not bad to try out a lower dose, the reality is that if your trough is at 500 with 120mg/week, then with 84mg/week your dose might be too low and you'd feel bad. Nothing wrong with trying it out anyway, but having some data at least explains what's going on and sets some expectations. Personally I did regular blood tests during my experimentation, but I mostly tested just total T and E2, as this was enough to tell me what's going on, and to keep the costs of tests as low as possible.

If your interested here is my own thread about my experimentation with a bunch of updates: Test P improved TRT, libido still at 0 – what next?

Click to expand...

Personally I did regular blood tests during my experimentation, but I mostly tested just total T and E2, as this was enough to tell me what's going on, and to keep the costs of tests as low as possible.

TT means nothing without knowing where your FT level sits!

Again as I have been preaching on the forum over the years although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects!

Throw in the RBCs, hemoglobin and hematocrit too which are also critical blood markers that one needs to know when using exogenous T!

It was stressed in my reply to you how absurd your trough FT was on that whopping daily dose of TP you were injecting!

As you should very well know TP has more active T/mg.

Again to put this in perspective.

We can nitpick here on the approx free equivalents but you get the point!

25 mg TP (175 mg/week) is a whopping amount of active T (minus the ester).

175 mg TP (145.25 mg active T)/week would be the equivalent of banging 207.5 mg TC (145.25 mg active T)/week.

This gets even more nuttier when you think about the daily production of a healthy young male which would be 5-7 mg T, 10 mg T daily top f**king end to boot which would be 70 mg T/week!

Your were banging 145.25 mg T/week or better yet 20.75 mg T daily!

Most men on TTh are injecting 100-200 mg TC or TE/week whether once weekly, twice-weekly (every 3.5 days), M/W/F, EOD or daily.

The majority of men can easily hit a healthy let alone high or in some cases absurdly high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Yes there are outliers who may need the higher-end weekly dose 200 mg T/week but it is far from common as in RARE!

Such dose would be overkill for the majority.

Your trough FT was is in the 30s ng/dL which is absurdly high!

Again this is your trough (lowest point) 24 hrs post-injection as you were injecting a whopping 25 mg TP daily.

Again show me a healthy young male with low/lowish SHBG hitting a TT 1000+ ng/dL.....such does not exist!

Top it off that your peak TT/FT would have been sky-high due to the PK of TP.

You were clearly overmedicated here!