Erection Problems

Hey guys!

I've posted in the past and then had some good luck for a while and then have problems again.

I have issues where I have erections that are about a 6 out of 10 on a scale.

Sometimes I have a day or two where I have a good strong erection but many days I don't.

My labs are attached.

I take 160/40 Testosterone cypionate propionate blend from empower. .08 ml daily.

I also take a daily tadalafil 20mg. Losartan 25 mg. Crestor 5 mg. Wellbutrin 300 mg. Dexilant 60mg.

Is there someone who can look at my labs and tell me what I'm missing? I've been seeing Dr saya for many years and I'm considering a different doctor.


I do have testosterone cream and I don't know if it's coincidence or not but I use it every few days to keep my DHT up on my scrotum and I feel like on those days it works better.

TRTinNY said:

Hey guys!

I've posted in the past and then had some good luck for a while and then have problems again.

I have issues where I have erections that are about a 6 out of 10 on a scale.

Sometimes I have a day or two where I have a good strong erection but many days I don't.

My labs are attached.

I take 160/40 Testosterone cypionate propionate blend from empower. .08 ml daily.

I also take a daily tadalafil 20mg. Losartan 25 mg. Crestor 5 mg. Wellbutrin 300 mg. Dexilant 60mg.

Is there someone who can look at my labs and tell me what I'm missing? I've been seeing Dr saya for many years and I'm considering a different doctor.


I do have testosterone cream and I don't know if it's coincidence or not but I use it every few days to keep my DHT up on my scrotum and I feel like on those days it works better.

Click to expand...

From my understanding you have been on a rollercoaster ride here from the get-go struggling with libido/ED, high RBCs, hematocrit, hemoglobin and crashed ferritin.

Last I heard you had lowish SHBG to boot.

Glad to see that you had your FT tested using the most accurate assay (gold standard Equilibrium Dialysis)!

Still caught up on this needing high FT/high DHT nonsense I see!

One of the biggest myths in the HRT shit show game when it comes to erectile function/libido!

I would seek out a urologist that specializes in treating ED!

Dr. Mulhall is one of the best.

If you live in or near NYC I would give it a go!

Memorial Sloan Kettering.






post #5

Sorry to hear this.

When did you see him and what testing was done?

Did he performed your Doppler US examination?

Post your results from the Doppler.

If your peak systolic velocity (PSV) was borderline then your underlying vascular health would be at risk if you were not taking measures (lifestyle/underlying health issues) to address such.

You stated:

I have issues where I have erections that are about a 6 out of 10 on a scale.

Sometimes I have a day or two where I have a good strong erection but many days I don't.

My labs are attached.

I take 160/40 Testosterone cypionate propionate blend from empower. .08 ml daily.

I also take a daily tadalafil 20mg. Losartan 25 mg. Crestor 5 mg. Wellbutrin 300 mg. Dexilant 60mg.


You are taking tadalafil let alone a whopping daily dose which in most cases would most likely mean that you need a higher dose for it to be effective which indicates that you have some degree of vascular/endothelial dysfunction.

Your erections are 6/10 not too far off from a 5/10 and this is with a whopping dose of tadalafil so where would you truly sit without the use of a PDE5i?

Ones underlying vascular health/generation or bioavailability of NO will play a strong role in how well you respond to said dose.

You are also taking medications to control high blood pressure, high cholesterol, acid reflux and depression (MDD/SAD).

Even though lack of nocturnal erections/morning wood would indicate hormonal as it is common in men with low testosterone, high levels of T let alone DHT are not needed for healthy erectile function/libido which was the point being stressed.



3:33-7:13

* if you look at men with ORGANIC ED we can talk about psychogenic ED a little later on if we have time but if you take men with ORGANIC ED PROBABLY 70% OF THEM ARE GOING TO HAVE A VASCULAR COMPONENT INFLOW OR OUTFLOW PROBLEMS and that includes men with diabetes, those high profile causes like medication induced or hormonal ED or Arteriogenic ED, radical pelvic surgery for example account for the vast minority of patients with erectile dysfunction and if you focus in on HORMONE PROBLEMS such as TESTOSTERONE that accounts for the VAST MINORITY of MEN with ERECTION PROBLEMS so the BULK of ED that's PHYSICALLY BASED is VASCULOGENIC as its called!


* the whole link between TESTOSTERONE and ERECTILE FUNCTION it's a WEAK LINK, it's not a POTENT ERECTO-GENIC HORMONE, it's CERTAINLY a LIBDO-GENIC HORMONE and an ORGASMO-GENIC HORMONE but if you take men who have got LOW TESTOSTERONE who have ERECTILE DYSFUNCTION and you treat them with T the AVERAGE CHANGE in ERECTILE FUNCTION is MINIMAL if you use the validated scores (the international index of erectile function scores) so the ELEVATION in those scores is MINIMAL so the CONTRIBUTION of T you DON'T NEED A LOT of T you need SOME you DON'T NEED A LOT of T for ERECTION FUNCTION!




What role does DHT (dihydrotestosterone) play with erections?


9:33-11:54

* it is CERTAINLY ALL ANDROGENS are involved in ERECTILE TISSUE HEALTH and ERECTILE FUNCTION but as an ANDROGEN PERTAINING SPECIFICALLY to ERECTILE HEALTH it is NOT the MAJOR PLAYER TESTOSTERONE ITSELF would be MORE IMPORTANT!




It's a f**KING BIG MYTH still being pushed by all those sheep stinking up the so called men's health/HRT forums with that more T is better mentality!

You know the ones loaded with all those blast n cruizzzers those grown ass men abusing T/AAS!

Most of those so called HRT GURUs polluting the net let alone RUN of the MILL T-CLINICS are caught up on that sheep mentality!

Pure nonsense!

Need to tread lightly on who you take advice from when it comes to this HRT SHIT SHOW GAME!




Also keep in mind that it is not a given that everyone will experience morning wood 7 days a week as it is more common when you wake up during REM stage of sleep as this is when nocturnal erections peak.

What is more important is that you are having nocturnal erections throughout the night.

Neurotransmitters, vascular health, and healthy hormones all play a big role in erectile function/libido.

As you should know getting quality sleep is also critical.

Many men over 40 suffering from ED have some degree of vascular/endothelial dysfunction/reduced generation or bioavailability of NO.

Depending on the severity this can be overcome to some degree with the use of PDE5i/intracavernosal injections and in cases that are more severe worst case scenario would be a penile implant.

First line therapy for treating ED would be oral therapy and when it is no longer effective the next step would be intracavernosal injections or in some cases oral combined with ICI the final step for severe cases that do not respond to first or second line therapies would be surgery for placement of a penile implant!

As you would know high blood pressure, hyperlipidemia and high homocysteine are big markers for contributing to vascular/endothelial dysfunction, luckily you are treating such!

Bupropion can have a positive impact on libido due to its effects on neurotransmitters mainly dopamine but it is not a given in every case!

Even then looking over your protocol although I see no issue with one running a high-end/high trough FT within reason if they are not experiencing any sides let alone blood markers remain healthy but you are clearly struggling with issues (ED, elevated RBCs, hemoglobin and hematocrit) with borderline ferritin to boot!

You need to keep in mind although you are injecting daily your trough FT is high steady-state seeing as you are injecting a TC/TP blend.

Point here being is running a high-end/high trough FT steady-state can easily have a negative impact on erectile function let alone libido due to hammering the SHIT out of your DOPAMINE 24/7!

We are not talking about a short-lived daily peak here!

Again T also has a tonic effect on the CNS and can easily make one feel amped up which can stress the nervous system.

The body was never meant to be jacked up on T 24/7!

Again if you have no underlying issues (OSA, COPD, smoking) then your RBCs, hemoglobin and hematocrit are high due you high steady-state FT.

This has been an ongoing issue with you on here due to being caught up on that more T is better mentality.

Your estradiol is high due to your high FT which would be expected.

Your TIBC, iron saturation is high, normal iron and borderline low ferritin.

Are you still donating blood and if so when was your most recent donation.

Calcium, protein and albumin, A1C just over the top-end.

Need to address that very high homocysteine.

Low uric acid.

If you want to kill 2 birds with one stone as in struggling with the elevated hematocrit and hammering the shit out of your dopamine then I would strongly suggest giving oral TU (Kyzatrex) a go!

Two daily short-lived peaks with long trough times while at the same time achieving a high-end TT/FT (depending on the dose) and increasing DHT to boot!

400 mg BID is most likely where its unless you are one of those hyper responders who will fare well on a lower daily dose!

TRTinNY said:

Hey guys!

I've posted in the past and then had some good luck for a while and then have problems again.

I have issues where I have erections that are about a 6 out of 10 on a scale.

Sometimes I have a day or two where I have a good strong erection but many days I don't.

My labs are attached.

I take 160/40 Testosterone cypionate propionate blend from empower. .08 ml daily.

I also take a daily tadalafil 20mg. Losartan 25 mg. Crestor 5 mg. Wellbutrin 300 mg. Dexilant 60mg.

Is there someone who can look at my labs and tell me what I'm missing? I've been seeing Dr saya for many years and I'm considering a different doctor.


I do have testosterone cream and I don't know if it's coincidence or not but I use it every few days to keep my DHT up on my scrotum and I feel like on those days it works better.

Click to expand...

I have a significant degree of ED as well. I have had had total T go from as high as 1800 down to 560 and it makes little difference in the ability to perform. Yes, when I had higher T levels, I had more libido, but that doesn't increase or improve performance in any meaningful way. Do as Madman suggested and see a specialist generally a urologist or you can google the US Sexual medicine society and see if someone in the group is close enough for you to see. Bottom line, driving T thru the roof WON"T give anyone a better erection, because the problem isn't hormonal its likely vascular. What will help that you can get thru a real trained, knowledgeable doc, is a better diagnosis or your actual ED root cause, and a treatment regimen to address it. It might mean Tri mix or quad mix, even higher doses of tadalafil, (yes its generally safe with a doctors order) Vyleesi, or addyi, newer protocols for shockwave treatments, botox, vacuum pump use, and more. THERE ARE OPTIONS that should help you. Find a good, trained in doc in ED and lean on them. If you are in NY, Dr Muhall is outstanding. If you are in DC area, Dr. Rachael Rubin is outstanding.

If you guys are over 60, try Bi-mix. Works amazing, painless injection, instantly rock hard, no side-effects, have sex anytime, anywhere.

Have you considered dropping your T dosage a bit? Your labs indicate you may be a bit too high across a number of dimensions, including E2.

In my experience, improperly balanced E2 can negatively impact NO levels, which can certainly cause the issues you are experiencing.

The subjective improvement you see when supplementing T cream is an important clue supporting E2 levels being too high, as DHT is a potent natural aromatase inhibitor.

If you decide to drop your dosage a bit, stick with it for several weeks as it will take some time for all of the downstream adjustments to take hold.

Are your E2 and SHBG missing in the OP?