ED On TRT. Bloods good on paper

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Joseywales95

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Hey guys,

I was hoping someone may be able to help me with my current ED situation.

To provide additional context to my ongoing health journey, particularly concerning my struggles with erectile dysfunction (ED) while on TRT. Enclosed, Below is my most recent bloodwork, taken during my current TRT regime of 120mg Testosterone Enanthate (Test E) administered MWF.

Testosterone, Total, LC/MS 1067.6
Testosterone, Free 30.00
Sex Horm Binding Glob, Serum 51.4
Estradiol, Sensitive 29.2
Prolactin 10.2
Iron Bind.Cap.(TIBC) 294 (250 - 450)
Iron 61 (38 - 169)
Ferritin 98 (30-400)

A bit about my background: I've been an athlete throughout my life, including being a college swimmer. My fitness journey continued through after college. I maintain a healthy diet for about 5-6 days a week. Prior to hormone therapy, I did not experience any issues with ED or sexual health. To give you a clearer picture, my pre-TRT response to Cialis worked amazingly

My stats are as follows: 6'5" and weighing 215 lbs.

Current supplements: multivitamins, fish oil, vitamin D, selenium, p5p, along with Cialis and Viagra.

The challenge I am facing is ED, which has persisted for the past year and a half despite being on TRT. Initially, I wasn't a candidate for TRT as I had no hypogonadism test was ~375, but I started the treatment in April 2022 (with a dose of 120 from a TRT clinic) to optimize my gym and work performance, and possibly explore performance-enhancing drugs in the future. The first six weeks were promising with enhanced gym performance, libido, and erection quality. However, I soon experienced a decline in libido and erection quality. Following the clinic's advice, I reduced my dose to 100mg and incorporated HCG, but the ED issues persisted. I have experienced moving the dose around for 5-6weeks but to no avail. (All under 200mg)

Despite trying various online suggestions and medication adjustments, including 20mg of Cialis and 100mg of Viagra, my erection quality is still only about 50-70% of what it was pre-TRT. I don't experience nocturnal erections / morning erections.

Curious if anyone has any thoughts! Much appreciated
 
Last edited:
Defy Medical TRT clinic doctor
Too much testosterone can be as bad on sexual function as not enough. It would be interesting to see where your ferritin levels sit.

ED drugs cannot work without adequate iron.
 
Joseywales95 said:
Hey guys,

I was hoping someone may be able to help me with my current ED situation.

To provide additional context to my ongoing health journey, particularly concerning my struggles with erectile dysfunction (ED) while on TRT. Enclosed, Below is my most recent bloodwork, taken during my current TRT regime of 120mg Testosterone Enanthate (Test E) administered MWF.

Testosterone, Total, LC/MS 1067.6
Testosterone, Free 30.00
Sex Horm Binding Glob, Serum 51.4
Estradiol, Sensitive 29.2
Prolactin 10.2
Iron Bind.Cap.(TIBC) 294 (250 - 450)
Iron 61 (38 - 169)
Ferritin 98 (30-400)

A bit about my background: I've been an athlete throughout my life, including being a college swimmer. My fitness journey continued through after college. I maintain a healthy diet for about 5-6 days a week. Prior to hormone therapy, I did not experience any issues with ED or sexual health. To give you a clearer picture, my pre-TRT response to Cialis worked amazingly

My stats are as follows: 6'5" and weighing 215 lbs.

Current supplements: multivitamins, fish oil, vitamin D, selenium, p5p, along with Cialis and Viagra.

The challenge I am facing is ED, which has persisted for the past year and a half despite being on TRT. Initially, I wasn't a candidate for TRT as I had no hypogonadism test was ~375, but I started the treatment in April 2022 (with a dose of 120 from a TRT clinic) to optimize my gym and work performance, and possibly explore performance-enhancing drugs in the future. The first six weeks were promising with enhanced gym performance, libido, and erection quality. However, I soon experienced a decline in libido and erection quality. Following the clinic's advice, I reduced my dose to 100mg and incorporated HCG, but the ED issues persisted. I have experienced moving the dose around for 5-6weeks but to no avail. (All under 200mg)

Despite trying various online suggestions and medication adjustments, including 20mg of Cialis and 100mg of Viagra, my erection quality is still only about 50-70% of what it was pre-TRT. I don't experience nocturnal erections / morning erections.

Curious if anyone has any thoughts! Much appreciated
Click to expand...
When did you take these labs in relation to your dosing? What type of free T test is that? Was it Labcorp direct free T or something? That test is very inaccurate. Your Vermeulen calculated free T, which is often a little bit higher than the real value, is 20 ng/dL. Your E2 is actually pretty low for a guy on TRT and very low for a guy with such high SHBG (your free E2 will be significantly less than a guy with the same E2 and lower SHBG).

You say you experimented with other doses for periods of 5-6 weeks. What doses did you try? Changing protocols at 5-6 weeks is very premature. It is not uncommon for the character of a particular protocol to dramatically change in the weeks after week 6. The prevailing advice around here, which I have realized is very sensible, is to maintain a protocol for 12 weeks if you want an accurate assessment of its potential.

For example, there's one guy I know whose libido goes to shit every time he changes his protocol and it does not come back for at least 8 weeks. So imagine if you are anything like that guy -- it would mean you have gathered no useful or accurate data on how any of those protocols affected your libido so far.

Coming back to your current lab values, the direction I would adjust from there is up, not down, given your low free E2 and the negative effects that can have on libido and sexual function. That's just my personal opinion.
 
Joseywales95 said:
Following the clinic's advice, I reduced my dose to 100mg and incorporated HCG, but the ED issues persisted.
Click to expand...
What were the doses and frequencies for each? Have you tried low-dose daily Cialis? How is your sleep? Blood pressure? Any other medications? Can you get hard when masturbating alone?
 
Nelson Vergel said:
What were the doses and frequencies for each? Have you tried low-dose daily Cialis? How is your sleep? Blood pressure? Any other medications? Can you get hard when masturbating alone?
Click to expand...
I was pinning EOD for the Test C 100mg and pinning 300IU of hgh EOD. Yes, I have tried Cialis and Viagra to avail. Blood pressure is perfect and no other medications. I sleep 7-8 hours a day. No same problem with weak erections alone orwith a partner.

Note prior to TRT my libido was low but erection quality was always perfect.

My current protocol I dropped the HCG and just using Test C 120mg pinning MWF. I've recently added DHEA and Pregnenolone.
 
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FunkOdyssey said:
When did you take these labs in relation to your dosing? What type of free T test is that? Was it Labcorp direct free T or something? That test is very inaccurate. Your Vermeulen calculated free T, which is often a little bit higher than the real value, is 20 ng/dL. Your E2 is actually pretty low for a guy on TRT and very low for a guy with such high SHBG (your free E2 will be significantly less than a guy with the same E2 and lower SHBG).

You say you experimented with other doses for periods of 5-6 weeks. What doses did you try? Changing protocols at 5-6 weeks is very premature. It is not uncommon for the character of a particular protocol to dramatically change in the weeks after week 6. The prevailing advice around here, which I have realized is very sensible, is to maintain a protocol for 12 weeks if you want an accurate assessment of its potential.

For example, there's one guy I know whose libido goes to shit every time he changes his protocol and it does not come back for at least 8 weeks. So imagine if you are anything like that guy -- it would mean you have gathered no useful or accurate data on how any of those protocols affected your libido so far.

Coming back to your current lab values, the direction I would adjust from there is up, not down, given your low free E2 and the negative effects that can have on libido and sexual function. That's just my personal opinion.
Click to expand...
This was the trough tested before my Wednesday injection. And this is whatever Lab corp provides.

Of course not medical advice but is there a protocol you would advise?
 
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Joseywales95 said:
This was the trough tested before my Wednesday injection. And this is whatever Lab corp provides.

Of course not medical advice but is there a protocol you would advise?
Click to expand...
Is MWF the only thing you've done with frequency? For libido specifically, alot of guys seem to do better with less frequency. I'd maybe try twice weekly or once weekly.
 
FunkOdyssey said:
Is MWF the only thing you've done with frequency? For libido specifically, alot of guys seem to do better with less frequency. I'd maybe try twice weekly or once weekly.
Click to expand...
Hi Funk, I've tried everything from ED, EOD, MWF, & every four days. TBH I don't think I could feel the difference. At the end of the day I'm more concerned about erection strength than libido...

So would you recommend I up the dose to 150mg per week and maybe one shot a week?
 
Joseywales95 said:
So would you recommend I up the dose to 150mg per week and maybe one shot a week?
Click to expand...
I would lower your dosage, not increase it. My reasoning is your libido may have been low, but your erectile strength was great according to you.

This tells me you weren't far off the mark as far as hormones go. Most guys with full blown hypogonadism have both erectile and libido issues.
 
Joseywales95 said:
Hi Funk, I've tried everything from ED, EOD, MWF, & every four days. TBH I don't think I could feel the difference. At the end of the day I'm more concerned about erection strength than libido...

So would you recommend I up the dose to 150mg per week and maybe one shot a week?
Click to expand...
I think it's worth a shot, no pun intended.

What were your baseline pre-TRT labs?
 
FunkOdyssey said:
I think it's worth a shot, no pun intended.

What were your baseline pre-TRT labs?
Click to expand...
Ranged from 350-400. I was not hypogonadal, and while my energy and libido were on the low side I was still able to build muscle and my sexual function was perfect. I thought TRT would only be a boost to my QOL and in hindsight I was very wrong and ignorant.

I'm going to try for another 4-6 months to dial in and if I can't I will PCT off. I love the energy and mental clarity I have on TRT but if I can't get hard without 20mg of Cialis and 100mg of Viagra it's not worth it. This morning I increased my dose to 150mg and going to give myself a shot every 5 days. Going to try to increase my DHEA and pregnenolone as well.

Still open to anyone suggestions and experiences.
 
Crazy stuff man. This thread is very helpful because I was curious what someone with basically "perfect" numbers on paper and a healthy lifstyle should do if TRT kills their erections. I am similar to you, better in pretty much every way but worse erections. Boggles my mind.

Systemlord mentions Iron but there is more to it than just iron. All the minerals including copper need to be balanced for them assimalted correctly. Couple products to check out.


Another path to explore is the nandrolone based HRT with a small amount of Test added in. Seems like a few have really exceptional results with it. Don't know if it is for everybody but some that don't do well with test seem to like it. Search the forum.
 
DixieWrecked said:
Crazy stuff man. This thread is very helpful because I was curious what someone with basically "perfect" numbers on paper and a healthy lifstyle should do if TRT kills their erections. I am similar to you, better in pretty much every way but worse erections. Boggles my mind.

Systemlord mentions Iron but there is more to it than just iron. All the minerals including copper need to be balanced for them assimalted correctly. Couple products to check out.


Another path to explore is the nandrolone based HRT with a small amount of Test added in. Seems like a few have really exceptional results with it. Don't know if it is for everybody but some that don't do well with test seem to like it. Search the forum.
Click to expand...
Thanks Dixie much appreciated. My supplement list is pretty long already but I'll take a look at those links and order them. I heard about Nandrolone as HRT but that stuff scares me long term...

Anything you have tried that made a material difference? And can you get full erections using Cialis and Viagra?
 
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