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trtthings

Active Member
So my experience so far with TRT has been that morning wood is non-existent without anastrozole, and I can make it appear like clockwork when taking it.

However for the past week or so I've been having trouble with erection quality and duration (when using it). Does anyone have any insight on what might be going on?

So far my thoughts are:
* Too high E2
* Too low E2
* Too low PRL? It was lower than usual on a recent blood test
* Blood pressure rising due to TRT and salt intake? (I haven't measured nor do I have a solid baseline)

And what do you guys use to combat this, if anything? Cialis?
 
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trtthings said:
So my experience so far with TRT has been that morning wood is non-existent without anastrozole, and I can make it appear like clockwork when taking it.

However for the past week or so I've been having trouble with erection quality and duration (when using it). Does anyone have any insight on what might be going on?

So far my thoughts are:
* Too high E2
* Too low E2
* Too low PRL? It was lower than usual on a recent blood test
* Blood pressure rising due to TRT and salt intake? (I haven't measured nor do I have a solid baseline)

And what do you guys use to combat this, if anything? Cialis?
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Maybe your dose is too low and the AI is allowing you to have higher free t and dht due to less e2 conversion.
 
trtthings said:
What about low FT4? When I measured my FT4 on Friday it was on the lower end of normal. And perhaps progesterone?

Any input? @Vince @Cataceous
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I've had transient problems like this while on TRT and I could rarely establish a straightforward causal connection to what the easily-measured hormones were doing at the time. I'm pretty sure there's a connection between kisspeptin and erections, based on comments in the literature and on personal experience. Unfortunately, at this time we can't just run over to Quest or LabCorp to test our levels. And there's still uncertainty about how much TRT affects kisspeptin. There has to be significant suppression at the hypothalamus, but I am not sure about the broader effects.

In the end it's probably about hormonal balance. Having low testosterone is a significant destabilizer of male sexual function. TRT is a decent remedy, but the resulting HPTA shutdown has destabilizing effects of its own.

I know you're looking for more specific advice, but if your experience is like mine then there's a chance these issues will simply come and go no matter what you do—assuming you're limited to tweaking the basics: testosterone, estradiol, prolactin and the thyroid hormones.
 
Cataceous said:
I've had transient problems like this while on TRT and I could rarely establish a straightforward causal connection to what the easily-measured hormones were doing at the time. I'm pretty sure there's a connection between kisspeptin and erections, based on comments in the literature and on personal experience. Unfortunately, at this time we can't just run over to Quest or LabCorp to test our levels. And there's still uncertainty about how much TRT affects kisspeptin. There has to be significant suppression at the hypothalamus, but I am not sure about the broader effects.

In the end it's probably about hormonal balance. Having low testosterone is a significant destabilizer of male sexual function. TRT is a decent remedy, but the resulting HPTA shutdown has destabilizing effects of its own.

I know you're looking for more specific advice, but if your experience is like mine then there's a chance these issues will simply come and go no matter what you do—assuming you're limited to tweaking the basics: testosterone, estradiol, prolactin and the thyroid hormones.
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Interesting to hear. For the record I decided to try mirtazapine. If you read the literature you'll see that it lowers FT4 in favour of FT3. In fact, the more it does that the more likely it is to work for depression (according to one study). It's one of the few ADs that don't increase prolactin and supposedly have no sexual side effects. So I'm not even sure it's related. My FT4 has never been close to high, but with it it's definitely pushing it down to the lower end. I wonder if that alone is enough to have an effect, even if FT3 might be higher. Hypothyroidism and sexual side effects are connected.
 
@Cataceous @Vince

I had the doctor add TPO antibodies to the blood test. It came back raised, and then I got a Levothyroxine prescription. Working up to 50 mcg/daily.

I am still curious to try T3 for various reasons, but I can also just keep measuring my FT4 and FT3 and see if this doesn't affect FT3 as well.

As I mentioned above as well though, if I keep the mirtazapine studies show that it increases T4 -> T3 conversion. As does testosterone, whereas estradiol inhibits it. So I should be getting my T3.

The one bad thing about this is.. taking it in the morning doesn't really fit my schedule well as it has to be on a fasted stomach (for at least half an hour). I can maybe do half an hour maximum. Is there anything I can do to aid absorption? I haven't researched this much yet.
 
trtthings said:
@Cataceous @Vince

I had the doctor add TPO antibodies to the blood test. It came back raised, and then I got a Levothyroxine prescription. Working up to 50 mcg/daily.

I am still curious to try T3 for various reasons, but I can also just keep measuring my FT4 and FT3 and see if this doesn't affect FT3 as well.

As I mentioned above as well though, if I keep the mirtazapine studies show that it increases T4 -> T3 conversion. As does testosterone, whereas estradiol inhibits it. So I should be getting my T3.

The one bad thing about this is.. taking it in the morning doesn't really fit my schedule well as it has to be on a fasted stomach (for at least half an hour). I can maybe do half an hour maximum. Is there anything I can do to aid absorption? I haven't researched this much yet.
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That’s why it would be nice, if you had a complete thyroid panel. To see if you’re converting T4 into T3. You may just be pooling your T3.

yep you need to take it on an empty stomach no food or drink for 45 minutes.
 
Vince said:
That’s why it would be nice, if you had a complete thyroid panel. To see if you’re converting T4 into T3. You may just be pooling your T3.
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You mean I could be making too much T3? I do have some T3 numbers I can pull up..

There are several things though that point to hypothyroidism. One being immense sensitivity to cold. I was standing outside with a 70 year old this morning for a few moments and I was shivering and not him. This is a recurring thing. Likewise dry skin, scalp, eyebrows. Constipation and bad digestion. Depression. Brain fog. Always tired.

In any case I will try this.
 
Curious though, no food or drink? This might be less of a problem if I woke up earlier before work, but that's hard to do when the main thing you're battling is fatigue.
 
trtthings said:
You mean I could be making too much T3? I do have some T3 numbers I can pull up..

There are several things though that point to hypothyroidism. One being immense sensitivity to cold. I was standing outside with a 70 year old this morning for a few moments and I was shivering and not him. This is a recurring thing. Likewise dry skin, scalp, eyebrows. Constipation and bad digestion. Depression. Brain fog. Always tired.

In any case I will try this.
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Pooling would be suggesting that the t3 is not getting into the cells and the free t3 levels is just "pooling in the blood"
 
Vince said:
Pooling would be suggesting that the t3 is not getting into the cells and the free t3 levels is just "pooling in the blood"
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Interesting, is there any way around that?

Btw I know this sounds ridiculous, especially with Levothyroxine (T4) but I feel like I've felt a notable improvement today in mood and mental clarity. My thinking at work was much clearer. But this is day #1 of 50mcg.
 
trtthings said:
Btw I know this sounds ridiculous, especially with Levothyroxine (T4) but I feel like I've felt a notable improvement today in mood and mental clarity. My thinking at work was much clearer. But this is day #1 of 50mcg.
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I also noticed an improvement on day one, unfortunately like TRT it was sort lived.
 
trtthings said:
Interesting, is there any way around that?

Btw I know this sounds ridiculous, especially with Levothyroxine (T4) but I feel like I've felt a notable improvement today in mood and mental clarity. My thinking at work was much clearer. But this is day #1 of 50mcg.
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That’s nice to hear, Hopefully you will continue getting a positive result.
 
Vince said:
That’s nice to hear, Hopefully you will continue getting a positive result.
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Thanks Vince. I was wondering, can you educate me a bit on the difference between Levothyroxine and other possible preparations?

I was quite surprised to see the following on Levothyroxine:

"Levothyroxine is synthetic thyroxine (T4). Due to its prolonged half-life, levothyroxine steady-state concentrations are not achieved until ~6 weeks after therapy is initiated or dosage adjustment".
 
Nelson Vergel said:
When did you start?

Are you masturbating or having more sex?
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33% more sex, roughly. Masturbation hasn't changed.

When did I start.. exactly 14 days ago. Things weren't "rock solid" before that, but there was a definite drop. Whether mental or otherwise.

It is known to not increase prolactin unlike most antidepressants. And _possibly_ has less sexual side effects. Mirtazapine substitution in SSRI-induced sexual dysfunction - PubMed

I will see after some time on the thyroid hormone whether I try to taper off it or not.
 
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