Erections gone, PDE5i's stopped working, E2 related?

[Farmer Bryan]

Greetings,

I've been trying to sort this out on my own for a while, but I'm at my wits end. Really hoping someone can help me solve this dilemma.

Over the past few months erectile function has gone from being able to get really hard with the help of 12.5-25mg viagra to completely dead dick, zero morning wood, and loss of sensation, significant loss of libido. 50mg of viagra doesn't do anything. Cialis at 10mg every day for a week hasn't worked either. Too afraid to try higher doses of viagra since it elevates my heart rate too much.

I'm married and in a very good relationship. I am very attracted to my wife but my body just won't cooperate with me at all and it is becoming very distressing.

I am 40 years old, been on TRT for about 5 years or so. Protocol is currently 140mg T Enanthate weekly in divided doses (E3D) with HCG 500iu E3D. Pin T on day 1, HCG on day 2, nothing day 3, repeat. Been taking 0.25mg Arimidex once per week.

I am also hypothyroid, and am being treated with 125mcg T4, and 50mcg T3 daily (divided doses with cytomel 25, 12.5, 12.5).

Recent blood work:
Free T4: 11.5 (11.5-22.7)
Free T3: 6.3 (3.5-6.5)
TSH: (0)
Reverse T3: (awaiting results, although it hasn't been elevated in recent years)
Estradiol 29 pg/ml (measured 6 days after my 0.25mg dose of ADEX)
Total Testosterone 30.9 mol/L (8.4-28.8)
Free Testosterone 450 pmol/l (115-577)
Bioavailable Testosterone 10.5 nmol/l (2.7-13.5)
SHBG 65.6 nmol/L (10-70)
Prolactin: 5.2 ug/l (2.1-17.7)
A1C: 4.7 (4.5-5.9)
Hematocrit 0.508 (0.410-0.510)
Hemoglobin 170 (135-170)
Ferritin 205 (40-300)

Mood is low and depressed, but I attribute this directly to my lack of sex drive and ED. When I can get hard and have good sex drive, life is great. This has been ongoing since this past summer, getting progressively worse and it's causing me significant anxiety.

The one thing that stands out to me is my SHBG being at the top of the reference range. Historically it has been right smack dab in the middle of the reference range, but has climbed up over the last year. This is most likely due to my T3 (cytomel) dose having gone from about 37.5mcg to 50mcg over the past year as I was beginning to get hypothyroid symptoms again. At 50mcg many of my hypo symptoms have resolved (cold all the time, dragging ass, diminished cognitive function, not digesting) so that seems to be dialled in now.

My E2 level is the big question mark for me. It looks like it is at a good level, but since I don't have access to the sensitive lab test here in western Canada, I really don't know for sure. I'm also wondering if my SHBG being so high could be gobbling up all my E2? From what I understand SHBG has a lower binding affinity for E2 than it does T, but I'm not well versed in SHBG issues.

Any suggestions would be welcome.

Thank you.

 

[Systemlord]

Mood is low and depressed, but I attribute this directly to my lack of sex drive and ED.

If your E2 is 29 several days after taking anastrozole, it could be significant lower closer to taking your AI and is recovering later in the week.

I would cut your AI dosage in half.

 

[Farmer Bryan]

Your issues don’t seem hormonal related, it’s something else. I got very depressed with low vitamin D and low iron. Before I became vitamin D deficient, I would eat bacon or something with a lot of vitamin D in it, completely unaware my vitamin D was low and would have very good days when consuming foods with vitamin D.

The days I went without vitamin D, life sucked. If your vitamin D is low, it would be lowest now in Winter.

I take 10,000 iu vitamin D daily, and my levels are at the top of the reference range. Iron is also not a problem for me, always healthy levels with that too.

I should specify the depressed and down mood is resulting from the sexual dysfunction. I was really happy and motivated until my dick stopped working. As that continued to get worse that brought on the depressed mood.

 

[Systemlord]

I take 10,000 iu vitamin D daily, and my levels are at the top of the reference range. Iron is also not a problem for me, always healthy levels with that too.

I should specify the depressed and down mood is resulting from the sexual dysfunction. I was really happy and motivated until my dick stopped working. As that continued to get worse that brought on the depressed mood.

Review my updated post.

 

[sammmy]

Revert your protocol to where it was when your erection was responding to viagra.

If you are not trying to father a child, HCG and Arimidex are pointless.

Also you may want to drop the T dose to 100mg/week. You already witnessed that testosterone levels at the upper end do not guarantee better sexual performance so it's pointless to chase high numbers.

 

[Farmer Bryan]

Revert your protocol to where it was when your erection was responding to viagra.

If you are not trying to father a child, HCG and Arimidex are pointless.

Also you may want to drop the T dose to 100mg/week. You already witnessed that testosterone levels at the upper end do not guarantee better sexual performance so it's pointless to chase high numbers.

While I’m not looking to have kids (vasectomy) when I tried going without HCG for a time I had pretty significant testicular shrinkage that made me quite self conscious. I also had a constant dull ache in my testicles that was really bothersome. This resolved once I resumed the HCG. Also of note is that when I had blood labs drawn for the period of time that I was off HCG, my e2 levels didn’t change much. So it seems HCG doesn’t spike my e2 like it does in other guys. For now, I’d rather keep it going and avoid the testicular pain. Does HCG effect anything else other than T and E2 that could potentially cause ED and loss of libido?

Also, I checked back at my notes from the previous year when viagra was still working for me, everything was the same with my protocol with the exception of cytomel. I was taking a smaller dose back then. 100mcg of T4 and 37.5 mcg T3 as compared to my current 125mcg T4, and 50mcg T3. I’ve never heard of thyroid medication causing loss of erections, in fact it’s usually the opposite, so I doubt it is related.

As for lowering Test back down to 100mg, I’m not one of those guys who thinks more is always better, but at 100mg per week my free T went pretty low and I had a lot of trouble keeping up with my daily chores on the farm. I spent an afternoon building a fence and I could hardly move for over a week afterwards due to muscle pain. I felt 10 years older than my age. At 140mg I can work hard physical labour all day and my muscles are only a bit sore the next day. So while sexual function is unchanged at the higher dose, overall function and my ability to meet my daily demands is significantly better at 140mg a week. I’m not chasing higher numbers, I’m chasing symptom resolution and the ability to keep up with my responsibilities.

Edit to add: I haven’t taken a dose of Arimidex in 10 days, and I will refrain from taking any for the next few weeks to see if that has any positive effect. Although I’m sure it’s already well out of my system now and I don’t feel any change thus far. I will report back if I notice any changes in that regard.

 

[Systemlord]

Does HCG effect anything else other than T and E2 that could potentially cause ED and loss of libido?

Yes, hCG can lower libido, cause ED, and mood problems. The way I see it, if hCG is causing your issues, you’ve traded a lack of testicle atrophy for depression, low mood, lack of sex drive and ED.

That’s a bad trade-off.

 

[Farmer Bryan]

Yes, hCG can lower libido, cause ED, and mood problems. The way I see it, if hCG is causing your issues, you’ve traded a lack of testicle atrophy for depression, low mood, lack of sex drive and ED.

That’s a bad trade-off.

I agree, that does seem like a bad trade off when you lay it out like that.

I always thought the problems associated with HCG were E2 related. What would be the mechanism whereby sexual function would be reduced by HCG even in the presence of healthy E2 levels?

Is this a common occurrence? Everyone seems to rave about HCG and it’s positive effects on libido.

 

[DaytonaJonah]

I take 10,000 iu vitamin D daily, and my levels are at the top of the reference range. Iron is also not a problem for me, always healthy levels with that too.

I should specify the depressed and down mood is resulting from the sexual dysfunction. I was really happy and motivated until my dick stopped working. As that continued to get worse that brought on the depressed mood.

It's possible for many that taking too much vitamin D can kill your libido, erection quality, and orgasm ability. Take a few weeks off and see if things improve.

I was taking 5000iu daily of vit.D3 and after 6 weeks...all sexual function basically seized up. After a couple of weeks off of D3, everything returned back to normal.

 

[t_spacemonkey]

my libido is high on 60-70 e2. no typical symptoms of high e2 (although i have been dealing with anxiety lately, not 100% yet if there is something to it.
i've been taking 50k IU D for months. also feeling great.
HCG also ramps up my libido even higher. cialis at 2.5mg i run with a hard one half a day. I'm 44. what is your body fat? Also your TSH is 0? any other drugs you are taking. what is your diet.
TBH your blood looks ok to me. I am wondering maybe this has something to do with your thyroid?

 

[Systemlord]

What would be the mechanism whereby sexual function would be reduced by HCG even in the presence of healthy E2 levels?

hCG is an LH analog, it mimics LH. LH is pulsatile, the half-life is 20 minutes, rising and falling rapidly whereas hCG half-life (2.3 days), staying in the system longer.

Is this a common occurrence? Everyone seems to rave about HCG and it’s positive effects on libido.

It’s more common than you think. Use the search function.

 

[Farmer Bryan]

my libido is high on 60-70 e2. no typical symptoms of high e2 (although i have been dealing with anxiety lately, not 100% yet if there is something to it.
i've been taking 50k IU D for months. also feeling great.
HCG also ramps up my libido even higher. cialis at 2.5mg i run with a hard one half a day. I'm 44. what is your body fat? Also your TSH is 0? any other drugs you are taking. what is your diet.
TBH your blood looks ok to me. I am wondering maybe this has something to do with your thyroid?

Yes my TSH is suppressed as I am on a replacement dose of T3 and T4. I take just enough T4 to maintain bottom of reference range so as to not convert much to RT3 and then I take three doses of Cytomel throughout the day as I can’t tolerate a single large dose very well. Thyroid most definitely can be an issue when it’s low but my levels seem to be pretty good at the moment judging by my digestion, pulse rate, BP, and body temp.

 

[Farmer Bryan]

It's possible for many that taking too much vitamin D can kill your libido, erection quality, and orgasm ability. Take a few weeks off and see if things improve.

I was taking 5000iu daily of vit.D3 and after 6 weeks...all sexual function basically seized up. After a couple of weeks of off of D3, everything returned back to normal.

Very interesting. I wonder if this is due to Vitamin D’s aromitase inhibiting effect?

 

[Nelson Vergel]

Mood is low and depressed, but I attribute this directly to my lack of sex drive and ED. When I can get hard and have good sex drive, life is great. This has been ongoing since this past summer, getting progressively worse and it's causing me significant anxiety.

I am sorry to hear. I feel the same! High sex drive= great health and mood.

Have you tried an antidepressant like Wellbutrin or Trintellix?

How to reverse sexual dysfunction caused by antidepressants

In an open-label study of 1,022 patients with a mean 40 years of age, 59.1% reported antidepressant-associated sexual dysfunction.10 The study analyzed the following antidepressants: citalopram, paroxetine, venlafaxine, sertraline, fluvoxamine, fluoxetine, mirtazapine, nefazodone, amineptine...

www.excelmale.com

 

[Farmer Bryan]

I am sorry to hear. I feel the same! High sex drive= great health and mood.

Have you tried an antidepressant like Wellbutrin or Trintellix?

How to reverse sexual dysfunction caused by antidepressants

In an open-label study of 1,022 patients with a mean 40 years of age, 59.1% reported antidepressant-associated sexual dysfunction.10 The study analyzed the following antidepressants: citalopram, paroxetine, venlafaxine, sertraline, fluvoxamine, fluoxetine, mirtazapine, nefazodone, amineptine...

www.excelmale.com

Thanks, Nelson.

No, I have not tried antidepressants. I am typically a very happy, motivated, and affable person. I have a good life and am very blessed in many ways so I don't feel that is the right approach for me.

I know my symptoms are a result of something wrong with my protocol, as the very moment my libido comes back and my dick starts working again, life is splendid and all is well.

This has happened sporadically over the course of the past 6 months. For whatever reason, the stars align and all of a sudden I'm back to my horny happy self for a day or two, I can get a good erection without any viagra or cialis, then it's gone, but for the life of me I cannot connect the dots.

Needless to say I'm now tracking absolutely everything and taking copious notes in my daily journal.

I'm determined to get to the bottom of this.

The three variables that I'm hovering around right now are the following:

My E2 is lower than usual - although perfectly in range, in years past I would hover around top of the reference range (again, not a sensitive E2 test as I can't get it)

My SHBG has gone from mid-range to top of the reference range (maybe eating up all my E2??)

And my cytomel dose has gone up (the likely cause of the elevation of my SHBG)

One other thing I just thought of...Over the past 6 months I've noticed a dramatic increase in the number of eye floaters I have. I've always had a few, but this is a significant increase. Probably not related at all, but I know visual disturbances and eye floaters have been reported in some men taking clomid (which I've never taken). I can't find any info that suggests this would be possible with Arimidex, but if eye floaters are somehow related to E2 levels perhaps this could be a clue?

 

[Systemlord]

Over the past 6 months I've noticed a dramatic increase in the number of eye floaters I have.

That happens when estrogen is low, the anastrozole is likely the cause. We don’t know where your estrogen sits closer to the AI dose.

The lower than usual estrogen and the eye floaters are the smoking gun.

I had eye floaters when I had low-T and low E2.

 

[Jucaro]

I agree, that does seem like a bad trade off when you lay it out like that.

I always thought the problems associated with HCG were E2 related. What would be the mechanism whereby sexual function would be reduced by HCG even in the presence of healthy E2 levels?

Is this a common occurrence? Everyone seems to rave about HCG and it’s positive effects on libido.

HCG drops my libido and give me ED even if I keep me E2 under control. So it is not only related to E2 levels, but I have not found informations what else could be the reason ather than E2. I am on HCG for fertility, my wife not getting pregnant yet, and I have very low libido, 2.5 mg of cialis used to work nice for 3 days on me, now with 5 mg cialis plus 100 mg viagra some times I fail to have the erection or I loose it very easy.

 

[Golfboy307]

Just a quick comment on the psychological side, like you, I can get trapped in a negative thought/anxiety cycle when erections are sub-par or nonexistent. Hyper focus on the issue only makes things worse. Just keep that in mind..

If Viagra/Cialis suddenly stopped working suddenly, then yes the lead suspect would be e2 levels (either high or low) or as others mentioned HCG.

Keep digging you will figure it out. But just remember as we get older, there are times when things "just aren't right" down there due to stress, lack of sleep, hormones etc. Being accepting of that fact helps bring the stress levels down.

 

[Farmer Bryan]

That happens when estrogen is low, the anastrozole is likely the cause. We don’t know where your estrogen sits closer to the AI dose.

The lower than usual estrogen and the eye floaters are the smoking gun.

I had eye floaters when I had low-T and low E2.

Well hot damn! Now we’re getting somewhere. This is very helpful, thank you!

HCG drops my libido and give me ED even if I keep me E2 under control. So it is not only related to E2 levels, but I have not found informations what else could be the reason ather than E2. I am on HCG for fertility, my wife not getting pregnant yet, and I have very low libido, 2.5 mg of cialis used to work nice for 3 days on me, now with 5 mg cialis plus 100 mg viagra some times I fail to have the erection or I loose it very easy.

Thank you for the feedback, this is also very helpful. I wonder what HCG could be spiking that is causing this? Perhaps progesterone?

 

[Farmer Bryan]

Just a quick comment on the psychological side, like you, I can get trapped in a negative thought/anxiety cycle when erections are sub-par or nonexistent. Hyper focus on the issue only makes things worse. Just keep that in mind..

If Viagra/Cialis suddenly stopped working suddenly, then yes the lead suspect would be e2 levels (either high or low) or as others mentioned HCG.

Keep digging you will figure it out. But just remember as we get older, there are times when things "just aren't right" down there due to stress, lack of sleep, hormones etc. Being accepting of that fact helps bring the stress levels down.

I appreciate that. I have been spending extra time on mental health during this uncomfortable time in order to keep myself from spiralling down. Meditation, a bit of yoga (which I suck at), hikes in nature, cooking for my wife etc. Trying to keep focused on other things while I sort this out.