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.
"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."
I understand you are not necessarily wanting to take a high dose of testosterone (in my opinion 140 mgs per week is a high dose) for physical gains. However, I will give you my thoughts on what could be too much testosterone in your case:
I also understand your symptoms, I had similar sexual issues when I was taking too much testosterone.
If you feel the need to increase your T dose in order to cope with the physical demands you are putting on your body it is not dissimilar to increasing it for better performance in a sport. Yours however, being for more essential reasons of course.
It may be that the high dose you are currently on is acting as a "band-aid" for something else causing your issues which is making you less physically able than what you think a 40 yo should be. One needs to be careful here in knowing the difference between a 40 yo and a 25 yo.
This does not come without consequences. I dislike AI's greatly. In my opinion, if you need to use them it is a sign that too much T is circulating in your body. They are very difficult to control and can cause dramatic sexual issues. I feel it is much better to lower your dose to a point where you do not need them at all.
If you have been using 140 mg per week for a reasonable time you would need to go through a withdrawal period, when you do significantly lower your dose as it can take time for your body to adjust to a new lower level. During this time you may or may not notice any improvement in sexual function and you may feel physically weaker until you become more sensitive and adjusted to a more normal level of T.
I mention all of this in regard to your sexual difficulties. This is one of the trade offs for using too much testosterone: sexual function suffers especially erectile function for some men. As you are injecting 140 mg a week of T , plus 1500 iu of hCG on top of this adding in even more testosterone, I can see why your recent numbers are so high. Excessive testosterone can elevate sympathetic nervous system activity in the body, especially in your penis, which has the effect of lessening the power of the pro-erectile pathways in the erectile tissues. Essentially the pathways that maintain the penis in a flaccid state become more dominant; thereby making the parasympathetic and NO pathways less able to overcome its constant tonic force. This can also manifest as anxiety and other psychological problems due to neurotransmitter imbalances. Sexual sensitivity in the genitals themselves can also decrease because of this, further exacerbating ED.
This can be a side effect for some guys even on a moderate dose of T. The way in which exogenous testosterone is administered is very different to how we produce it naturally in a circadian rhythm, this I feel can upset the autonomic nervous system causing issues with erectile function and sexual sensitivity and the ability to orgasm. I feel some men are far more sensitive to this change in delivery to testosterone in this regard. I am one of those individuals.
I am curious to know how long you were on 100 mg per week? I agree with System Lord; that the AI may be causing much of your issues, possibly driving your estrogen far too low. However, the need to take them is most likely due to too much T in the first place.
You mention that sometimes “the stars align” and you suddenly experience almost normal sexual function. I am very familiar with these transient episodes when I was on higher amounts of testosterone (120 mg per week) than I am currently. They are, in my opinion, moments when the chemistry in your body is able to find a more normal balance (homeostasis) of hormones and neurotransmitters, a particular balance whereby sexual function can work well, something which it finds very difficult to do when an excess of one hormone is being artificially implanted into what is a very finely tuned system. It does not help when some vital hormones are almost missing as well, which are also part of sexual function. These high levels of testosterone can work for some men for a period of time, seemingly improving sexual function, somehow our body manages to cope with it and then it just doesn't. Dysfunctions occur.
If you are taking too much testosterone in order to compensate for other issues in your body, such as aging combined with other comorbidities (I am suspicious of your thyroid issues) then there will be problems. Testosterone is a very powerful chemical messenger. It can appear to ameliorate many issues in our bodies, especially when they start aging, however, we start walking into unnatural territory here and this in when more problems arise.
There has been some interesting research done in the recent past on excessive sympathetic activity in the penis which has been speculated to occur in middle age and beyond. This may mean as we age the mechanisms that keep the penis flaccid most of our waking hours gradually become more powerful or dominant as we age. This has been clearly shown in the animal model. Certain disease states such as diabetes can apparently accelerate this process. The mechanisms in the penis that cause flaccidity (predominantly the NE and the the Rho-kinase pathways) are actually working constantly to keep smooth muscle in all of the expansive tissues in a contracted state, so in effect its in a constant state of "tension" not "relaxation". However, such is the design of this system, that it is the strongest and most resistant mechanism, when compared to the opposing pro-erectile mechanism, known as the parasympathetic and NO pathways. When we are very young the balance between these two forces is much more equal. Not so at middle age, and much less in old age.
I feel TRT can cause further issues here and excessive testosterone may exacerbate this process sooner.
I think some men are more susceptible to this. They are more sensitive to the contractile mechanism in the penis than others, these guys are more prone to performance anxiety or stress causing erectile issues. Even more so as they age.
These men are also sensitive to erectile difficulties from drugs that cause adrenaline to rise in the body, such as cocaine and amphetamines, even coffee.
It would follow that any increase in sympathetic activity caused by TRT in these men may cause significant ED issues.
I wrote a post recently that covers much of what I have discussed here on the topic for another guy who has sexual issues from what I suspect is also too much testosterone. I go into other aspects of TRT there which you may find relevant.
www.excelmale.com
I have just seen your last post about the significant improvement since stopping the AI and reducing hCG (which may also be lowering testosterone). Most likely your estrogen did crash far too low. I note your need for PDE5i for reliable erections, this need may be due to the elevated activity of sympathetic function in the penis. PDE5i boost the power of the NO pathway, thus helping overcome the dominance of the other inhibitory pathway. If you can lessen the power of the sympathetic pathway by reducing that which is stimulating it, will make PDE5i work even better, or you may not need them at all. You may find that after stopping the AI, your estrogen (given your T dose) may swing the other way, which may cause more sexual issues again. Be wary of sudden improvements whenever you make a protocol change as these are often not the true longstanding effects. These can often be just the result of hormone levels surging or dropping.
Good to hear your issues have improved.
I hope the above helps in some regard.
