Hello All. Been on TRT for 5 years. I am 42 years old. Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex. I am happily married to my wife of 20 years. I find her extremely attractive and sexy. I have a great life, but this problem has been wearing on me mentally. When I started TRT, I would fantasy about my wife everyday. I hardly ever think about sex now and takes me a long time to get an erection. My doc runs my levels a little high due to my high SHBG. Before you chime in about my high estrogen, i felt worst with normal estrogen. I started supplementing with 1000units of vitD/k2 a day. Pleae help. My current labs:
Total T: >1500(300-890)
Free T: 247(47-244)
DHEA: 263
Estradiol: 52.5 (10-42)
Vit D: 21.5 (30-80)
SHBG: 60
TSH: 2.1
fT3: 3.2
Total t3: 88(80-200)
My doc runs my levels a little high due to my high SHBG.
Understatement to say the least!
When were labs done?
You are injecting 160 mg T/week (80 mg T every 3.5 days) + 500IU hCG twice weekly and if blood work was done at the true trough (84 hrs post-injection) then you are hitting an absurdly high trough TT >1500 ng/dL and more importantly your trough FT level will be sky-high even with high/highish SHBG.
Even then you have no clue where your TT truly sits as you had it tested using the wrong assay the electrochemiluminescence immunoassay (ECLIA) which caps out at 1500 ng/dL.
You would need to use the most accurate assay LC/MS-MS-No upper limit.
More importantly, you have no clue where your FT level truly sits as you never had it tested using an accurate assay.
The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration (next best).
This is critical, especially in cases of altered SHBG.
These are the tests/assays everyone should be using/relying upon for the time being.
Any one of these would suffice.
Most are using #2/3.
Labcorp
1.
500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp
Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)
2.
070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp
Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)
Quest Diagnostics
3.
Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)
Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)
Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex.
Look into testing prolactin to see where it sits.
What assay was used for testing your estradiol?
Unfortunately, when it comes to libido let alone ED they are multifactorial and there is much more involved than just having healthy hormones (TT, FT, estradiol, DHT, prolactin).
*Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.
My reply from a previous thread regarding ED/libido:
ED has multiple etiologies including vascular, neurologic, and endocrine disorders.
Underlying vascular health is critical!
Even when using PDE5is although effective for many most men have some degree of vascular/endothelial dysfunction.
Some men are poor responders and will end up needing to use intracavernosal injections to achieve/maintain an erection.
Having healthy testosterone levels is beneficial to one's libido/erectile function but it is far from the only thing that is required to achieve such.
Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone
underlying vascular health can all have a big impact on one's libido/erectile function.
Unfortunately, libido/ED is much more complex than simply having healthy testosterone levels.