Help with urinary issues while on TRT - BPH or 'overactive pelvic floor muscle'

[TonyG]

Hi there. I'm hoping you guys can help.

I am 32 years old. I've been on TRT for 3 years now. 1 ML Test Cyp per week combined with Anastrozole (0.5mg every other day) and HCG 3x a week.

Since I started TRT I have been experiencing urinary issues - intermittence, urgency, frequency, strain (not nocturnal thank God). Stream stops on it's own, almost like something is contracting by itself, have to push and force to restart. No feeling of relief after going. Sometimes going back to back.

I came off TRT for 8 months and everything returned to normal. Got back on TRT and the urinary issues came back.

I've seen a doctor for it who confirmed the prostate is slightly enlarged. Urology also mentioned it might be due to an overactive pelvic floor muscle.

I reduced my Test injection to 0.8ML two months ago hoping it would help but it has not made a difference.

I tried Flomax for a few days it helped but the sides were horrible so I stopped it immediately.

I am now trying Cialis - 5mg per day, it's been a few days since I started and I have not seen any improvement. The sides are also brutal (muscle pain, numbness, inflammation, aches, feeling like you have a cold).

My question is will the Cialis fix this problem? Will the sides effects fade? Is there anything else recommended to treat this issue? Should I drop the Cialis dose to half?

Thank you

 

[M.J]

Cialis side effect goes Away after maybe 2weeks to one month of use, at least this is what happened to me,I also read people saying the same here.

 

[madman]

Hi there. I'm hoping you guys can help.

I am 32 years old. I've been on TRT for 3 years now. 1 ML Test Cyp per week combined with Anastrozole (0.5mg every other day) and HCG 3x a week.

Since I started TRT I have been experiencing urinary issues - intermittence, urgency, frequency, strain (not nocturnal thank God). Stream stops on it's own, almost like something is contracting by itself, have to push and force to restart. No feeling of relief after going. Sometimes going back to back.

I came off TRT for 8 months and everything returned to normal. Got back on TRT and the urinary issues came back.

I've seen a doctor for it who confirmed the prostate is slightly enlarged. Urology also mentioned it might be due to an overactive pelvic floor muscle.

I reduced my Test injection to 0.8ML two months ago hoping it would help but it has not made a difference.

I tried Flomax for a few days it helped but the sides were horrible so I stopped it immediately.

I am now trying Cialis - 5mg per day, it's been a few days since I started and I have not seen any improvement. The sides are also brutal (muscle pain, numbness, inflammation, aches, feeling like you have a cold).

My question is will the Cialis fix this problem? Will the sides effects fade? Is there anything else recommended to treat this issue? Should I drop the Cialis dose to half?

Thank you

Those are symptoms of LUTS/BPH.

The daily use of a PDE5i can definitely improve symptoms of LUTS/BPH.

It is common for many to experience side-effect (varying degrees) when first starting daily tadalafil.

Just tough it out as they will eventually fade and to what degree will depend on the dose used/individual.

There are many other beneficial effects when it comes to daily use of aPDE5i.

Regarding your hrt protocol(dose T/injection frequency) post your labs with the reference ranges/assays used for TT/FT/e2.

What is your SHBG?

Your original protocol of 200 mg T/week is a whopping dose of T to be started on as it would result in very high TT/FT/e2 levels let alone drive up your RBCs/hemoglobin/hematocrit.

Efficacy and tolerability of combination therapy with alpha-blockers and PDE-5I compared with monotherapy for LUTS

Purpose: This study aimed to compare the efficacy and safety of combination therapy consisting of a-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis. Method: Relevant articles were retrieved from the...

www.excelmale.com

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are prevalent conditions that have negative impacts on quality of life and self-confidence.[1,2] The prevalence of LUTS in men aged over 50 years old has been reported to be more than 50%.[3] Based on the pathophysiological relationships between BPH-LUTS and ED, several studies have confirmed that both diseases often coexist and have a growing prevalence with age.[4,5]


6. Conclusions

In conclusion, combination therapy with a-blockers and PDE5Is was significantly more effective than a-blocker monotherapy at improving LUST. Among the combinations, vardenafil (10mg) combined with a-blockers, sildenafil (25mg) combined with a-blockers, and tadalafil (20mg) combined with a-blockers appear to be better choices than monotherapies with either a-blockers or PDE5Is and other combination therapies of a-blockers plus PDE5Is in terms of efficacy. However, our present results need to be verified with more high-quality studies with comprehensive data.

Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED

Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED A. Sebastianelli & P. Spatafora & S. Morselli & L. Vignozzi & S. Serni & K. T. McVary & S. Kaplan & S. Gravas & C. Chapple & Mauro Gacci Abstract Purpose of Review Aim of our systematic review is to...

www.excelmale.com

Conclusions

In conclusion, daily tadalafil, in particular at a dosage of 5 mg, is effective for the treatments of LUTS/BPH and ED. All the available evidence shows that the occurrence of TEAEs is low and most of the patients are “satisfied” by this treatment. Combination therapy of tadalafil 5 mg and tamsulosin 0.4 mg allows a further improvement of urinary symptoms and ED, against a higher rate of TAEs. Discontinuation of tamsulosin or tadalafil, after combination therapy, seems to allow preservation of the results obtained for LUTS relief. However, tadalafil only is able to retain ED improvement.

Pharmacological treatment of LUTS in BPH:

Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: consequences on sexual function and possible endocrine effects ABSTRACT Introduction: Benign prostate hyperplasia (BPH) is one of the most prevalent diseases in aging men. It may adversely affect...

www.excelmale.com

8. Expert opinion

First-line therapy for BPH/LUTS syndrome is represented by α1-adrenoreceptor blockers. The adverse-event profile of these drugs depends on the affinity rather than selectivity for the α1Aadrenoceptor. Hence, the probability of ejaculatory dysfunctions is highest with silodosin than with other drugs with lower affinity for this receptor subtype (tamsulosin, alfuzosin, doxazosin, and terazosin). However, classifying these patients by age (older vs. younger) and sexual activity (present or not), the use of PDE5is should be considered even if this is more expensive especially when BPH/LUTS coexists with ED. Indeed, due to the benefits of erection, PDE5i represents the most advantageous class of drugs for the treatment of LUTS-BPH in patients with ED. Interestingly, the remarkable effects of daily PDE5is on body composition and endothelial function other than sexual improvements are reported [121] and suggest a pleiotropic beneficial effect of these drugs. LUTS-BPH often associates with metabolic syndrome, although the exact mechanism has not been clarified yet. Molecular studies address insulin as a role in prostatic hyperplasia and inflammation [122].

Pharmacology of the lower urinary tract: update on LUTS treatment

Abstract: The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor...

www.excelmale.com

Emerging drugs to target lower urinary tract symptomatology (LUTS)/ benign prostatic hyperplasia (BPH): focus on the prostate

Abstract Objectives The benign prostatic syndrome, comprising lower urinary tract symptomatology secondary to benign prostatic hyperplasia/enlargement, represents a major health care issue in westernized countries. The pharmacological management involves alpha-adrenoceptor antagonists...

www.excelmale.com

Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms:

Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms: a multicentre, double-blind, randomized, placebocontrolled trial Dae Yul Yang*, Hyun Cheol Jeong*, Kyungtae Ko*, Seong Ho Lee† , Sang Kon Lee‡ , Tae Young Shin‡ , Jin Seon Cho§ and Won Ki Lee...

www.excelmale.com

In conclusion, taking tadalafil 5 mg once daily reduced PMD symptom severity and PMD volume in men with PMD and other LUTS more effectively than placebo. The present results also show that tadalafil does not induce serious TEAEs. These results suggest that taking tadalafil 5 mg once daily may be an effective and well-tolerated PMD treatment, and suggest that PDE-5 inhibitors have a potential role in treating PMD.

Tadalafil for the treatment of benign prostatic hyperplasia

ABSTRACT Introduction: In men, lower urinary tract symptoms (LUTS) are primarily attributed to benign prostatic hyperplasia (BPH). Therapeutic options are targeted to relax prostate smooth muscle and/or reduce prostate enlargement. Areas covered: This article reviews the major preclinical...

www.excelmale.com

Expert opinion: Preclinical and clinical data have clearly demonstrated that PDE5 inhibitors induce bladder and prostate relaxation, which contributes to the improvement seen in storage symptoms in both animal models of bladder and prostate hypercontractility. Tadalafil is effective both as a monotherapy and add-on therapy in patients with LUTS secondary to BPH. Furthermore, as LUTS-BPH and ED are urological disorders that commonly coexist in aging men, tadalafil is more advantageous than α1- adrenoceptors and should be used as the first option. Tadalafil is a safe and tolerable therapy and unlike α1- adrenoceptors and 5-alpha reductase inhibitors, which can cause sexual dysfunctions, tadalafil improves sexual function.


8. Conclusion

Tadalafil represents a well-tolerated and effective treatment option in men with LUTS-BPH with or without ED. As LUTS-BPH and ED can appear concomitantly in aging men, a drug that improves the signs and symptoms of both conditions is of therapeutic relevance.

Testosterone and Benign Prostatic Hyperplasia

Testosterone and Benign Prostatic Hyperplasia Giulia Rastrelli, MD, PhD, Linda Vignozzi, MD, PhD, Giovanni Corona, MD, PhD, and Mario Maggi, MD ABSTRACT Introduction: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are frequent in aging. Nonetheless, their...

www.excelmale.com

Objective impacts of tadalafil on storage and voiding function in male patients with BPH: 1‑year outcomes from a prospective urodynamic study

Objective impacts of tadalafil on storage and voiding function in male patients with benign prostatic hyperplasia: 1‑year outcomes from a prospective urodynamic study Yoshihisa Matsukawa1 · Shun Takai1 · Tsuyoshi Majima1 · Yasuhito Funahashi1 · Naoto Sassa1 · Masashi Kato1 · Tokunori Yamamoto1...

www.excelmale.com

Conclusions

The treatment with tadalafil for 12 months significantly relieved storage and voiding functions, along with LUTS, in patients diagnosed with LUTS/BPH. Monitoring the parameters of LUT function, such as bladder capacity, DO, Qmax, and BOOI, revealed that beneficial effects of tadalafil treatment observed at 3 months continued to improve until 12 months.

 

[TonyG]

Those are symptoms of LUTS/BPH.

The daily use of a PDE5i can definitely improve symptoms of LUTS/BPH.

It is common for many to experience side-effect (varying degrees) when first starting daily tadalafil.

Just tough it out as they will eventually fade and to what degree will depend on the dose used/individual.

There are many other beneficial effects when it comes to daily use of aPDE5i.

Regarding your hrt protocol(dose T/injection frequency) post your labs with the reference ranges/assays used for TT/FT/e2.

What is your SHBG?

Your original protocol of 200 mg T/week is a whopping dose of T to be started on as it would result in very high TT/FT/e2 levels let alone drive up your RBCs/hemoglobin/hematocrit.

Efficacy and tolerability of combination therapy with alpha-blockers and PDE-5I compared with monotherapy for LUTS

Purpose: This study aimed to compare the efficacy and safety of combination therapy consisting of a-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis. Method: Relevant articles were retrieved from the...

www.excelmale.com

Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are prevalent conditions that have negative impacts on quality of life and self-confidence.[1,2] The prevalence of LUTS in men aged over 50 years old has been reported to be more than 50%.[3] Based on the pathophysiological relationships between BPH-LUTS and ED, several studies have confirmed that both diseases often coexist and have a growing prevalence with age.[4,5]


6. Conclusions

In conclusion, combination therapy with a-blockers and PDE5Is was significantly more effective than a-blocker monotherapy at improving LUST. Among the combinations, vardenafil (10mg) combined with a-blockers, sildenafil (25mg) combined with a-blockers, and tadalafil (20mg) combined with a-blockers appear to be better choices than monotherapies with either a-blockers or PDE5Is and other combination therapies of a-blockers plus PDE5Is in terms of efficacy. However, our present results need to be verified with more high-quality studies with comprehensive data.

Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED

Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED A. Sebastianelli & P. Spatafora & S. Morselli & L. Vignozzi & S. Serni & K. T. McVary & S. Kaplan & S. Gravas & C. Chapple & Mauro Gacci Abstract Purpose of Review Aim of our systematic review is to...

www.excelmale.com

Conclusions

In conclusion, daily tadalafil, in particular at a dosage of 5 mg, is effective for the treatments of LUTS/BPH and ED. All the available evidence shows that the occurrence of TEAEs is low and most of the patients are “satisfied” by this treatment. Combination therapy of tadalafil 5 mg and tamsulosin 0.4 mg allows a further improvement of urinary symptoms and ED, against a higher rate of TAEs. Discontinuation of tamsulosin or tadalafil, after combination therapy, seems to allow preservation of the results obtained for LUTS relief. However, tadalafil only is able to retain ED improvement.

Pharmacological treatment of LUTS in BPH:

Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: consequences on sexual function and possible endocrine effects ABSTRACT Introduction: Benign prostate hyperplasia (BPH) is one of the most prevalent diseases in aging men. It may adversely affect...

www.excelmale.com

8. Expert opinion

First-line therapy for BPH/LUTS syndrome is represented by α1-adrenoreceptor blockers. The adverse-event profile of these drugs depends on the affinity rather than selectivity for the α1Aadrenoceptor. Hence, the probability of ejaculatory dysfunctions is highest with silodosin than with other drugs with lower affinity for this receptor subtype (tamsulosin, alfuzosin, doxazosin, and terazosin). However, classifying these patients by age (older vs. younger) and sexual activity (present or not), the use of PDE5is should be considered even if this is more expensive especially when BPH/LUTS coexists with ED. Indeed, due to the benefits of erection, PDE5i represents the most advantageous class of drugs for the treatment of LUTS-BPH in patients with ED. Interestingly, the remarkable effects of daily PDE5is on body composition and endothelial function other than sexual improvements are reported [121] and suggest a pleiotropic beneficial effect of these drugs. LUTS-BPH often associates with metabolic syndrome, although the exact mechanism has not been clarified yet. Molecular studies address insulin as a role in prostatic hyperplasia and inflammation [122].

Pharmacology of the lower urinary tract: update on LUTS treatment

Abstract: The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor...

www.excelmale.com

Emerging drugs to target lower urinary tract symptomatology (LUTS)/ benign prostatic hyperplasia (BPH): focus on the prostate

Abstract Objectives The benign prostatic syndrome, comprising lower urinary tract symptomatology secondary to benign prostatic hyperplasia/enlargement, represents a major health care issue in westernized countries. The pharmacological management involves alpha-adrenoceptor antagonists...

www.excelmale.com

Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms:

Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms: a multicentre, double-blind, randomized, placebocontrolled trial Dae Yul Yang*, Hyun Cheol Jeong*, Kyungtae Ko*, Seong Ho Lee† , Sang Kon Lee‡ , Tae Young Shin‡ , Jin Seon Cho§ and Won Ki Lee...

www.excelmale.com

In conclusion, taking tadalafil 5 mg once daily reduced PMD symptom severity and PMD volume in men with PMD and other LUTS more effectively than placebo. The present results also show that tadalafil does not induce serious TEAEs. These results suggest that taking tadalafil 5 mg once daily may be an effective and well-tolerated PMD treatment, and suggest that PDE-5 inhibitors have a potential role in treating PMD.

Tadalafil for the treatment of benign prostatic hyperplasia

ABSTRACT Introduction: In men, lower urinary tract symptoms (LUTS) are primarily attributed to benign prostatic hyperplasia (BPH). Therapeutic options are targeted to relax prostate smooth muscle and/or reduce prostate enlargement. Areas covered: This article reviews the major preclinical...

www.excelmale.com

Expert opinion: Preclinical and clinical data have clearly demonstrated that PDE5 inhibitors induce bladder and prostate relaxation, which contributes to the improvement seen in storage symptoms in both animal models of bladder and prostate hypercontractility. Tadalafil is effective both as a monotherapy and add-on therapy in patients with LUTS secondary to BPH. Furthermore, as LUTS-BPH and ED are urological disorders that commonly coexist in aging men, tadalafil is more advantageous than α1- adrenoceptors and should be used as the first option. Tadalafil is a safe and tolerable therapy and unlike α1- adrenoceptors and 5-alpha reductase inhibitors, which can cause sexual dysfunctions, tadalafil improves sexual function.


8. Conclusion

Tadalafil represents a well-tolerated and effective treatment option in men with LUTS-BPH with or without ED. As LUTS-BPH and ED can appear concomitantly in aging men, a drug that improves the signs and symptoms of both conditions is of therapeutic relevance.

Testosterone and Benign Prostatic Hyperplasia

Testosterone and Benign Prostatic Hyperplasia Giulia Rastrelli, MD, PhD, Linda Vignozzi, MD, PhD, Giovanni Corona, MD, PhD, and Mario Maggi, MD ABSTRACT Introduction: Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are frequent in aging. Nonetheless, their...

www.excelmale.com

Objective impacts of tadalafil on storage and voiding function in male patients with BPH: 1‑year outcomes from a prospective urodynamic study

Objective impacts of tadalafil on storage and voiding function in male patients with benign prostatic hyperplasia: 1‑year outcomes from a prospective urodynamic study Yoshihisa Matsukawa1 · Shun Takai1 · Tsuyoshi Majima1 · Yasuhito Funahashi1 · Naoto Sassa1 · Masashi Kato1 · Tokunori Yamamoto1...

www.excelmale.com

Conclusions

The treatment with tadalafil for 12 months significantly relieved storage and voiding functions, along with LUTS, in patients diagnosed with LUTS/BPH. Monitoring the parameters of LUT function, such as bladder capacity, DO, Qmax, and BOOI, revealed that beneficial effects of tadalafil treatment observed at 3 months continued to improve until 12 months.

Labs are above. I did take Finasteride for a year to lower DHT but it made no impact on the urinary symptoms, eventually I stopped it as it was not making a difference.

I don't know my SHBG as it is not on the labs requested by the Doc.

Does the Cialis crash E2 levels?

 

[madman]

View attachment 12152
View attachment 12153
View attachment 12154
Labs are above. I did take Finasteride for a year to lower DHT but it made no impact on the urinary symptoms, eventually I stopped it as it was not making a difference.

I don't know my SHBG as it is not on the labs requested by the Doc.

Does the Cialis crash E2 levels?

Are these labs from your current protocol 160 mg T/week + hCG (3x/week) and when were they done?

Are you still taking an AI as your e2 is on the low end?

 

[TonyG]

Are these labs from your current protocol 160 mg T/week + hCG (3x/week) and when were they done?

Are you still taking an AI as your e2 is on the low end?

These labs are 3 months old, @ 200mg T/week and 1mg AI every other day

I have since reduced the AI to 0.5mg every other day, raising E2 and found that is my sweet spot - best mood, zero anxiety

reduced the Test to 160mg T/week

i tried not taking an AI at all but the spike in E2 wreaked havoc on my prostate and made the urinary symptoms worse, it was terrible

 

[madman]

These labs are 3 months old, @ 200mg T/week and 1mg AI every other day

I have since reduced the AI to 0.5mg every other day, raising E2 and found that is my sweet spot - best mood, zero anxiety

reduced the Test to 160mg T/week

i tried not taking an AI at all but the spike in E2 wreaked havoc on my prostate and made the urinary symptoms worse, it was terrible

How many days after your injection were labs done?

 

[TonyG]

How many days after your injection were labs done?

7 days. Lab was done just before my weekly injection.

 

[madman]

7 days. Lab was done just before my weekly injection.

Finally!

As you can clearly see not only is your trough TT absurdly high 1362 ng/dL on such a whopping dose of T 200g/week but more importantly, your trough FT is high, and even than I would put money on it that it is higher than you think as unfortunately, you had it tested using the piss poor direct immunoassay.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

When testing FT it is critical to have it done using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration if you want to know where your FT level truly sits on such protocol.

You were on a horrible protocol which would be the cookie-cutter Tmill recipe type which is high dosed T injected once weekly with an AI let alone absurd dose thrown in to boot!

Sad that these doctors would start someone on such a high dose of T than throw an AI in the mix right off the hop.

Seeing as you were hitting such an absurdly high TT trough of almost 1400 ng/dL and high FT your TT/FT peak levels post-injection (8-12 hrs) and during the first few days will be insanely high and drive up estradiol.

Hard to give any further advice as we have absolutely no clue where your trough TT/FT/e2 levels sit as of now on your current protocol as you did not post labs?

You need to look into possibly tweaking your protocol (dose T/injection frequency) and may very well fair better lowering your overall weekly dose of T and injecting more frequently depending on where your current protocol (160 mg/week T) has your trough TT/FT/e2 levels

The downfall of injecting such a large dose of T once weekly is not only will there be a big difference in the peak--->trough as TT/FT levels will be sky-high early in the week only to be followed by much lower levels come weeks end and in your case still too high come weeks end (trough) let alone blood levels will not be as stable throughout the week.

 

[TonyG]

Finally!

As you can clearly see not only is your trough TT absurdly high 1362 ng/dL on such a whopping dose of T 200g/week but more importantly, your trough FT is high, and even than I would put money on it that it is higher than you think as unfortunately, you had it tested using the piss poor direct immunoassay.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

When testing FT it is critical to have it done using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration if you want to know where your FT level truly sits on such protocol.

You were on a horrible protocol which would be the cookie-cutter Tmill recipe type which is high dosed T injected once weekly with an AI let alone absurd dose thrown in to boot!

Sad that these doctors would start someone on such a high dose of T than throw an AI in the mix right off the hop.

Seeing as you were hitting such an absurdly high TT trough of almost 1400 ng/dL and high FT your TT/FT peak levels post-injection (8-12 hrs) and during the first few days will be insanely high and drive up estradiol.

Hard to give any further advice as we have absolutely no clue where your trough TT/FT/e2 levels sit as of now on your current protocol as you did not post labs?

You need to look into possibly tweaking your protocol (dose T/injection frequency) and may very well fair better lowering your overall weekly dose of T and injecting more frequently depending on where your current protocol (160 mg/week T) has your trough TT/FT/e2 levels

The downfall of injecting such a large dose of T once weekly is not only will there be a big difference in the peak--->trough as TT/FT levels will be sky-high early in the week only to be followed by much lower levels come weeks end and in your case still too high come weeks end (trough) let alone blood levels will not be as stable throughout the week.

Are you saying tweaking the protocol by injecting more frequently can possibly fix the BPH issue?

I will get new labs done.

 

[BigBamBoo]

Another thing that jumps out at me in your labs is your high TSH.
You should add a full thyroid panel as well.

As madman posted, you have a terrible protocol. You should find a new doctor or go to small injections more frequently.

 

[Cataceous]

On a weekly injection protocol it's common for peak testosterone to be 2.5 to 3 times higher than the trough value. It's a good bet yours had been over 3,000 ng/dL. That's not TRT. A 20% dose reduction isn't nearly enough. If you want to stay closer to physiological norms for most of the week then your dose should be more like 70-75 mg per week, unless your SHBG is particularly high. Splitting up the dose is preferred for stability.

If you are attaining that high vitamin D level through supplementation then you might consider cutting back:
"We now have several studies, some even large and recent, that show that raising 25-hydroxy levels above 50 (or perhaps 60) ng/dl is risky and associated with increased risk of chronic disease. Results seem to indicate that there is an optimal zone for Vitamin D."

Vitamin D: The Dangers of High Levels

Now it is pretty well-known in the men's health community that correcting a Vitamin D deficiency can increase testosterone, something...

www.peaktestosterone.com

 

[Novaman]

Good luck- you are awfully young to have BPH symptoms already. This doesn't usually happen until you are in your 50's. If it is prostate enlargement, there are things you can do for that. One thing to consider is a Prostate Artery Embolism procedure- where the doc deposits beads into the arteries supplying blood to the prostate to reduce the blood supply, thereby shrinking the prostate. If it is pelvic floor tension, you should check out the Wise Anderson Protocol

 

[madman]

superior efficacy of tamsulosin + PDE5i in treating BPH-related LUTS and ED

Efficacy and Safety of Combination Comprising Tamsulosin and PDE5-Is, Relative to Monotherapies, in Treating Lower Urinary Tract Symptoms and Erectile Dysfunction Associated With Benign Prostatic Hyperplasia: A Meta-Analysis Abstract We report the safety and efficacy of combination therapy...

www.excelmale.com

 

[TonyG]

Preliminary labs are above. This was taken on 1/4/21, before my injection.

The week before on 12/28/20 I began to split the Test dose to 0.4ml twice a week (Monday AM, Thursday PM). Keeping the AI at 0.5 EOD, 500IU HCG 3x a week. No Cialis.

I assume it's way too soon for these labs to reflect the splitting of the dosage..

Previous dosage was 0.8ml once a week with AI 0.5mg EOD, 500IU HCG 3x a week. No Cialis.

Disregard the TSH being high as I take a B supplement with Biotin which will throw off the result. I had all Thyroid tests done last year with no B supplement and everything was in range.

I am hoping splitting the dose will shrink the prostate back to normal size.

However the issue now is I am having serious mood swings, anxiety attacks, panic, fear...... all of which were not happening before splitting the dose.

I am assuming keeping the AI at the same dose while splitting the Test crashed my E2 levels?

 

[madman]

View attachment 12422


View attachment 12423
View attachment 12425
Preliminary labs are above. This was taken on 1/4/21, before my injection.

The week before on 12/28/20 I began to split the Test dose to 0.4ml twice a week (Monday AM, Thursday PM). Keeping the AI at 0.5 EOD, 500IU HCG 3x a week. No Cialis.

I assume it's way too soon for these labs to reflect the splitting of the dosage..

Previous dosage was 0.8ml once a week with AI 0.5mg EOD, 500IU HCG 3x a week. No Cialis.

Disregard the TSH being high as I take a B supplement with Biotin which will throw off the result. I had all Thyroid tests done last year with no B supplement and everything was in range.

I am hoping splitting the dose will shrink the prostate back to normal size.

However the issue now is I am having serious mood swings, anxiety attacks, panic, fear...... all of which were not happening before splitting the dose.

I am assuming keeping the AI at the same dose while splitting the Test crashed my E2 levels?

Lab work was done way too soon as you just recently switched your protocol from 0.8 ml once weekly--->0.4ml twice weekly.

You would need to wait 4-6 weeks for blood levels to stabilize and blood work would be done at the true trough (lowest point) which would be 84 hrs after your last injection as you are injecting twice weekly (every 3.5 days).

Even then if you were previously injecting 0.8 ml which would be 160 mg T/week if the strength is 200 mg/ml (which it most likely is) when you switched over to injecting 0.4 ml twice weekly (80 mg every 3.5 days) you are still injecting the same weekly dose of T.

Top it off that you are also injecting 500 IU hCG 3 x week.

Why would you not lower your T dose slightly?

Keep in mind that it is normal to experience ups/downs during the transition as your hormones will be in flux until blood levels stabilize at 4-6 weeks.

Also does not help that you are taking the AI and have no idea where your e2 sits as of now as you are waiting on the results but again you had blood work done way too soon.

As you can see your trough TT/FT levels are on the high end and your peak TT/FT/e2 levels will be higher let alone you did not have your FT tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration so we have no idea where your FT level truly sits on such protocol.

Even then your labs will only reflect where your levels sit as of now and you would need to retest at 6 weeks to know where the new protocol (dose T/injection frequency) has your trough TT/FT/e2 levels let alone other blood markers.

At least with your most recent labs once your e2 (sensitive) comes back you will know where your e2 sits and what impact the aromatase inhibitor has.

 

[TonyG]

I’m open to dropping the Test to 0.3ml twice a week.

i know from experience it takes my mood 5-6 days to normalize when adjusting the AI dose.

Do you recommend dropping the AI dose to 0.25mg ? Keep HCG the same?

 

[madman]

I’m open to dropping the Test to 0.3ml twice a week.

i know from experience it takes my mood 5-6 days to normalize when adjusting the AI dose.

Do you recommend dropping the AI dose to 0.25mg ? Keep HCG the same?

You drove your e2 very low when you were taking the AI along with the piss poor 200 mg T/week protocol you were started on.

You are still taking an AI now (lower dose) and you are also on a lower weekly dose of
T as you went from 200 mg/week--->160 mg/week and just recently switched over to 160 mg/week split into twice-weekly injections (80 mg every 3.5 days) and although you just had labs done it was way too soon as again you would need to wait 4-6 weeks until blood levels stabilize to see where your new protocol (dose T/injection frequency) has your trough TT/FT/e2 levels.

Getting labs less than two weeks after you just started the new protocol was a waste of money.

Luckily e2 was tested but you are waiting on the results and unfortunately, we have absolutely no idea where your e2 sits as of now (is it still on the low end or did you crash it?).

Once your e2 comes back if it is too low then I would drop the AI before lowering your T dose.

Stick to the protocol and get bloodwork done at the 6-week mark then decide if any adjustments need to be made.

Experiencing ups/downs is common during the transition as hormones are in flux.

 

[madman]

From my previous reply post#9

When testing FT it is critical to have it done using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration if you want to know where your FT level truly sits on such protocol.


Yet you went and had it tested using an inaccurate assay the piss poor direct immunoassay.

Next set of labs 6 weeks into your new protocol make sure to have it tested using (ED or UF).

You can purchase from Nelsons discountedlabs.

1 Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2 Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

 

[TonyG]

The tank in mood is hitting me hard, feels like withdrawal, almost like coming off T entirely. Tomorrow will be the start of the third week. Is this normal even when I have not dropped the dose, just changed the frequency?