I've posted here before I believe about a similar issue. Not so much all of the other side effects listed. TRT has increased my overall health markers. My cholesterol, triglycerides, BP, bodyfat, muscle mass, mental health, energy levels have all improved. It's been a great increase to the quality of my life in many ways. I still have sky high hemoglobin and hematocrit. And ever diminishing quality of erections.
Morning and spontaneous erections are completely gone.
I always need some sort of physical stimulation for erections. That was never the case before TRT.
Mostly they are at maybe 70% of what they were before TRT.
Before TRT, if I took 50mg of sildenafil, I should get flush, warm and stuffy nose and have 100% rock solid erections. Now, I do get some boost from PDE5i's, but barely even the side effects. That's why I think there's something chemical that I'm missing.
Early on when I noticed my erection quality diminishing, I would take a small dose of anastrozole and erections would come storming back the next morning. Even the PDE5i side effects would come back stronger. Not so much anymore.
All of my personal tests have pointed to it being a chemical issue in some way. I've tried every combination of dose and injection frequency. I'm actually thinking about creating some sort of variable injection frequency to simulate the peaks and valleys of natural levels.
The other issue I'm experimenting with is what someone else mentioned, I believe. Dopamine. My first couple years of TRT was me just banging the wife every day..... or 4x a day.
Seriously, in the beginning, it was an insatiable drive. And she was going along with it, getting me worked up, buying cute outfits, etc. It was fun. All of that while I was growing more muscle than I ever had in my life. Experiencing vitality and drive like I hadn't in years. ETc, etc, etc. On top of that I look at my lifestyle. I have a screen/device in front of me all the time. All of the social media apps are addicting. I had to delete TikTok and Instagram because eventually the algorithm just showed me "fitness" girls spreading their vaginas for the camera. Now, YouTube is doing it to me with the YouTube shorts. ******** is feeding me college cheerleaders. The things I see accidentally or are fed to me on social media would have been considered pornography just 10 years ago. Have I just completely blown out my dopamine system in the last couple years?
So how do we reset this dopamine system in this world? I'm trying to figure that out and spending as much time away from screens as possible. Andrew Huberman has a good podcast about it.
Having said all of that, I still think there is a hormonal component to my decrease in erection quality. I still have plenty of sex and it's important to me and feeling close/connected with my wife. But, if the quality decreases any more, I may have to back off of TRT as my next experiment, which I would hate to do.