On TRT, good looking numbers, horrible ED and no morning wood STILL.. help

[audiognostic]

Hey

Here are some lab numbers I have

Total T 916

Free T 24.5 (2.7%)

E2: 37 (AI doesnt seem to help and only makes things worse, ive tried arimidex and aromasin)

SHBG: 23 ( a little on the low end, but nothing like i see "low shbg guys" struggling with in the teens and stuff)

DHT: 50 (tested about 2 years ago after starting trt still feel the same now)

Prolactin : 8 (not high at all)

Progesterone looks normal.

Thyroid, diabetes markers, all look good and normal

no other major health issues


morning wood is non existant, libido is low, erections suck, i can get it up but i lose it very fast and easy, sensitivity sucks, my dick feels like it has about as many nerve receptors as my pinky finger

otherwise i feel mostly good and fine in terms of energy levels etc, nothing amazing but just normal

its like everything is about a 7/10 in terms of how i feel and sexual function is a 2/10

I already take every day injections of testosterone cypionate daily IM

I tried taking 250 IU HCG once per week recently, also tried before at twice per week, no difference, if i take more than that it boosts my E2 really high and AI doesnt help any of my issues

im only 29 years old

Not sure how much longer i can deal with this, i cant have a relationship with anybody

Ive never seen anyone with numbers as good as mine having these issues

anyone have any ideas on what else to investigate?

its really bad, 100 mg viagra barely helps and 20 cialis barely does anything


one other thing is sometimes i get random fluctuations, ill get morning wood for a couple weeks, or ill get really good erections for a couple weeks, then it will all randomly go away, E2, total t free t and SHBG stays the same meanwhile while tested in good and bad cycles

what else could be causing this?

 

[Systemlord]

My SHBG levels are about the same as yours and I have some ED and low libido with my estrogen in the high 30's, but you never considered Free E2. SHBG being on the lower end means estrogen towards the higher end more often than not causes problems.

HCG is known to increase estrogen and AI's can't effect estrogen produced inside the testicles forcing you to lower the HCG dosage.

If still on HCG, lower the dosage or stop it. If that doesn't help lower your T dosage a little waiting at least 6 weeks between adjustments until you find libido.

 

[audiognostic]

My SHBG levels are about the same as yours and I have some ED and low libido with my estrogen in the high 30's, but you never considered Free E2. SHBG being on the lower end means estrogen towards the higher end more often than not causes problems.

HCG is known to increase estrogen and AI's can't effect estrogen produced inside the testicles forcing you to lower the HCG dosage.

If not on HCG, lower your T dosage.

Really? so youre saying that AI cant lower "Estrogen produced inside the testes"?

so maybe HCG is not a good idea?

Funny thing is i recently started getting a bit of morning wood and yea i added a little HCG by someones recommendation and my morning wood has gone away, and AI has not seemed to bring it back

so you think I should stop the HCG?

Whats odd is even when i started getting some morning wood erections were still pretty shit..

What are you SHBG levels and have you been able to have anything improve or be at least pass-able on your end?

I have seen plenty of guys with SHBG levels 20+ doing fine.. so what the hell , this is really a bummer

maybe i should stop the HCG and just chase that morning wood

 

[Systemlord]

Really? so youre saying that AI cant lower "Estrogen produced inside the testes"?

That is correct, anastrozole can't affect anything inside the testicles. Mostly HCG cause mood issues, low libido and ED. There are a lot of men who solve a lot of problems by eliminating HCG from their TRT protocol.

You need to first dial-in your TRT in isolation and find the Total T and estrogen range that libido and erections respond best.

Losing body fat will go a long way to lowering estrogen along with reducing your dosage.

 

[audiognostic]

Thanks for your input that is highly appreciated, im going to try to cut the HCG back out and see if my morning wood comes back.. then ill see what happens..

its odd my SHBG is 23.. everyone tells me thats not low, but im still dealing with what i feel are low-SHBG related issues, that is the only number i see that could cause any problems because all my other numbers look totally dialed in

luckily its 23 and not 13 , ive had periods of time where things have been good, so i have some faith i may possibly be able to make it work.

I think my focus will be in getting as de-estrogenated as possible, because if i go off feel, thats definitely how i feel, i basically feel like my estrogen is high despite not having e2 numbers be too high once i take AI.. i still feel like my estrogen is high.. thats probably what it could be.. that free e2 and testicular e2.. thats what i was reading about being an issue with lower SHBG levels.. that matches all my symptoms.. lack of morning wood, dick feels numb, ed, low libido, etc..

have you been able to get your situation more dialed in?

im miserable because i cant get a relationship because of these up and down issues where ED gets really bad

 

[Gman86]

Your issue could be DHT related. Your DHT is on the lower end, imo. A testosterone cream would fix this issue. You don’t necessarily need to switch to a testosterone cream. Some guys do well just but adding a little bit of cream to their testicles and shaft, along with their testosterone injections. I think there’s a thread going around here recently about it.

 

[Vince Carter]

I've understood an AI to be less effective in the testicular environment, not ineffective, but it may just be splitting hairs.


Usually I would take this as a sign that your E2 is too low, for you. When E2 is like this you can't get wood no matter what you do.

its really bad, 100 mg viagra barely helps and 20 cialis barely does anything

 

[Vince Carter]

Note too that you're not posting labs except typing out vague numbers and even more vague statements like "look good and normal"...which isn't meaningful to any one that wants to help you out.

 

[Gman86]

I was going to say something similar to what Vince said about the labs. It would be helpful to see your thyroid and diabetes labs, with ranges. Thyroid imbalance, and insulin resistance issues, can both absolutely play a role in regards to libido and erection function/ quality. It would be a big mistake to rule out either. Post your labs and we’ll go over them real quick for ya. They might all be within range like you said, but the worst mistake anyone can make is just trusting their doctor tell when they tell them “everything is within range, and looks good”.

 

[Systemlord]

Vince Carter makes an excellent point, normal isn't useful because the reference ranges for TSH aren't normal and doctors cannot agree on what is normal, some don't believe Reverse T3 has any negative effects on the body.

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter.

 

[sh1973]

There are a good number of men including myself that do not receive any positive effect on libido from TRT. In fact all the ancillary meds such as HCG, DHEA, Pregnenolone ETC... made matters exponentially worse in me and does in many others as well. I started TRT at 440ng and have had levels all the way the 1900ng over the last 9 years. At no point has libido been as good as it was at 440ng. I have had decent energy and wellbeing but sexual desire has in no way been affected positively by TRT other than not having ED. The only positive effects on libido have been at times of changing my protocol and have been extremely brief. I firmly believe there are factors with sexual desire that are truly uncharted territory, because too many men have sexual issues on TRT and there's no denying that.

 

[Gman86]

There are a good number of men including myself that do not receive any positive effect on libido from TRT. In fact all the ancillary meds such as HCG, DHEA, Pregnenolone ETC... made matters exponentially worse in me and does in many others as well. I started TRT at 440ng and have had levels all the way the 1900ng over the last 9 years. At no point has libido been as good as it was at 440ng. I have had decent energy and wellbeing but sexual desire has in no way been affected positively by TRT other than not having ED. The only positive effects on libido have been at times of changing my protocol and have been extremely brief. I firmly believe there are factors with sexual desire that are truly uncharted territory, because too many men have sexual issues on TRT and there's no denying that.

You’re without a doubt correct. There are many other aspects that effect libido. Things that TRT could potentially throw off. For instance, TRT can deplete magnesium. Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions. Without proper magnesium levels, a person can have a lot of the same symptoms as someone with low testosterone. Including lowered libido, and especially difficulty with erections, believe it or not. TRT can also effect cortisol levels. Usually lower them, from my understanding. Low cortisol levels can wreak havoc on someone. Including issues with libido and erections. I’m not sure if TRT can effect thyroid function or not, but even if it doesn’t, thyroid imbalance can 100% effect libido and erections, and should be looked at extremely thoroughly. There’s probably a few other things that can cause TRT to make someone feel worse, but those are just a few things off the top of my head.

 

[sh1973]

It’s certainly been elusive for me. My thyroid numbers haven’t budged in the 9 years on trt and cortisol has stayed pretty well the same. I’ve went as far as having nutritional deficiency tests and tried supplements that affect neurotransmitters to no avail. I’m not knocking TRT because it does help some but anyone would be denying the elephant in the room if they didn’t see how it affects many man’s libido negatively. There’s just something that changes that unfortionately just doesn’t show up in the standard labs. Without fail I can have a couple alcoholic beverages and my libido seems normal like it used to for an hour 100% of the time. I’ve told this to every doctor I’ve had over the years but unfortunately alcohol affects many neurotransmitters so narrowing down which one is in question is extremely hard. It’s like when doing weekly injections whether the dose is 60 mg or 150 mg with me at Day 6 I have a half day where my libido a strong then it’s gone again. I’ve never had ED while on testosterone replacement but the desire for sex or thinking about sex has probably been three out of 10 at best for me.

 

[sh1973]

I also did 6 months of Wellbutrin at one point but really didn’t help.

 

[Gman86]

I feel like men are having much more success on creams, in regards to libido and erections. I wonder what the difference is that’s causing this. Obv the increased DHT is the first thing that comes to mind, but I’m sure there are other factors that are coming into play. Maybe something with the fact that levels are in and out of the system quickly. Or maybe the fact that while on creams, a guy can still have some natural LH and FSH going on.

 

[sh1973]

Not really sure but I’d love to know. Even with injectable my dht is at the higher end. I used topicals for quiet a while in the beginning and the effects faded with that as well. No matter what someone puts in their bodies, it will try to maintain homeostasis. My theory is with some men, no matter how much exogenous hormones that are introduced, the body will dial other processes back to counteract the hormones. I think this is were the honeymoon period comes from until Mother Nature slams on the brakes.

 

[Charliebizz]

To add to sh post. I think it’s funny when guys talk about how important optimal testosterone is. Is it really optimal to boost testosterone by injecting it and shutting down other biological processes I think not.

Does it help some absolutly but it’s so complicated and for me personally my body functions better even with the lower testosterone then it does on. I feel very unstable on trt. Meaning I can feel fine and then bad for no reason in the matter of minutes. Where off trt I can usually tell how my day is going to be based off what I did the day before.

 

[Tonyp56]

To add to sh post. I think it’s funny when guys talk about how important optimal testosterone is. Is it really optimal to boost testosterone by injecting it and shutting down other biological processes I think not.

Does it help some absolutly but it’s so complicated and for me personally my body functions better even with the lower testosterone then it does on. I feel very unstable on trt. Meaning I can feel fine and then bad for no reason in the matter of minutes. Where off trt I can usually tell how my day is going to be based off what I did the day before.

I have to agree with you here. I'm the same. Hate it. Before trt I knew if I went to gym and had hard work out or hard day at work I was going to feel crappy for a couple days. Now with TRT I have no clue until it hits. Sexually I'd say, 90% of the time, things don't work, physically it is so up and down I couldn't begin to time it, and emotionally I'm all over the place.

I regret ever going to doctor and letting them talk me into being on TRT. At 42 I'm screwed for life.

 

[Tonyp56]

If there is so many side-effects of being a trt patient then why do we do this? Isn't there a reason our bodies atop producing testosterone? Maybe just maybe we shouldn't screw with it. I'll never be the same and might as well give up on life because of how I feel. 6-17-17 is my death date!!

 

[Charliebizz]

If there is so many side-effects of being a trt patient then why do we do this? Isn't there a reason our bodies atop producing testosterone? Maybe just maybe we shouldn't screw with it. I'll never be the same and might as well give up on life because of how I feel. 6-17-17 is my death date!!

Why are you screwed for life. If you were manageable before trt just get off and you will go back to that state. I’m off trt over a month and I’m back to how I felt before. For me personally I was looking to get to that next level in how I feel. Back to 100% normal. I still have small lingering issues and since low t is legit the only thing that shows up in my bloodwork I keep trying it to get back to 100%. But for me fooling with my endocrine system directly just doesn’t work.

Nt drugs like low dose ssri have made the biggest improvement in my physical symptoms so I’m going to stay with that for now. I stay on the forums because it’s a great community and I think maybe one day down the line hrt could be for me if we figure some more things out.