Poor erection quality

[jsmack]

I started TRT about 8 weeks ago. 100mg/week split every 3 days.

Before TRT my numbers were:
Total T: 170
Free T: 5.7
E2: 19

My libido was actually fairly high at this point. I'd have sex every day if my wife was willing and able. Erection quality was ok, especially in the morning. At times I would help myself out with sildenafil or tadalafil and erection quality would be 100%.

My first 4 weeks of TRT was a whirlwind of sex. As much as my wife could tolerate. Multiple times a day, back to back sessions. At week 6 or so I noticed myself coming off the euphoric start of TRT. Libido calmed down like before TRT, still strong. However, my erection quality is maybe 50% what it used to be. I have very reduced sensitivity as well.

My numbers at this point were:
Total T: 738
Free T: 15
E2 at peak: 84
E2 at trough: 53

At this point, gynecomastia set in. My prolactin had gone from 4.6 to 8.9 during this time. So the doctor ruled that out. I'm going to run tamoxifen to protect myself now.

The other interesting point is that 5mg of daily tadalafil used to give me amazing erections all the time before TRT. Now, it seems no amount of PDE5 inhibitor can give me a solid erection. I've gone up to 10mg of tadalafil with 50mg sildenafil and it's still very weak. Also, 50mg of sildenafil used to give me some pretty noticeable side effects of flushing, tiredness, headache. Now, I get zero of that. I don't even feel it. Like something in my body is eliminating the PDE5 inhibitor before it can work.

I'm leaning towards thinking I need to bring E2 down. Does anyone have any insight or advice?

Thanks!

 

[Vince Carter]

What is the lab ranges especially for your E2...will tell us if you're using the correct tests.

 

[jsmack]

What is the lab ranges especially for your E2...will tell us if you're using the correct tests.

8-35 pg/ml sensitive estradiol from discountedlabs.

 

[S1W]

Why did you initially choose to start TRT - what symptoms were you trying to address?

What is your SHBG?

 

[DixieWrecked]

8-35 pg/ml sensitive estradiol from discountedlabs.

My penis was literally numb when my Estrogen got up to 55 on that same test. PDE5 inhibitors did nothing. AIs helped my numbers but didn't help how I felt. Lowering my dose and being lean has helped me out.

 

[jsmack]

Why did you initially choose to start TRT - what symptoms were you trying to address?

What is your SHBG?

Zero motivation, felt glued to the floor after work. Couldn't work out hard anymore. Was losing muscle and gaining fat around my waist.

SHBG went from 32 to now being 29.

 

[Wolverine]

Trial a small dose AI, .25 of Arimidex twice a week, or reduce your T dose. Your E is too high IMHO.

 

[Golfboy307]

If those are sensitive E2 readings, you answered your own question. Classic symptoms on high E2. The times I have been up that high erection quality was terrible with no sensitivity. PDE-5 inhibitors became nearly worthless.

You must have a very high rate of aromatase if your total T was only 738.

 

[jsmack]

If those are sensitive E2 readings, you answered your own question. Classic symptoms on high E2. The times I have been up that high erection quality was terrible with no sensitivity. PDE-5 inhibitors became nearly worthless.

You must have a very high rate of aromatase if your total T was only 738.

Thanks for the reply. Do you regularly use an AI now?

 

[S1W]

Zero motivation, felt glued to the floor after work. Couldn't work out hard anymore. Was losing muscle and gaining fat around my waist.

SHBG went from 32 to now being 29.

So far, do you feel that TRT has helped you with any of those issues?

Your E2 does seem relatively high given your TT and your protocol. Lowering your dose may not be a great option given that it is already fairly modest and your FT levels could be higher.

If you are overweight, lose weight. In the meantime, it might be worth injecting daily. Some guys have success with lowering their E2 on daily schedules...though it probably isn't going to bring you down into "normal" range.

 

[jsmack]

So far, do you feel that TRT has helped you with any of those issues?

Your E2 does seem relatively high given your TT and your protocol. Lowering your dose may not be a great option given that it is already fairly modest and your FT levels could be higher.

If you are overweight, lose weight. In the meantime, it might be worth injecting daily. Some guys have success with lowering their E2 on daily schedules...though it probably isn't going to bring you down into "normal" range.

It has definitely helped. I'm a monster in the gym now. I'm not a bodybuilder, but not overweight. I've got your typical 40 yr old dad bod that's been in the gym for 20 years. My doctor is switching me to EOD subQ as of today.

Would dropping to 80mg/wk and adding HCG be something to consider?

 

[equel]

Its cause of high e2. NEVER listen to anyone who tells you high e2 is not a problem, It iS a problem, a very big one.

Fix your estrogen and ur sex drive will be back.

 

[S1W]

It has definitely helped. I'm a monster in the gym now. I'm not a bodybuilder, but not overweight. I've got your typical 40 yr old dad bod that's been in the gym for 20 years. My doctor is switching me to EOD subQ as of today.

Would dropping to 80mg/wk and adding HCG be something to consider?

Glad to hear it.

I would not add HCG because with a lot of guys, it causes E2 to go up even further. Switching to EOD would likely be beneficial - however, I guess I'm just not sure about the dosage decrease given your FT levels. Hopefully someone else can chime in on that.

 

[Golfboy307]

I notice high E2 symptoms whenever I get > 35. This typically only occurs when I am over 1000 TT. So, I try to stay in the 700-900 range (I inject 2X week, 75mg total/wk)
This keeps me around 20-25 E2. So at these levels I don't need an AI or HCG. You may need an AI if your conversion rate is that high. Hope that helps

 

[Systemlord]

E2 at peak: 84
E2 at trough: 53

Here is your erectile problem, you need daily injections because you aromatise like crazy.

 

[SilverSurfer]

It has definitely helped. I'm a monster in the gym now. I'm not a bodybuilder, but not overweight. I've got your typical 40 yr old dad bod that's been in the gym for 20 years. My doctor is switching me to EOD subQ as of today.

Would dropping to 80mg/wk and adding HCG be something to consider?

A “typical dad bod” is obese. I think your dismissing your obesity / overweight rather cavalierly. What’s your BMI?

 

[jsmack]

A “typical dad bod” is obese. I think your dismissing your obesity / overweight rather cavalierly. What’s your BMI?

I guess we might have different ideas of dad bod. My bmi is around 26. You can see veins in my biceps and chest. Not fat by any means.

 

[Tonyp56]

Just putting my own experience in here. Started trt 6-17-17. First ~1 1/2 months was great. Sex drive, ability to get and or keep an erection almost 100% went away for nearly a year. (First clinic compounded 1 mg of anastrozole with pre-filled syringes of 200mg of testosterone injections that they sent me, crashed my e-2 (below 5 on sensitive e2 test). Started injections protocol with Defy July 2018. Estradiol sensitive went sky high to about 64 in trough by around September. Was put on anastrozole .125mg EOD numbers got better. Current protocol is 36 mg of testosterone EOD (injection) , .1mg of anastrozole EOD, and 500 I.U. of hcg 2x week (injection). Latest blood work (11-5) e2 sensitive 21 ng/ml (8-35) Ft 23.2 pg/ml (6.8-21.5) tt 879 ng/dl (264-916) Dht 45 ng/dl (was told to add this test to see if dht is causing issues, of course no range given on test so have no idea if this is possible issue). Anyways throughout all of that, my erection strength/quality is not even to pre-trt levels STILL. this in regard to ability to get and maintain an erection. In all honesty it's about 70% of what it was pre (right now and it's the best it has been on trt currently). Sad I wish for my pre-trt erection ability. Oh tsh was 1.91 just in case.

 

[Tonyp56]

Just putting my own experience in here. Started trt 6-17-17. First ~1 1/2 months was great. Sex drive, ability to get and or keep an erection almost 100% went away for nearly a year. (First clinic compounded 1 mg of anastrozole with pre-filled syringes of 200mg of testosterone injections that they sent me, crashed my e-2 (below 5 on sensitive e2 test). Started injections protocol with Defy July 2018. Estradiol sensitive went sky high to about 64 in trough by around September. Was put on anastrozole .125mg EOD numbers got better. Current protocol is 36 mg of testosterone EOD (injection) , .1mg of anastrozole EOD, and 500 I.U. of hcg 2x week (injection). Latest blood work (11-5) e2 sensitive 21 ng/ml (8-35) Ft 23.2 pg/ml (6.8-21.5) tt 879 ng/dl (264-916) Dht 45 ng/dl (was told to add this test to see if dht is causing issues, of course no range given on test so have no idea if this is possible issue). Anyways throughout all of that, my erection strength/quality is not even to pre-trt levels STILL. this in regard to ability to get and maintain an erection. In all honesty it's about 70% of what it was pre (right now and it's the best it has been on trt currently). Sad I wish for my pre-trt erection ability. Oh tsh was 1.91 just in case.

Should also add have followed current protocol for ~6 months and have consult on Tuesday. Main point here was to point out erection ability did not change really from crashed to fairly high e2 levels (along with normal) also shbg is 19.5 on latest test too.

 

[Charliebizz]

Should also add have followed current protocol for ~6 months and have consult on Tuesday. Main point here was to point out erection ability did not change really from crashed to fairly high e2 levels (along with normal) also shbg is 19.5 on latest test too.

How do you feel other wise in trt did it improve other areas ?