Tired of these weak erections on TRT. Can't seem to find a solutions after 4 years.

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jchems

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My lowest Total Testosterone reading before TRT was in the 170ng/dl range. At that time, I had no erection issues. 10mg of tadalafil or 20mg of sildenafil would light me up all night. I would have sex every day at times when the wife was willing. Once I started TRT, that quickly moved to 4x a day on some days. :) I had great sex on TRT for the most part for the first 18 months to two years. The last couple years have been miserable. I would rate my erections at mostly a 6 out of 10. Sometimes less than that.

I can't remember the last time I had a spontaneous erection. I no longer wake up with them. I don't get strong erections through the night. I don't get erections when seeing my wife in sexy lingerie. It takes a good bit of physical stimulation to become aroused. Once I have an erection, it's gone almost immediately without physical stimulation. My libido is good. I want sex every day.

Early on, when I was figuring out my protocol, I would inject large amounts spread out 2x a week. I found that when I did that, taking anastrozole would bring erection quality back. I moved to daily injections to keep levels more stable and not spiking too high. That trick doesn't seem to work anymore and I don't want to be on anastrozole. I've also found that tamoxifen increases both libido and erection quality.

Before my erection issues, I would take 20mg of sildenafil and get flush, warm ears and extremities, stuffy nose and raging erections. Now, I can take 120mg of sildenafil + 20mg of tadalfil and I don't even get those negative side effects (I do get the acid reflux from tadalafil). Not even the side effects??? It's like whatever is happening in my body is completely blocking the effects of PDE5i's. All of my blood work is find. I've tried various levels from 700 Total to 1000 Total. I do better at 700 than 1000. Maybe I need to go back to 600 next to try that for a while.

This is an acute problem since TRT. I'm healthy otherwise. I'm going to say I don't watch porn, but I am starting to think social media feeds like ******** and Instagram are borderline porn always showing me fitness girls and similar things. I've removed Instagram from my phone.

One idea I'm still toying with is that for the first 2 years on TRT, I was banging my wife 10x a week. I was lifting weights hard for the first time in years, I was looking better, I had energy, people were noticing me physically changing for the better. Did I fry my dopamine system? I have restless leg syndrome and one of the medications for that is a dopamine agonist, ropinirole. That medication helps my legs. Meaning, my body is looking for more dopamine. Caffeine doesn't work too well on me anymore either.

I've read other similar situations online from guys that say their erections and/or libidos went south after a couple years of TRT.

Anyone have any other ideas for me to try? I've tried every protocol from 2x a week to daily injections, 100mg to 175mg per week of Test C. I still have sex, but this is now starting to get to the mental part for me where I'm never sure if it's going to be enough.

Thanks!
 
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Defy Medical TRT clinic doctor
It's like whatever is happening in my body is completely blocking the effects of PDE5i's.
There’s one thing that these ED drugs need to work, the mechanism by which both Cialis and Viagra target, that’s nitric oxide, without nitric oxide, these ED meds won’t do much of anything.

Another reason for Cialis and Viagra not working, worsening Type 2 Diabetes, which reduces nitric oxide.

I found suboptimal ferritin, iron for a reason for Cialis no longer working.
 
There’s one thing that these ED drugs need to work, the mechanism by which both Cialis and Viagra target, that’s nitric oxide, without nitric oxide, these ED meds won’t do much of anything.
I take large amounts of citrulline, arginine and beet root to try to account for this. That would be a solution to the issue you're describing, correct?
 
I haven't measured my estradiol in some time. I may take a good dose of anastrozole to see what happens.

Effect of estradiol on penile erection: a cross-sectional study
"Our data indicate that estradiol inhibits penile erection, particularly at the penile base."


The role of estradiol in male reproductive function
"ED from increased estradiol exposure is independent of testosterone level."

Relationship between penile erection and the ratio of estradiol to testosterone: A retrospective study
"In summary, our study demonstrated a negative relationship between E2/T ratio and penile erection, particularly at the root of the penis."
 
I haven't measured my estradiol in some time. I may take a good dose of anastrozole to see what happens.
I know it is tempting to just "do something" to possibly address the situation but for your long-term success here, you should really grab your current E2 value, while things still suck, before changing anything. After you get the blood drawn, if you want to pop an anastrozole pill to see what happens, I'd say go for it.
 
I had great sex on TRT for the most part for the first 18 months to two years

Early on, when I was figuring out my protocol, I would inject large amounts spread out 2x a week. I found that when I did that, taking anastrozole would bring erection quality back.

So keep doing that.



I moved to daily injections to keep levels more stable and not spiking too high. That trick doesn't seem to work anymore and I don't want to be on anastrozole.

And stop doing this.



So everything was just dandy for 2 years. That ain't no honeymoon...

Then you read some stuff, the latest fad at the time which was:
1. "stable levels" and
2. Anastrozole is the devil.

So you changed your protocol and everything went to shit. If it aint broke don't fix it! If anastrozole was working keep using it! The peanut gallery has broken your dick. Ill place a 50% bet on this.

The other 50%, could be as you said due to the dopamine agonist. Dopamine agonists also give you excellent libido in the short run for sure. Could be you fried your receptors after long use.

Look into swopping out the DA with selegiline instead, which may both fix the above problem AND your restless leg syndrome.
 
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There is not one study or even anecdotes in the past 13 years of ExcelMale that shows any benefits on ED of using anastrozole. None.

We have lots of info here. Daily Cialis or Trimix as needed are two effective solutions.


 
Don't overlook any other medications, pharmaceuticals, chemicals, or supplements that you may be taking either in part or in combination as a possible culprit. Consider dropping anything that is non-essential for a period of time and allow your body the opportunity to reset. More dopamine isn't going to guarantee you erections. If anything, I sense that relaxation would be good for you.
 
There is not one study or even anecdotes in the past 13 years of ExcelMale that shows any benefits on ED of using anastrozole. None.
I agree I haven't seen much on benefits of controlling E2 for erections on this forum, however, I have seen alot of that discussion elsewhere. There is both the common broscience around the topic, where weakening erections are taken as a sign that E2 is climbing too high, and a number of studies that suggest excessive estradiol has negative effects on erection, independent of testosterone levels. Here's a few that implicate high estradiol as problematic for erections (even when testosterone is normal or high):

 
I agree I haven't seen much on benefits of controlling E2 for erections on this forum, however, I have seen alot of that discussion elsewhere. There is both the common broscience around the topic, where weakening erections are taken as a sign that E2 is climbing too high, and a number of studies that suggest excessive estradiol has negative effects on erection, independent of testosterone levels. Here's a few that implicate high estradiol as problematic for erections (even when testosterone is normal or high):

I noticed years ago that higher estradiol gives me soft erections and I have trouble staying hard. I did the AI thing but it was too big a pain in the ass finding the right dose and I discovered I’m highly sensitive to anastrozole. I lowered my dose and don’t have the problem anymore.
 
So everything was just dandy for 2 years. That ain't no honeymoon...

Then you read some stuff, the latest fad at the time which was:
1. "stable levels" and
2. Anastrozole is the devil.

So you changed your protocol and everything went to shit. If it aint broke don't fix it! If anastrozole was working keep using it! The peanut gallery has broken your dick. Ill place a 50% bet on this.

The other 50%, could be as you said due to the dopamine agonist. Dopamine agonists also give you excellent libido in the short run for sure. Could be you fried your receptors after long use.

Look into swopping out the DA with selegiline instead, which may both fix the above problem AND your restless leg syndrome.
Not exactly. I was dialing in the first year. At 6 months or so I had complete ED and when I stopped injecting 2x a week and went to more frequent, it helped. Also, anastrozole woke me back up. But the first year I was gradually increasing my dose as well and as my levels continued to rise, it seemed OK. But basically, any protocol I'm on, erection quality tends to gradually decline until I then take anastrozole. I will say when I was on 2x a week injections, my estradiol levels (which I checked against my provider's advice) were spiking. They were almost doubling and halving. However, that was early on and I don't think my body responds like that anymore.

I've gone through every experiment over the years with my TRT. Raising Free T. Raising DHT. Adding HCG. Injecting daily. Anastrozole has brought my erection strength back 100% of the time. The anti-AI crowd refuses to believe me. Heck, I'm in the anti-AI crowd! I don't want to take it if I don't have to.

Thanks for your input!
 
There is not one study or even anecdotes in the past 13 years of ExcelMale that shows any benefits on ED of using anastrozole. None.

We have lots of info here. Daily Cialis or Trimix as needed are two effective solutions.


I'll be your anecdote.

That link is about TRT not leading to better erections or sex drive. What about when TRT results in less erection quality?

I don't want anyone to hear what I'm saying and suggest "he says killing estradiol levels is good for erections." I don't know the mechanism at play. I can just say that every time I take anastrozole, my erections improve to pre-TRT levels. I have NOT taken anastrozole long term. Maybe after I took it for a number of months the side effects would add up on me and I'd drop it.
 
I noticed years ago that higher estradiol gives me soft erections and I have trouble staying hard. I did the AI thing but it was too big a pain in the ass finding the right dose and I discovered I’m highly sensitive to anastrozole. I lowered my dose and don’t have the problem anymore.
That's where I'm trending now. I'm thinking of maybe just finding a dose that puts me in the 500ng/dl Total area. That would probably put my Free T at 20ng/dl or less. I know I certainly do better at 700 than I do at 1000 for a variety of reasons.
 
That's where I'm trending now. I'm thinking of maybe just finding a dose that puts me in the 500ng/dl Total area. That would probably put my Free T at 20ng/dl or less. I know I certainly do better at 700 than I do at 1000 for a variety of reasons.
Keep us updated. I too have found that sometimes popping an anaz helps. But other times it makes it worse. Its not a fun game to play. And rolling the dice to see if I can get hard during sex is no fun either.

Thankfully cialas and sidenifil work about 90% of the time.
 
That's where I'm trending now. I'm thinking of maybe just finding a dose that puts me in the 500ng/dl Total area. That would probably put my Free T at 20ng/dl or less. I know I certainly do better at 700 than I do at 1000 for a variety of reasons.
One thing I didn’t add was when I was using the AI I was taking 1 cc a week, and as long as I kept my E2 somewhere under 40 I didn’t have problems, even with sky high test levels. The problem was I was so sensitive to anastrozole it was almost impossible to keep it from going too low.

I dropped my dose due to this and the fact high levels of test aggravate pre existing anxiety. Settled around 70-80 mg a week and my free is usually around 13-15. No problems with erections at all. But I have tried to creep the dose up a few times, and once I get to around 120 a week or so the soft erections come back and my E2 checks in at over 40…and anxiety gets worse. Which has caused me to wonder if it’s not actually the elevated E2 rather than the test that does it.
 
One thing I didn’t add was when I was using the AI I was taking 1 cc a week, and as long as I kept my E2 somewhere under 40 I didn’t have problems, even with sky high test levels. The problem was I was so sensitive to anastrozole it was almost impossible to keep it from going too low.

I dropped my dose due to this and the fact high levels of test aggravate pre existing anxiety. Settled around 70-80 mg a week and my free is usually around 13-15. No problems with erections at all. But I have tried to creep the dose up a few times, and once I get to around 120 a week or so the soft erections come back and my E2 checks in at over 40…and anxiety gets worse. Which has caused me to wonder if it’s not actually the elevated E2 rather than the test that does it.
i forgot the exact video, (T optimization channel youtube), but on of the docs (rauschenbach or something) said that guys with anxiety need to supplement pregnenolone+magnesium. he recommend 100mg of P. i supplement at that dose + magnesium at 450mg. i too get anxiety if i go above 35mg/T prop daily. my total T is around 1000 and free 40ng/dl. and that with SHBG of 11. daily injection around .25-.3cc T prop. ibido is though the roof. erections amazing. 44y old male. good diet/working out.
 
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