TRT and cialis not quite cutting it

[crazyhaha]

Hey everyone, I started on TRT (T. Cyp and HCG and DHEA with Defy) in November 2016 and I feel so much better physically and emotionally. I’m 41, and my T has gone up from 200-300 before TRT to 655 (2-2017)!

Although I am very thankful for the improvement, things in the sex department aren’t back to what they should be.

I am currently on 5 mg of cialis daily (¼ of a 20 mg troche from Empower Pharmacy, taken in the morning) and just bumped it up to ~7.5 mg by taking an additional ⅛ at night.

Problems:
So, the problem is, that while I get erections they don’t seem to stay. I’ve noticed as I lose the erection I tend to orgasim which then ends things prematurely.

I’m sure a lot of this has to do with the mental side, as the past couple years have been very frustrating for my wife and I. Any suggestions would be welcome!!


I get a lot of sinus pain which I think may be related to the cialis. I already take zyrtec, singulair, and OTC steroid nose spray (Nasacort), so adding those is not an option. Does timing of the daily dose make a difference? Would a different ED med make a difference?

I have discussed trimix with Dr. Saya and others at Defy. The concern is that I am 41, and people tend to get psychologically dependent on trimix. That would be a potentially long time for me to use injections and side effects would be a concern. Any thoughts on this? Has anyone used it for a short time effectively and stopped?

Thank you!! Excel Male rocks!

 

[CoastWatcher]

This is an erectile, not a libido issue? All of your other blood markers, particularly estradiol, are balanced?

 

[Vince]

You can try other ED meds, VIAGRA or Levitra and buy the genetic version from India pharmacies.

 

[Vince Carter]

I find that I have to use 10mg Cialis and I have to take it no less than 6hours before any expected activity, seems to take hours before it becomes effective. For me. Have heard this from other guys, too. I may take one in the morning and it's fully effective by late afternoon and evening. Pair it with a 25mg Viagra taken 2hrs prior to date time and you can really get down to business.

 

[crazyhaha]

Yeah, it could be libido...I'm interested but then it just kinda fades away. My last estradiol was 24.7, and as far as things out of normal, Thyroid is a bit high (5.8) and my lipids are never correct (low HDl, high Ldl). You reminded me that I have been forgetting to take fish oil!

 

[Dr Justin Saya MD]

Yeah, it could be libido...I'm interested but then it just kinda fades away. My last estradiol was 24.7, and as far as things out of normal, Thyroid is a bit high (5.8) and my lipids are never correct (low HDl, high Ldl). You reminded me that I have been forgetting to take fish oil!

Hi crazyhaha, a couple points. If that thyroid level you mentioned is the TSH, then you/we will want to order a few more thyroid labs to assess for hypothyroidism (at minimum FT3, FT4, rT3...if family h/o hypothyroidism or autoimmune disease then antibody check as well).

Nitric oxide enhancers like Gene's NO stack are often helpful. I find that some folks also acclimate to the PDE-5i medications (Cialis especially being longer acting). A clue is if you start needing to increase dosage with poor response. In these cases a short "holiday" where you stop taking for a few weeks, then resume, usually resets things. Also, as VC noted, sometimes throwing in a shorter acting PDE-5i such as viagra (sildenafil) closer to "game time" does the trick.

Lastly, to be discussed with the practitioner on your next consult, you may need some subtle adjustments to your TRT regimen.

 

[Dr Justin Saya MD]

...and as you mentioned, Trimix is the big gun if all else fails.

 

[user_joe]

Can't speak on the ED issues, but regarding libido you may want to consider a change in protocol if this is really important. It was night and day difference for me once my TT passed a certain point. IIRC it was 700+. Now peak was 1200 TT, and DHT was at the top of range as well. I was getting every other benefit of TRT at lower doses, but libido took more. Just one person's experience but food for thought.

 

[Mountain Man]

You can continue to take the 5 to 7.5 mg per day, but it may not be enough to sustain the erection you want. I'd try a higher dose before sex in addition to the daily dose.

I'd also wonder if your T levels could be a little higher.

 

[Vince]

Where to Buy Cheaper Generic Cialis

https://www.excelmale.com/forum/showthread.php?1884-Where-to-Buy-Cheaper-Generic-Cialis

 

[Virginian]

I have discussed trimix with Dr. Saya and others at Defy. The concern is that I am 41, and people tend to get psychologically dependent on trimix. That would be a potentially long time for me to use injections and side effects would be a concern. Any thoughts on this? Has anyone used it for a short time effectively and stopped?

You would probably become psychologically dependent on trimix. Once you have tried it nothing else comes close in effectiveness. I first tried trimix over 10 years ago when I was 64. Since then I have not once attempted sex without it.

 

[Mountain Man]

Nitric oxide enhancers like Gene's NO stack are often helpful. I find that some folks also acclimate to the PDE-5i medications (Cialis especially being longer acting). A clue is if you start needing to increase dosage with poor response. In these cases a short "holiday" where you stop taking for a few weeks, then resume, usually resets things. Also, as VC noted, sometimes throwing in a shorter acting PDE-5i such as viagra (sildenafil) closer to "game time" does the trick.

Very good info here. I often find that some brands of generic cialis and viagra differ quite a bit, and sometimes changing the brand makes a very noticeable difference. I've settled in on ceebus and manly from All Day Chemist and they are the best combo I've found. I also learned from someone on the forum, I think Coast Watcher, that viagra can be taken sublingually to avoid the barrier of a large meal. My doctor is Abraham Morganthaler, who suggests the larger dose.

I agree with Dr. Saya's suggestion of low dose daily of cialis and a 50 or even 100 of viagra just before. I recall a thread where Vince suggested this regimen, and I found it to be very effective. Vince and I are both in our 60's, so I have to think it will work well for you. I was in my mid to late 40s when I "asked if a prescription for viagra was right for me" and have used pde5s ever since. My doctor said if you are in good condition and bloodwork is on point, there is virtually no risk.

What's your opinion Dr. Saya?

 

[Dr Justin Saya MD]

Very good info here. I often find that some brands of generic cialis and viagra differ quite a bit, and sometimes changing the brand makes a very noticeable difference. I've settled in on ceebus and manly from All Day Chemist and they are the best combo I've found. I also learned from someone on the forum, I think Coast Watcher, that viagra can be taken sublingually to avoid the barrier of a large meal. My doctor is Abraham Morganthaler, who suggests the larger dose.

I agree with Dr. Saya's suggestion of low dose daily of cialis and a 50 or even 100 of viagra just before. I recall a thread where Vince suggested this regimen, and I found it to be very effective. Vince and I are both in our 60's, so I have to think it will work well for you. I was in my mid to late 40s when I "asked if a prescription for viagra was right for me" and have used pde5s ever since. My doctor said if you are in good condition and bloodwork is on point, there is virtually no risk.

What's your opinion Dr. Saya?

Generally safe with the main risk being potentially fatal hypotension if combined with nitrates (such as nitroglycerin for chest pain). Most folks are well aware of this risk from the commercial disclaimers. Don't forget to tell that ER doc you take a PDE-5i if presenting with chest pain!

 

[Vince]

Generally safe with the main risk being potentially fatal hypotension if combined with nitrates (such as nitroglycerin for chest pain). Most folks are well aware of this risk from the commercial disclaimers. Don't forget to tell that ER doc you take a PDE-5i if presenting with chest pain!

I do like the effect Viagra gives me, along with my daily Cialis. I also like the effect it has on my girlfriend.


Oops I meant to attach Mountain Man reply.

 

[crazyhaha]

Thanks! I'll look at All Day Chemist and add Viagra to the mix.

 

[crazyhaha]

Awesome advice from everyone!! So, I'm checking out the NO stack, going to try slightly more cialis and add viagra as needed, and NOT going for trimix. I have labs due soon so I'll see how my T is doing. Love this place.

 

[SuperDutyDave]

I've found that even with daily Cialis and numbers being good there can still be lagging issues with erectile function. I've found having trimix ready to go is the way to fly

would prefer it to be like it was when I was 20 but unfortunately it doesn't seem to ever get there with consistency

Trimix is awesome. Guaranteed results that are quick easy and stress free If you really want to bring your A game it's the ticket