Worsening Symptoms, "Dead Penis"

[Strengthandlibido]

Instead of taking Defy's dosing advice, I tried going "low and slow" for six weeks, but my libido and sensitivity completely dried up after a couple of weeks. Defy had recommended 100 mg T cypionate/week, divided into three doses, but I went with 10 mg/daily. They have also recently added hCG and nasal gel pens for me, along with anastrozole for occasional use. But I'm reluctant to complicate things that much. I stopped the injections after six weeks because of the dead-penis feeling. I tried to mirror Natesto dosing by using the nasal gel by itself for a bit, but the dead-penis condition persists. This was me trying my best to play things conservatively with the least side effects and impact on the HPTA. Now I'm not sure if I want to continue with any TRT as I'm in shock with how quickly my remaining libido and sensitivity disappeared on 10 mg/day. But if I do continue, maybe I should just take Defy's dosing advice for both the T cypionate and hCG..? Part of me wants to try the scrotal gel to see if that can produce any libido, but mainly I think I want to try to restart with enclomephine. This just seems too daunting and complex with minimal chance of positive impact on my libido.

 

[Systemlord]

What's the point of using Defy if you're not going to take their advice?

As far as libido it's very complex and multiple factors affect it. If any one of these below are a problem, it's a good chance it's causing your libido problem.

Things that affect libido:

• Obesity
• High blood pressure
• Diabetes
• Poor sleep
• Medications
• Stress/depression
• Low testosterone
• Infections
• High prolactin
• Low thyroid hormones
• Alcohol & drugs
• Surgery
• Heart disease
• High cholesterol

 

[Strengthandlibido]

What's the point of using Defy if you're not going to take their advice?

As far as libido it's very complex and multiple factors affect it. If any one of these below are a problem, it's a good chance it's causing your libido problem.

Things that affect libido:

• Obesity
• High blood pressure
• Diabetes
• Poor sleep
• Medications
• Stress/depression
• Low testosterone
• Infections
• High prolactin
• Low thyroid hormones
• Alcohol & drugs
• Surgery
• Heart disease
• High cholesterol

My point was that test cypionate injections made things worse, so I don't know about continuing.

So it's impossible to fix libido. There's no way to isolate and fix all those factors. I was diagnosed hypogonadal; I am pre hypertensive, but doctors won't medicate me for it; I have Graves' disease and take methimazole to control it; I take meds for bipolar disorder; I am under extreme stress; I have a history of steroid and recreational drug use. I sleep poorly. I could go on, but I suspect I'm beyond Defy's ability to help. (And the thing is I had some libido left before starting on the test injections.)

 

[DixieWrecked]

I know exactly what you mean with the dead penis. At about the 6 week mark I got that as well and it scared the hell out of me. I'm telling you it is going to be ok, I am not saying its going to be all rainbows and sunshine, it may be struggle for you, but your penis is not "dead". You will fiddle around with things and it will improve. Its was hard to keep a calm rational head when that happened and I felt like it sent me down a bad path for a while so I offer this post as reassurance and comfort and encouragement to not freak out. Like systemlord mentioned, try to detach and just do what Defy says. Patience. It's easier on the mind.

 

[S1W]

10mg/day doesn't work for me either. The low dose daily thing is not for everyone.

For whatever reason, TRT is basically ineffective for me until it gets my levels to at least the upper part of the range.

Also, I've had very good success with scrotal cream.

This is going to be a looooong ride so set your expectations accordingly. It's a game of trial and error that will likely take years to figure out just what works for you.

My $0.02:

- Do the 100mg/week for at least 6 weeks. I'd just do E3.5D (Mon AM, Thur PM) to keep it simple but perhaps Defy told you MWF for a reason... After 6 weeks, evaluate how you feel, get labs.
- Then add in the HCG. Wait another 5 weeks or so. Evaluate how you feel, get labs, see if it made a positive/negative/any difference for you.
- Avoid using the AI at this point. Not everyone needs them and I don't think they should be included at the very beginning of a protocol. Add in as symptoms/labs indicate at some point in the future.

 

[Systemlord]

Now I'm not sure if I want to continue with any TRT as I'm in shock with how quickly my remaining libido and sensitivity disappeared on 10 mg/day.

Daily injections isn't going to be optimal for everyone, some guys need swings in hormones to feel good.

 

[RonMexico]

I get "Dead Penis" with IM injections. SubQ works better for me. It causes the testosterone to release slower. IM gives a more vascular reaction and raises my E2.

I find that if I switch from IM to SubQ my penis takes 4-7 days to get back to normal. Try SubQ for a week and see if this helps.

I also do testosterone cream two clicks on inner thigh that helps with libido.

 

[Kuhlsnu]

Six weeks minimum after first starting TRT to know how you respond and check labs.

This is the way. There's an odd phenomenon that occurs in your brain when you've been hypogonadal and that has to reset while being on a regular dose. Six weeks to give time for your testes to shut off and be out of the picture.

I would do what your doctors recommend. It sounds like a very reasonable protocol, and you haven't provided enough information for any of the users here to want to contradict their recommendations.

 

[sfjohn]

My Dr has me taking 5mg generic Cialis at bedtime every night. It has helped with morning erections, performance and a small improvement in libido.

 

[UltraNalu]

Defy recommended 100 per week, but taking 10 daily is only 70 per week. So you are under-dosing by 30 each week. They recommended 100 per week for a reason, based on your blood work. If they believed 70 per week would work, I'm sure they would have gone with that. Most healthcare professionals want to be as conservative as possible on dosage, so if they thought they could get the results you need on 70 they would have told you 70. Stick with the 100 for 6 weeks and get your blood work done again AFTER that to see what your new levels are at. THEN talk w/ Defy about your results and what you are seeing / feeling.

 

[Cataceous]

Defy recommended 100 per week, but taking 10 daily is only 70 per week. So you are under-dosing by 30 each week. They recommended 100 per week for a reason, based on your blood work. If they believed 70 per week would work, I'm sure they would have gone with that. ...

You're giving them and many other testosterone prescribers too much credit. The standard pre-TRT blood work is not revealing the metabolic clearance rate of testosterone, which is what you need to predict a reasonable dose in advance. A protocol of 100 mg per week is likely to be a legacy of the original Depo-Testosterone protocol of one injection of 200 mg every two weeks. This protocol leads some to the incorrect conclusion that 100 mg per week is always appropriate, when in reality it is a high dose that's meant to compensate for infrequent injections. If you're injecting daily then you don't need to worry about serum levels falling too low a few days after each injection. Instead you can focus on what's likely to be physiological for you. We know that average testosterone production for healthy young men is around 6-7 mg daily. This corresponds to 9-10 mg testosterone cypionate daily, or 60-70 mg per week.

 

[UltraNalu]

So, why doesn't the protocol START with 10 daily instead? Why do they even bother with 1x week or 2x week? I'm not being a smartass, I'm asking a legit question. I'm working with Defy Medical and I started with 35 x 2/week, but they recently switched to 33 x 3/week instead. Now I'm wondering why not just do daily injections if that is the most effective? Why aren't we all doing daily injections?

 

[Cataceous]

More than a few guys do not want to be injecting daily. And presumably a good number can get acceptable results with less frequent injections. Also, arguably we're still in the midst of this progression from infrequent large injections to frequent small injections. Physician and patient acceptance proceeds slowly in the absence of clinical trials backed by manufacturers or large independent studies. Subcutaneous injections make it a lot more practical, but only in recent years are they getting to be more mainstream as well.

 

[UltraNalu]

More than a few guys do not want to be injecting daily. And presumably a good number can get acceptable results with less frequent injections. Also, arguably we're still in the midst of this progression from infrequent large injections to frequent small injections. Physician and patient acceptance proceeds slowly in the absence of clinical trials backed by manufacturers or large independent studies. Subcutaneous injections make it a lot more practical, but only in recent years are they getting to be more mainstream as well.

So, since there's not a lot of clinical trials to base off of, then it would seem we're kind of just learning from trial and error. We are the lab rats! I prefer the subQ over the IM, for sure. I'm fine with daily, but am only doing 3x week currently. Thanks for the enlightening information.

 

[Strengthandlibido]

100 mg/ week of T cypionate seemed arbitrary to me, so I figured I'd use physiological production as a guide to come up with something more appropriate. But we've heard it said that a mg of exogenous test is not the same as a mg of endogenous test. Maybe I just need a higher dose?

I'm considering getting back on injections at doses the clinic advises instead of doing my own thing. I was just trying to play it really safe. I didn't like my blood pressure and heart rate on the 10 mg/day, and I'm worried about the side effects increasing with the dosage. But I'm willing to try the 120 mg/week (the latest suggestion), maybe divided up into the two doses, along with the hCG to keep my testicles from aching and withering away to nothing.

Right now I'm using just the nasal gel as I consider my options, but feeling absolutely nothing from it. I was hoping some magic would happen while I was using this minimally suppressive delivery method on its own. It looks increasingly like scrotal gel will be the next addition after the T cyp injections + hCG.

 

[Cataceous]

... But we've heard it said that a mg of exogenous test is not the same as a mg of endogenous test. ...

It's said, but rarely is it followed by an explanation. At the molecular level it's nonsense—we're using bioidentical testosterone. There's some plausibility in the argument that the lack of diurnal variation in serum levels when using products with long half-lives increases the amount needed by up to 20%. Beyond this there are vague implications that maybe higher doses somehow compensate for the disruption of other hormones by TRT. It seems dubious, though perhaps is true in some cases. There is a specific circumstance bolstered by theory: though ill-advised, it may be possible to alleviate symptoms of high estradiol with very high doses of testosterone. The reason it can work is that high serum levels of testosterone begin to saturate the aromatase enzyme, which in turn drives down the estradiol-to-testosterone ratio.

...
I'm considering getting back on injections at doses the clinic advises instead of doing my own thing. I was just trying to play it really safe. I didn't like my blood pressure and heart rate on the 10 mg/day, and I'm worried about the side effects increasing with the dosage. But I'm willing to try the 120 mg/week (the latest suggestion), maybe divided up into the two doses, along with the hCG to keep my testicles from aching and withering away to nothing.

Right now I'm using just the nasal gel as I consider my options, but feeling absolutely nothing from it. I was hoping some magic would happen while I was using this minimally suppressive delivery method on its own. It looks increasingly like scrotal gel will be the next addition after the T cyp injections + hCG.

Learn from our mistakes. If you make frequent protocol changes then you can end up chasing your tail, never really figuring out what causes what. Reiterating previous advice: with the current protocol you want to ensure you've restored HPTA function and have peak testosterone at healthy levels. Then give it some time—at least another month or two.

 

[MIP1950]

My point was that test cypionate injections made things worse, so I don't know about continuing.

So it's impossible to fix libido. There's no way to isolate and fix all those factors. I was diagnosed hypogonadal; I am pre hypertensive, but doctors won't medicate me for it; I have Graves' disease and take methimazole to control it; I take meds for bipolar disorder; I am under extreme stress; I have a history of steroid and recreational drug use. I sleep poorly. I could go on, but I suspect I'm beyond Defy's ability to help. (And the thing is I had some libido left before starting on the test injections.)

Bipolar disorder/poor sleep/extreme stress. That's me, too. Probably most of the meds, except lithium, IMO, negatively impact sexual function; the trade off for trying to be stable. I'm treatment resistant. The only times I approach sexual function is when I'm hypomanic, which brings with it moderate to intense irritability. PDE-5 inhibitors, for me, bring out the worst of bipolar. But, with all that, don't give up.

 

[MIP1950]

You're giving them and many other testosterone prescribers too much credit. The standard pre-TRT blood work is not revealing the metabolic clearance rate of testosterone, which is what you need to predict a reasonable dose in advance. A protocol of 100 mg per week is likely to be a legacy of the original Depo-Testosterone protocol of one injection of 200 mg every two weeks. This protocol leads some to the incorrect conclusion that 100 mg per week is always appropriate, when in reality it is a high dose that's meant to compensate for infrequent injections. If you're injecting daily then you don't need to worry about serum levels falling too low a few days after each injection. Instead you can focus on what's likely to be physiological for you. We know that average testosterone production for healthy young men is around 6-7 mg daily. This corresponds to 9-10 mg testosterone cypionate daily, or 60-70 mg per week.

You're very much the scientist, using yourself as your own lab rat. There's a physician on T-Nation forums under the screenname, 'highpull'. He is on TRT and prescribes it. His experience is that one weekly injection, for most of his patients, including himself, works quite well.(He does 200 mg.) The doses range from 100 mg to 200 mg, IM. He does have some patients splitting the dose doing E3.5 days and a few EOD. No ai or HCG. On the other side of that, there's another guy on there who does 25 mg, daily, and once he got stable, never looked back.

@Strengthandlibido is correct in observing that there is a difference between endogenous T production and exogenous administration of T, as the former in the context of the milieu of other hormones and steroids working in a synergistic manner, which we try to emulate with varying doses of thyroid, DHEA, pregnenolone, progesterone. Why some men do well on once a week or even, as with Nebido or pellets every three months, we don't know. And it's the same 'we don't know' when it comes to low dose daily, IM or subq. More unknowns than knowns, IMO.

 

[DixieWrecked]

Whenever I up my dose I feel good for a couple weeks. I'd speculate that if one's levels (hormones, neurotransmitters, etc) are totally constant they would always feel flat as their baseline is never changing. This is how I feel. There are no highs without lows. Just the fact of being in a low causes the mind to look forward to the rebound and sparks the upward turn. Constantly raising your dose is not feasible solution, obviously.

Curious if anyone has had better luck on this forum with less frequent injections. Once weekly or less frequent. I have a buddy in the real world that does absolutely fine with weekly injections. He goes to Lipschultz in Houston so his care is top notch.

 

[MIP1950]

Whenever I up my dose I feel good for a couple weeks. I'd speculate that if one's levels (hormones, neurotransmitters, etc) are totally constant they would always feel flat as their baseline is never changing. This is how I feel. There are no highs without lows. Just the fact of being in a low causes the mind to look forward to the rebound and sparks the upward turn. Constantly raising your dose is not feasible solution, obviously.

Curious if anyone has had better luck on this forum with less frequent injections. Once weekly or less frequent. I have a buddy in the real world that does absolutely fine with weekly injections. He goes to Lipschultz in Houston so his care is top notch.

My urologist knows Dr. Lipschultz. Speaks highly of him.

There was someone on here several months ago who was changing up his dosage(and maybe frequency) every week or every other week(not sure) and finding good results with libido and erections, the rationale being, IIRC, to cause fluctuation of dopamine. I'm sorry if I'm foggy on this. I'll put in a query and see if I can find his post and screen name. We've read of guys who blast, then go back to their normal dosing. Maybe that's where he got the idea.

I've wondered(and played with the idea), since subq has a half life of 240 hours and a slower uptake, would injecting 200 or 300 mg every ten days or even twice a month, emulate, in a fashion, the ebb and flow of endogenous testosterone production? Or, two weeks out of the month, do a bolus of subq T, then go back to IM for the remaining two weeks. Or, some variation of that protocol.

There are those of us who are biochemical/endocrine outliers. We're the patients that challenge our doctors. The smart doctors in TRT will work with us, listening to our thoughts, observations and ideas. A 'good' protocol is the one that works.