x

[Hellvis Jones]

x

 

[madman]

I have posted in other sections of this forum previously, but I just got my results, so I created a new thread.

I'm 33 and I've been dealing with chronic erectile dysfunction all my life. I don't have complete ED: I'm usually able to have sex or to masturbate, but I lose my erection as soon as stimulation stops. I can't do many positions, for instance I can't stay hard enough to penetrate when doing doggy style. If I use ED pills, then I have a decent erection, but my libido remains pretty low. I haven't had morning wood for at least 15 years - actually I don't even remember when I lost it, but I'm pretty sure I had morning wood when I was a kid.

I've been doing NoFap for 14 months and I've seen some progress, but not a lot. I still have a very low libido, unreliable erections and no morning wood.

I decided to get checked by an anti-aging doctor and I got my results. You'll find them at the end of this post.

I'm wondering if my ED could be hormonal, but it seems the most important factors are in range. FSH and Vitamin D are very low, though. And I don't understand why my bioavailable testosterone is not included, I'll ask the doctor when I see her next week.

Any thoughts? Thanks a lot!


Testosterone
21.9 nmol/L (reference range: 5.7 – 27.3 nmol/L)

Free testosterone
508.3 pmol/L (reference range: 223.0 – 915.0 pmol/L)

SHBG
34 nmol/L (reference range: 11 – 78 nmol/L)

TSH
1.425 mU/L (reference range: 0.350 – 4.940 mU/L)

Free T3
5.8 pmol/L (reference range: 3.5 – 6.5 pmol/L)

Free T4
13.5 pmol/L (reference range: 11.0 – 22.7 pmol/L)

Prolactin
6.1 µg/L (reference range: 2.1 – 17.7 µg/L)

Progesterone
1.90 nmol/L (reference range: 0.89 – 3.90 nmol/L)

DHEA-S
7.3 μmol/L (reference range: 3.6 – 13 μmol/L)

FSH
1.4 U/L (reference range: 1.4 – 18.1 U/L)

LH
3.57 U/L (reference range: 0.57 – 12.07 U/L)

Estradiol
72 pmol/L (reference range: 40 – 161 pmol/L)

Vitamin D
30.9 nmol/L (reference range: 75 – 150 nmol/L)

Cortisol
365 nmol/L (reference range: 112 – 738 nmol/L)

Unhealthy (low/low-normal) FT levels will definitely have a negative impact on libido, erectile function including (NPT/spontaneous erections).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

When was blood work done?

Testing should be done in a fasted state between 7-10 am as we want to test at peak.

During the 24hr circadian rhythm of a healthy young male testosterone levels will start to increase around 3-4 am reaching a peak between 6-8 am and by 11-12 pm will start to decline late afternoon/early evening reaching a trough between 6-8 pm.

Fluctuations from peak--->trough would be around 20-25%

Natural T levels follow a diurnal 24 hr circadian rhythm and will start to rise gradually around 3 am reaching peak levels around 8 am

Natural endogenous testosterone secretion is pulsatile and diurnal.

As you can see you have a robust TT 631 ng/dL but more importantly seeing as your SHBG is 34 nmol/L (far from high) then you would have a healthy FT level.

Unfortunately, you did not have your FT tested using an accurate assay.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

When it comes to libido let alone ED much more is involved than just having healthy hormones.

Ones underlying vascular health is critical.

Dysfunction (thyroid/adrenals) can mimic symptoms of low-t.

Your AM cortisol is under the mean.

Cortisol should be highest in the AM and will gradually decrease throughout the day.

 

[Cataceous]

Aside from the vitamin D the numbers look pretty good. Normal SHBG and total testosterone mean it's unlikely that low free testosterone is the problem. Estradiol is at the low end of normal relative to testosterone. If this was not a sensitive test then there's a chance that it's even lower than indicated.

Another avenue to pursue is neurotransmitters. There are various supplements to boost levels, possibly revealing if you're headed in the right direction. Some possibilities discussed in this thread:

JustAskin's Erection Formula: DopaBean, Pantethine and More

JustAskin's Erection Formula: DopaBean, Pantethine and More

www.peaktestosterone.com

 

[JA Battle]

I would also look into your mineral/vitamin status especially iron status. This can have a pronounced effect on dopamine function. Lower estradiol can also lead to dopamine issues. Dhea is a bit low. Do you exercise? Exercise can increase cortisol levels. Cortisol is heavily implicated in your dopamine function.

 

[JA Battle]

Thank you very much!

I exercise regularly, and have a pretty good diet.

As you said, there’s a note on my lab results saying that Estradiol could be lower than indicated because of Fulvestrant and Biotin. I’ll keep that in mind, and also the fact that Vitamin D, DHEA and FSH are low.

The question is, should I try TRT? I’m meeting with the doctor next week, and I’m pretty sure she’ll give me a prescription for TRT, even if my levels aren’t that low. At this point, I believe it’s safe to assume that my ED isn’t hormonal, even if some hormones are pretty low (remember, we’re talking about chronic ED for more than 15 years here). So the question remains, should I give it a try? Can TRT have an impact on my hormones that are low?

I would say that libido and erectile quality is a very difficult thing for many men to dial in while on hrt. Some men have a reduction in libido after getting on trt even while they have an improvement in all the other areas of their male health.
I would say get the vitamin d up. Don’t exersize too much. supplement with low dose dhea.

what is your blood pressure like?

I’d try a few more things before I made the leap. Making the hrt choice takes on a life of its own and libido is not promised. I’d look into the iron component as well. Many men realize the iron issue after getting on trt and attempt to address it.

 

[JA Battle]

Thanks a lot! That sums it up very well. I'll definitely think about it carefully before to go on TRT. I'll try Vitamin D and DHEA supplements, and will investigate about the iron.

No problem. If your blood pressure is normal or low. I’d try an experiment with licorice root to see if that lower am cortisol is causing your issue. Strangely, Licorice root increases cortisol. I’d also get a more comprehensive set of thyroid labs: free t4, free t3 and reverse t3.

addressing these other issues if there is any gives you a very nice chance to improve your general androgen status

 

[DorianGray]

Perhaps a Doppler ultrasound would be in order to check for venous leakage. However, no morning wood at your age, I would have a through cardiovascular assessment done.

 

[Golfboy307]

If you are not getting regular morning wood or while you are sleeping, there is something physiological going on. However, are you under a lot of stress? Any signs of depression? That could be the "in between your ears" cause.

 

[Cataceous]

Instead of, or at least prior to TRT, consider a trial with a nasal testosterone gel such as Natesto. With these products you can see if higher testosterone is helpful without having to completely shut down your own production and risk the possible side effects.

 

[Cataceous]

...
But what about trying TRT for a short period? Can I shut down my own production if I try it only for, say, 2 months?

Two months is about the length of time it takes for TRT to shut down your own production and stabilize serum hormone levels. But various effects can take much longer to become apparent:

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are ...

www.ncbi.nlm.nih.gov

 

[JA Battle]

Damn… Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, but it takes up to 6 months to see changes on erections. Meaning, I will shut down my own production before to even see any changes on my ED.

That sounds very risky. I can’t just "give it a try" and stop the treatment whenever I want. If I want to try it long enough to see the full effect of the treatment on my ED, it will shut down my own production, and I’ll be stuck on TRT for the rest of my life.

Am I understanding this correctly?

there are men with low testosterone that sexually function relatively normally. there are many men on high doses of testosterone that are in here asking for help. It’s a matter of neurotransmitters. Hormones can greatly influence neurotransmitters.

it’s physiological and psychological at the same time. Our nervous system is the bridge between our psych and our body. It’s a nervous system issue that I also struggle with. My hormones are all adequate for the most part and I’ve experimented with replacing testosterone, dht, dhea, dheas, pregnenolone, progesterone, and estradiol, thyroid, hydrocortisone and also have used hcg at every dose. I’ve done these things in a variety of doses and schedule and administration routes.

we take for granted how much our body does on its own. When trt starts, our pituitary gland output may be affected and subsequently several different hormonal axises may be altered. It’s not as simple as we wish it was.

cataceous gives a great piece of advice about maintaining your own hormone production by using the rapid acting natesto to boost testosterone to see how it feels. I think if you put the right pieces in place you still have a chance to not go on trt.

I say this because I’ve been on trt for 3 years because of a varicocele on my right teste. I’ve yet to figure it out and I’ve experimented with more out of the box protocol variations than 99% of the men on this amazing forum. That does not mean you won’t have a quicker path to optimal if you were to try.

I just remember being in a similar situation as you not long ago. I literally researched the same thing in google “how long does it take to reap sexual benefits of trt” or something of the sort. I’ve since found that it is potentially utterly more complicated than I once thought.

it has not been bad, I actually enjoy the experimental nature of it. But it does not equal instant sexual god by any stretch.

 

[Florida777]

If you decide to start hrt I would advise you to strongly consider the gels. Specifically Testim, I use it and it keeps my TT in high normal and my dht is double the top range. Most men have improved erections and libido on the gels. Gels raise dht far more then injections which could resolve your issue. You may still need to use an AI with the gel, I do, so dont be afraid to add that in. Personally, i tell everyone not to start hrt unless absolutely necessary. But ED is one of the most frustrating things there is so I understand you considering this option.

 

[Vvs1]

Absolutely necessary to test “sensitive estradiol”, DHT, and salivary cortisol.

Then up the vitamin D, and give progesterone bio identical cream a try, starting small, since your progesterone is low but too much could also interfere with androgens if overdone. Too little progesterone interferes with nerve myelination and brain repair.

Also, let us know if you took accutane, Propecia or an SSRI, or any antibiotic or acne meds when this originally occurred.

Other options are TCM herbalists/naturopaths and pelvic floor specialists that are of high quality. Or else they’re kind of clueless.

 

[VacationMan]

Based on what I saw of your labs (sans Free T levels), I'm thinking the issue is likely in the dopamine department. Give PT-141 a try and see what happens to your erections.

 

[DorianGray]

... Give PT-141 a try and see what happens to your erections.

I’ll bet money on that one
Use only product from reputable pharmacy though, not a peptide internet site.

 

[Nelson Vergel]

@Hellvis Jones

I think the guys have given you great pointers.

Do you achieve a good erection when you masturbate? When you mention noFab, does that mean that you completely gave up porn?

How are you sleeping? What is your sexual partner situation (do you have a partner, are you single and dating, have you been married for a long time?)

I have been around for over over 25 years on online groups. I have learned that ED is multifactorial and can happen in men with "perfect" hormones at any age. Yes, it helps a lot to not have low T, hypothyroidism, high prolactin, and be free of medications that can induce ED, but there are other issues involved like depression, fatigue, substance abuse, performance anxiety, and other less talked about factors that can be involved.

Have you considered a cycle of daily Cialis?

Sorry that I came in late into this discussion.

 

[muscleasian]

I have posted in other sections of this forum previously, but I just got my results, so I created a new thread.

I'm 33 and I've been dealing with chronic erectile dysfunction all my life. I don't have complete ED: I'm usually able to have sex or to masturbate, but I lose my erection as soon as stimulation stops. I can't do many positions, for instance I can't stay hard enough to penetrate when doing doggy style. If I use ED pills, then I have a decent erection, but my libido remains pretty low. I haven't had morning wood for at least 15 years - actually I don't even remember when I lost it, but I'm pretty sure I had morning wood when I was a kid.

I've been doing NoFap for 14 months and I've seen some progress, but not a lot. I still have a very low libido, unreliable erections and no morning wood.

I decided to get checked by an anti-aging doctor and I got my results. You'll find them at the end of this post. I was tested at 7am, after a 12-hour fast (drank only water during the fast).

I'm wondering if my ED could be hormonal, but it seems the most important factors are in range. FSH and Vitamin D are very low, though. And I don't understand why my bioavailable testosterone is not included, I'll ask the doctor when I see her next week.

Any thoughts? Thanks a lot!


Testosterone
21.9 nmol/L (reference range: 5.7 – 27.3 nmol/L)

Free testosterone
508.3 pmol/L (reference range: 223.0 – 915.0 pmol/L)

SHBG
34 nmol/L (reference range: 11 – 78 nmol/L)

TSH
1.425 mU/L (reference range: 0.350 – 4.940 mU/L)

Free T3
5.8 pmol/L (reference range: 3.5 – 6.5 pmol/L)

Free T4
13.5 pmol/L (reference range: 11.0 – 22.7 pmol/L)

Prolactin
6.1 µg/L (reference range: 2.1 – 17.7 µg/L)

Progesterone
1.90 nmol/L (reference range: 0.89 – 3.90 nmol/L)

DHEA-S
7.3 μmol/L (reference range: 3.6 – 13 μmol/L)

FSH
1.4 U/L (reference range: 1.4 – 18.1 U/L)

LH
3.57 U/L (reference range: 0.57 – 12.07 U/L)

Estradiol
72 pmol/L (reference range: 40 – 161 pmol/L)

Vitamin D
30.9 nmol/L (reference range: 75 – 150 nmol/L)

Cortisol
365 nmol/L (reference range: 112 – 738 nmol/L)

I have similar situation and later on I realised i have varicocele

 

[Cataceous]

...
That’s about it. There’s only one thing that confused me when I met with the doctor: she told me that bioidentical hormones (which she prescribed me) don’t shut down your own production. I was surprised to hear that, because I haven’t read any reference to this on the forum. Does that make any sense?
...

This assertion demonstrates surprising ignorance and renders anything she says untrustworthy. It is negative feedback from endogenous—bioidentical—hormones that regulates the HPTA. Too much of them and you get suppression, period.

 

[Cataceous]

... The question still remains: should I give it a try? I don’t know. My testosterone is okay, and my progesterone is a little low, but overall my levels are fine. I still have to make up my mind about it.

I wouldn't if I were you. Aside from the problems with shutting down a normally functioning HPTA, the estrogen-opposing activity of progesterone could also worsen your situation, given that your estradiol is lowish relative to testosterone.

 

[Rentner2022]

Also, let us know if you took accutane, Propecia or an SSRI, or any antibiotic or acne meds when this originally occurred.

There's no scientific way to test this but I am almost certain my issues are the result of adult accutane use. Is there a specific response to that type of impairment that people agree on or is it just one more variable to throw in the mix?