T Nation

32, TRT & Erectile Dysfunction

Hey all,

Been on TRT for over 5 years now. The reason is that i had very low test levels (178 - 280 ng/dl).
Done 2 cycles before that. First one was 500 test per week over 10 weeks and second Test/Deca which includes full pct for both cycles.

Now during these past years on TRT, I’ve had lots of ups and downs. Mainly the “downs” would be fatigue, lethargy, mood swings and ED. Libido is not affected much.

I also noticed that when testicles seem smaller and scrotum tight most of the day, its when ED occurs.

TRT protocol:

  • 125mg testosteron enenthate per week SubQ (sometimes 250mg/w)
  • HCG 750mg per week / 250mg eod

Age: 32
Height: 6’2 / 188 cm
Weight: 200 lbs / 90 kg

Latest blood test:

  • Testosterone: 865 ng/dl (260 - 1000)
  • Estradiol: 40 pg/mL (11 - 44)
  • SHBG: 12.8 nmol/l (10 - 80)
  • DHEA-S: 720.5 ug/dl (160 - 449)
  • DHT: 56 ng/dL (30 - 85)
  • IGF-1: 297 ng/mL (115 - 307)
  • Progesterone: 0.2 ng/mL (<0.01 - 0.2)
  • Cortisol - Serum: 10.2 (AM) ug/dl (4.3 - 22.4)
  • T. Cholesterol: 6.09 nmol/L (3.00 - 5.18)
  • HDL: 1.63 nmol/L (1.3 - 1.6)
  • VLDL: 0.42 nmol/L (0.23 - 0.77)
  • Triglycerides: 0.93 nmol/L (0.5 - 1.7)
  • Free T3: 4.87 pmol/L (2.77 - 6.5)
  • Free T4: 11.83 pmol/L (11.5 - 22.7)
  • T.S.H: 2.674 mUI/L (0.35 - 4.94)
  • Insulin - random: 7.74 mUI/L (2 -55)
  • Glucose: 4.08 nmol/L (3.89 - 5.83)
  • Vtamin D3: 38.7 nmol/L (75 - 240)
  • Iodine: 64 ug/l (46 - 70)

You can see SHBG is very low and estradiol is in top end range.
Was thinking of getting some aromasin but its quite expensive here so i am still trying to figure this out.

Note: Can’t find a proper Endo where i live. Still looking though.

Would appreciate your help guys and thanks.

Low SHGB guys usually benefit from more frequent injections. Twice a week or even daily if that doesn’t work. I’d try 16mg/day before I added an AI in your place.

Where are you located? Affects diagnostic and treatment options.

You labs present some challenges. High E2 may be from low SHBG and high FT. That would make some sense. There are other technical possibilities that I will cover.

PCT probably wrong as most are. Most PCT advice is horrible. After 5 years, restart not suggested.

Iodine: Do you always use iodize salt?
The big concern is thyroid function, please eval that via oral body temperatures as per the last paragraph in this post.

TSH should be closer to 1.0
Thyroid test ranges are stupid and mislead doctors.
fT3 might be a bit low, this is the active hormone. I have some concerns re the lab range upper limit.
fT4 is far below mid-range.
Looks like iodine deficiency.
Are your outer eyebrows sparse?
Thyroid looks/feels enlarged, lumpy, feels sore?
Generalize hair thinning? - not male pattern baldness?
All possible with your normal thyroid results!

Your thyroid labs suggest that this may be the key to your not feeling great. But have to add that many on TRT with SHBG have a hard time finding a balance. Your FT may be high driving more FT–>E2. In that case you might find a smaller T dose good. But nothing will be right without an AI and anastrozole 0.5mg at time of T injections twice a week would be a good start. This may lower SHBG and make things more difficult as well.

DHEA [DHEA-s] is an adrenal hormone and way to high. Progesterone in males is also an adrenal hormone. Cortisol oddly is almost low. What time of day was this? One hour after waking up.

We see a pattern where some guys freely convert DHEA–>E2 inside their adrenals. We see that when they are taking DHEA as a supplement which probably you cannot get there.

Alternatively, E2 can be elevated by medications that compete with the same enzyme pathways that clear estrogens in the liver. Liver problems are a possibility and AST/ALT lab results are of value.

E2 will move with T dose changes. So we really do not know what the labs are based on. TT=865 suggests the lower dose. But hard to evaluate without knowing lab timing relative to injection times. When you inject once a week, T peaks and drops and lab timing is the biggest factor in your lab results. Please inject 62.5mg twice a week and always to labs halfway between to minimize lab timing artifacts.

Inject subq, not IM, that provides smoother T levels. You will need that at AI needs to work against a given T level, not a moving target driving FT–>E2.

E2=40 is horrible. Reducing T peaks by injecting T twice a week will help, but this case is more severe.

SHBG is low. Some guys are simply that way, but in this case I have to ask if you have body weight and diabetic issues. Low SHBG comes with diabetes. You glucose shows no problem.

SHBG is made in the liver and E2 increases and more FT decreases.
FT not tested, perhaps not available. With low SHBG we can expect that FT is very good as there is little SHBG+T.

Vit-D3 could be a little better. Can you find 5000iu Vit-D3? Converts to Vit-D25 a very important steroid hormone. Or going to get more sunshine to make your own?

Please provide: hematocrit, RBC, ferritin, hemoglobin

Endo’s are typically the worst!

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.