T Nation

Dr Knows Best or Does He? TRT, New Onset ED

Hi guys…looking for some advice on current dosing and additional labs. I have been on TRT for about 8-9 months and in the past month have began having some erection issues. I can get wood, but cannot always maintain a full erection. I still have nocturnal and morning wood. My spouse and I have been together for 14 years and nothing has changed in our relationship.

I don’t get spontaneous erections like I once did and really only get hard during foreplay, nocturnal and morning. I sometimes feel as though the sensitivity has decreased some as well. I cant help but think this has something to do with my levels. My Dr’s suggestion was Cialis…it works, but is expensive and I would prefer to fix it in my body if I can. I know, my Dr. is probably and idiot, but is pretty open to my suggestions and requests.

Current stats:
42 y/o white male
Waist 30in
144 lbs
Slim build, body fat remaining in my abdomen
Moderately body hair (chest, legs and arms, male pattern baldness on top…little on my back)
Hypertension, Low T, Hx of Kidney stones, Hx of increased cholesterol
Meds: Norvasc 5mg, Lisinopril 5mg, Adderall 20mg, Low dose ASA, Vitamin D 50,000iu once a week, Fish Oil, Cialis 20mg prn and Testosterone Cypo 2ml/400mg once a month injection.

Prior to beginning to address my increasing health issues, which included Hypertension, increased cholesterol, overweight, fatigue and moodiness; through diet and establishing a relationship with a physician, the below were my stats and lab.

36in waist
198 lbs
Stocky build, body fat abdomen, chest, butt, face…everywhere
Moderate hair

Lab March 2013:
CBC (March 2013)
WBC 5.2 (4-10.5)
RBC 5.11 (4.14-5.80)
Hemoglobin 14.6 (12.6-17.7)
Hematocrit 43.9 (37.5-51.0)
MCV 86 (79-97)
MCH 28.6 (26.6-33.0)
MCHC 33.3 (31.5-35.7)
RDW 14.5 (12.3-15.4)
Platelets 255 (140-415)
Neutrophils 56 (40-74)
Lymphs 35 (14-46)
Monocytes 7 (4-13)
Eos 2 (0-7)
Basos 0 (0-3)
Neutrophils (absolute) 2.9 (1.8-7.8)
Lymphs (absolute) 1.8 (0.7-4.5)
Monocytes (absolute) 0.4 (0.1-1.0)
Eos (absolute) 0.1 (0.0-0.4)
Basos (absolute( 0.0 (0-0.2)
Immature Granulocytes 0 (0-2)
Immature Grans (Abs) 0.0 (0.0-0.1)

Comp Metabolic Panel (March 2013)
Glucose, serum 85 (65-99)
BUN 14 (6-24)
Creatinine, Serum 0.86 (0.76-1.27)
eGFR 108 (>59)
BUN/Creatinine Ratio 16 (9-20)
Sodium, serum 142 (134-144)
Potassium, serum 4.1 (3.5-5.2)
Chloride, serum 101 (97-108)
Carbon Dioxide, total 22 (20-32)
Calcium, serum 9.5 (8.7-10.2)
Protein, total, serum 6.8 (6.0-8.5)
Albumin, serum 4.6 (3.5-5.5)
Globulin, Total 2.2 (1.5-4.5)
A/G Ratio 2.1 (1.1-2.5)
Bilirubin, Total 0.6 (0.0-1.2)
Alkaline Phosphatase 99 (25-150)
AST 22 (0-40)
ALT 41 (0-44)

Lipid Panel (March 2013)
Cholesterol, Total 218 (100-199)
Triglycerides 132 (0-149)
HDL 48 (>39)
VLDL Cholesterol Calc 26 (5-40)
LDL 144 (0-99)
T. Chol/HDL ratio 4.5 (0.0-5.0)

Vitamin D (March 2013)
Vitamin D, 25-Hydroxy 19.7 (30-100)

TSH 1.200 (0.450-4.500) (March 2013)

Testosterone (March 2013)
Testosterone, serum 365 (348-1197)
Free Testosterone (direct) 12.2 (6.8-21.5)

Testosterone (January 2014)
Testosterone, serum 296 (292-867)
Sex Horm Bind Globulin 25 (16-94)
Calc Free Testosterone 6.8 (4.8-25.0)

Testosterone (February 2014)
Testosterone, serum 213 (292-867)
Sex Horm Bind Globulin 30 (16-94)
Calc Free Testosterone 4.3 (4.8-25.0)

Testosterone (July 2014)
Testosterone, serum 731 (292-867) **this was drawn 1 week and 1 day after my injection of 2ml/400mg
Sex Horm Bind Globulin 29 (17-66)
Calc Free Testosterone 17.6 (4.8-25.0)

CBC (July 2014)
WBC 5.1 (4.0-11.0)
RBC 5.03 (4.10-5.70)
Hemoglobin 14.3 (13.0-17.0)
Hematocrit 43.2 (37.0-49.0)
MCV 85.9 (80.0-100.0)
MCH 28.4 (27.0-34.0)
MCHC 33.1 (32.0-35.5)
RDW 14.4 (11.0-15.0)
Neutrophils 54 (40-74)
Lymphocytes 36 (19-48)
Monocytes 8 (4-13)
Eosiniphils 1 (0-7)
Basophils 1 (0-2)
Platelet count 305 (130-400)

Comp Metabolic Panel (July 2014)
Glucose 89 (65-100)
BUN 13 (8-25)
Creatinine 1.0 (0.8-1.4)
EGFR 82 (>60)
Calc BUN/Creatinine 13 (6-28)
Sodium 143 (133-146)
Potassium 4.6 (3.5-5.3)
Chloride 104 (97-110)
Carbon Dioxide 23 (18-30)
Protein, total 6.3 (6.0-8.4)
Albumin 4.3 (2.9-5.0)
Calc Globulin 2.0 (2.0-3.8)
Calc A/G ratio 2.2 (0.9-2.5)
Bilirubin, total 0.8 (0.1-1.3)
Alkaline Phosphatase 69 (30-132)
AST 11 (5-35)
ALT 10 (7-56)

Lipid Panel (July 2014)
Cholesterol 136 (<200)
Triglycerides 71 (<150)
HDL 39 (>39)
Calc LDL 83 (<100)
Risk ratio LDL/HDL 2.12 (<3.55)

Thyroid Profile (July 2014)
T3 uptake 31.5 (20-38.5)
T4 6.0 (4.4-12.4)
Calc T7 1.89 (1.05-4.50)
TSH 0.6 (0.5-4.7)

Cortisol, AM, Serum (July 2014)
Cortisol 25 (7-25)

still not the best diet, rather than “dieting” I have learned to eat smaller portions rather than not allowing myself to have something and binge eating. I try to balance out anything fried or fatty with fresh veggies. I tend to eat little in the am and may have a snack in the afternoon and a small meal in the early evening. I get full very quickly and stop eating rather then stuffing myself like I did in the past. I have lost nearly 50 lbs since fall of last year…part to diet and probably part to the TRT.

I do not do much in the way of exercise other than mowing the lawn and daily activities. I am a District Sales Manager and spend most of my day on my feet, moving. Now that I have dropped most of the excess fat, I would really like to tone up. That is my next step.

No aching or fever

I hope that I have laid out a clear picture of where I was and were I am now and look forward to your feedback. I have done some reading and expect to see “idiot”, change in protocol, possible addition to my protocol and additional labs…just want to be sure and fully prepared when I visit my Dr next. Because my most recent T level was drawn so closely to my last injection, we are planning to do a level just before my next injection is due, this is when I want to request the additional labs.

Overall I feel much better than I did before losing weight and adding TRT. I do begin feeling sluggish and depressed near the end of the month and after reading information on here, pretty much know why. The ED has me concerned and I really want to get to the bottom of it.

Thanks in advance!

400 mg once a month injection??

your doctor is not just an idiot, he is dangerous motherfucking dumb shit. This is about the worst thing one can do.

[quote]Kwn wrote:
400 mg once a month injection??

your doctor is not just an idiot, he is dangerous motherfucking dumb shit. This is about the worst thing one can do.[/quote]


Read the stickies at the top of the page…
talk about a roller coaster !

Up to this point, I have determined the following steps:

Dose change
Lab to determine LH, E2 and PSA, pending those results possibly adding hCG and anastrozole.

My only concern is that the LH and E2 will be off because of the current high dose of T I am on and when the lab is drawn will be near the end of that dose. Will these labs be relevant or will I need to check LH and E2 after does change?

If I move to 100mg per week, when would the best time to recheck, T, LH and E2?

Thank guys!

After further reading, I have made some changes to my prior plan:

Forget the LH, worthless at this point
Add DHEA-S and Vit D (I am on supplements, but this has not been rechecked)
Had a DRE month before last

Am I on the right track?

Thought I updated:

Scratch the LH, worthless at this point
Vitamin D (on supplement, but levels have not been recently checked)
DRE last month

Am I on the right track??

Labs to be done when on TRT
-FT or bio-T
-Implications of injections VS transdermals [and injection frequency]
-Prolactin [optional and almost never on-going]
-DHT [should be checked, but perhaps not on-going]
-LH/FSH [optional and one last time -do I have cancer?]
-DRE: the dreaded digital rectal exam [Your doc does not enjoy this either!]

I see you have had some of this tested.

You for sure need to get your E2 tested.

-DO NOT test E2 ultra sensitive
-DO NOT do saliva testing for T or E2 and expect any help here
-DO NOT test for free E2
-DO NOT test total estrogens

This is in the: Lab Work, Blood Testing and Symptoms Sticky