T Nation

ED Issues

SYMPTOMS!

Already that you is not going to make a protocol without AI. I would increase the cyp for 200mg week, it would help a lot the DHT and would increase the IA.

The same - ED - just mainly ED - no brain fog , etc.

DHT looks decent…Definitely better than the E2…I would work on correcting that to see if you notice an improvement in ED.

I have a doctors appointment today - only thing I can see to possibly change is to try aromasin instead of the a-dex - E-2 is high but when I take the a-dex I dont get any relief

Just throwing this out there…

If you have no other signs or symptoms of low T other than ED…how do you know the ED is even linked to low T? In other words there are other causes than just hormones that lead to ED like vascular and psychological issues.

I’m not an expert but I think this possibility needs to be considered. I read many low T boards where people lump all their problems together as a single cause and while I don’t recommend looking for zebras immediately there are lots of guys on TRT who feel great but still have ED issues…makes me wonder if testosterone or E2 is even related?

Have you ever spoken to your doctors about other possible causes?

I am no help here but I sure can relate to the ed problems. Mine is directly due to trt and the unwillingness of doctors to reduce my estrogen levels. They just want me to suffer with this I guess. They have been telling me that it isn’t worth the risk. Heck I am ready for some risk. It sounds better to me that more of this ed and mental problems. My estradiol is 144 amd my estrone is 158. Sounds like something worth fixing to me.

Wish you the best. Hang in there your not alone.

Farmer1

I understand your question , I have thought the same thing however :

  • blood pressure great
  • sugar levels good
  • chol. levels in check
  • overall everything else pretty good
  • pre TRT - consistently tested 170 - 180 total T

Now it does eventually affect you mentally but with such a low total T pre trt logically there is likely a connection ?

[quote]DAVIDINSC wrote:
I understand your question , I have thought the same thing however :

  • blood pressure great
  • sugar levels good
  • chol. levels in check
  • overall everything else pretty good
  • pre TRT - consistently tested 170 - 180 total T

Now it does eventually affect you mentally but with such a low total T pre trt logically there is likely a connection ?[/quote]

Absolutely, as I said I wouldn’t start looking for zebras in the beginning and I’d leave no stone unturned with respect to TRT but keep in mind there are a significant number of guys on TRT who have excellent test and E2 numbers but still have ED. Either something has irreversibly changed due to their low T and it is not restorable or there is something else going on.

Warning…weak logic ahead but here we go. All ED medication targets one aspect of ED…vascular changes…this suggest the majority of ED issues are vascular. I’m sure if TRT did help a significant number of ED patients it would be all over TV. As I said before it’s my experience and based on what I’ve read that TRT really improves libido (the desire to have sex) more than penile erection. There is some blurry lines there though…obviously if you feel horny most men will have a harder erection but you get what I’m saying.

I think you’re overlooking the role of neurotransmitters - specifically dopamine - in erectile function. I don’t think you’re alone, I think it’s very common on TRT boards.

I remember reading (I’m sorry I don’t recall the source) that some minimum amount of test is needed to achieve an erection, something like 100ng/dL. Beyond that, erections are largely regulated by the dopaminergic system.

I don’t know that you will get a doctor to prescribe Caber or Bromo for your ED without extensive testing. That being said, they are available through other channels.

I do think that it’s worth your time and energy to research.

http://www.psy.fsu.edu/faculty/hull/DA%265HT_pdf.pdf

<-------------- Not an MD

Hello David. Do not believe that your problem is dopamine. You can take this doubt dosing prolactin, dopamine is antagonist of prolactin. When one is high, the other is low and vice versa. Your problem is in the testosterone/estradiol. First try to hit without HCG, then add it with time. I noticed that your SHBG is quite low, in this way will have more free testosterone, however will have more free estradiol also. With this you need low estradiol values as well. Know a guy who has 30 years of TRT, the SHBG it is around 24, it feels right with estradiol in 15pg. in my opinion the you would increase the dose of testosterone, deleted the HCG, and tried to control the estradiol in low levels with the arimidex until your back since. After adding the HCG with the time. Unfortunately this will take time and patience. But you’ll get. Good luck.

Thanks for the replies - I will take a look at the dopamine antagonists - PT141 peptide comes to mind ? As far as the low SHBG - very very little info on this - generally the goal is to lower it but if it is too low it is just as bad if not worse - if there was a way to measure free E vs. serum E that may be the key as you noted but then what ? Met with doc on Wed. - prescribed aromasin we are going to lower it and see if we can find a sweet spot - this is becoming very depressing but have to keep trying

Quiet friend. Think that could be worse, you’re in the best country in the world and has access to medical help you. I live in Brazil and I have done everything alone and still on top in my country do not think HCG to buy. You will win this battle, you need patience. your SHBG is very low, and this makes the TRT very difficult with certainty, needing total levels of estradiol low.

Don’t worry about dosing free estradiol has no practical use.We will try to climb this SHBG, because it will greatly facilitate the TRT. First i thought its T3 a little low. Make a complete panel of the thyroid gland. TSH, free T4, free T3, reverse T3 * (important). Another factor that lowers the SHBG levels and insulin resistance, look for diabetes.

I have to apologize…I didn’t see your updated labs and thought your E2 was still 19.

Yeah…that seems like the obvious place to start - an E2 of 54 is likely the culprit.

Do you have just ED issues, or libido issues as well?

When you’re about to make love to the lady, are you very aroused, but your penis doesn’t show it, or are you not that aroused either?

[quote]DAVIDINSC wrote:
Thanks for the replies - I will take a look at the dopamine antagonists - PT141 peptide comes to mind ? As far as the low SHBG - very very little info on this - generally the goal is to lower it but if it is too low it is just as bad if not worse - if there was a way to measure free E vs. serum E that may be the key as you noted but then what ? Met with doc on Wed. - prescribed aromasin we are going to lower it and see if we can find a sweet spot - this is becoming very depressing but have to keep trying[/quote]

Don’t be depressed. I have no doubt you’ll figure this out after some experimentation. Would like to see what finally works for you. Valuable information…

Btw Your E2 measurements were wildly different, but neither of them in the 20’s.

-Tom

Seemed to have one “normal day” and that was it - I wonder if e-2 fell down to a very small sweet spot window and then went too low ? - I am taking .25 aromasin eod - what is typical dose for aromasin ? thanks

.25 what?

[quote]DAVIDINSC wrote:
I have a doctors appointment today - only thing I can see to possibly change is to try aromasin instead of the a-dex - E-2 is high but when I take the a-dex I dont get any relief[/quote]

.25mg per week is woefully inadequate so it is no wonder your E2 is that high. I have experienced ED issues at those levels in the past. Why not move the dosage up to .25mg of Adex 3 or 4 times per week to try to dial in your E2 to the high teens or low 20’s. It could be a simple fix. Lef.org sells E2 test for $33. You don’t need a doc. Just order the test, schedule the appointment and get the results in 2 or 3 days. Get your E2 to a more reasonable number and if the problem persists, then try something else while keeping the E2 in check.

Also, your doc could be on to something with the insulin resistance. I think I had that issue as well. Read many books on the subject but would highlyy recommend “Living Low Carb” by Jonny Bowden. He does a great job of explaining the whole carb - insulin interaction. I thought I understood it until I read his book. It changed my diet and changed my life for the better (especially in the bedroom).

My mistake - sorry - taking exemestane 25mg eod