ED Medication Ineffective with TRT

You need to know total, shbg, and albumin to get the number that ACTUALLY matters which is free T. I don’t care what your total is. It is there merely to calculate what I want to know. I will never make a suggestion for protocol adjustment based on total T ever nor from estrogen levels (irrelevant).

It doesn’t change the ratio? Want to bet on that? Where do you guys come up with this stuff? Do you think my ratio is the same now compared to prior to TRT? Huh?

I meant we need to know total t because free t should be around 1-2% of total.

Again, read this again, and again:

Total T is required only to calculate free T. I don’t really care what total T is.

Not sure why this is so complicated.

I just said what its for and you completely dismissed it. Theres really no point debating you, you have the blinkers on and you’re going to argue your point even if youre completely wrong or have no confidence in what you are talking about.

I can assure you that I have confidence in what I’m saying considering I have thousands of people watching me on YouTube and would be mortified if I got the whole thing wrong (so trust me when I say I’ve looked into this stuff at length!). I stated we don’t care about total. Then you said we need to care about total to calculate T. I then clarified that’s the only reason you need total, but you don’t base your protocol on total. No blinkers required.

as per request I will combine all information here with regards to history, protocol and levels.
several years ago when i was in my late 30, i had all the same low T symptoms i do now. Lack of sleep, lethargy, low libido, poor memory, ED.
I basically begged my Dr for blood work; begrudgingly he ordered it. TT came in at 204, he said “you’re in the normal range, no further action required”. i tried to force the issue, he sent me to an endo who said “you’re in the normal range, we are not playing God here; no further treatment required”. prescribed meds for ED symptoms and sent on way. Over the years i have asked to be retested and declined.
a switch in care giver and she ordered bloods and cortisol, lipids and thyroid came in normal so i will only list TT and E2.
TT - 86.5 E2 - 16
she said i was a mess and my hormones were a disaster started me on weekly injections of 100mg cyp plus 15mg DHEA
8wks later checked bloods:
TT - 432 E2 - 39
she said test was coming up but so was E2. I mentioned that i didn’t feel any effect and ED meds were no longer working.
she increased dose of cyp to 140mg/wk plus 0.5mg arimidex twice per week plus 15mg DHEA
eight weeks later:
TT - 809 E2 - 45
it should be noted that about two weeks prior to this blood work, i split my dosage of test to 80mg every 4 days and decreased arimidex to 0.25mg every 4 days.
i have yet to have a follow up with my caregiver, but as per the majority of the information (i wont say consensus) i have switched to 20mg injections along with DHEA daily and eliminated the arimidex.
It’s been a couple weeks now and still feel nothing. Haven’t had spontaneous morning wood in years and am told to use that as a barometer of how current protocol is working.
I realize this is a journey and i am just starting out at only 5 months in; just frustrating.
I will be speaking with healthcare provider tonight and plan on asking for free test results, not just TT. Is there anything else i should be asking for or any other rocks to look under? I don’t want to change too many things or chase down every rabbit hole.
any advice is greatly appreciated.

There are those on here that may not agree your thyroid numbers are good depending on where they sit. May want to post those up just in case some may have differing opinions to share.

She’s giving you an AI with an E2 of 39? Is she nuts? She didn’t bother measuring the one USEFUL lab which is free testosterone?

Sounds like you’re dealing with an amateur.

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Have you checked: Free T3, Free T4, Reverse T3?
Also, do a 24 Hour Saliva Cortisol test. Both Hypothyroidism and Adrenal Insufficiency will prevent TRT from working. This explains your ED even with Cialis.

from the initial labs:
Free T4 - 0.93ng/dL (12pmol/L; Range 9-19)
Free T3 - 0.2539ng/dL (3.9pmol/L; Range 2.6-5.8)
TSH 2.16 mIU/L (Range 0.32-4.00)
i’m not sure if these are the units you usually work in; i’m in canada so they are expressed in SI units and i converted

Ranges?

@rabbit_ears
Give yourself time on the new 20mg/day with no AI protocol. Libido & erection quality take a long time but in the grand scheme it’s just a few months. Once you have them back you never have to think about it again. I’ve been there myself. Don’t change anything for the next 8 weeks minimum and report back how you’re feeling. You really need a total of 12 weeks on a protocol before it starts having maximal impact. Relax you’re doing the right thing. The worst thing you can do now is change shit or add shit.

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spoke with nurse practitioner last night and while she didn’t necessarily agree with cutting out the AI, she said it was my choice. so we have agreed to not change anything and run every day injections until the end of Feb and then do labs again (which will be about 8wks, since i changed to daily and eliminated AI).
I have asked for free T results to be tested. Any other levels i should be asking for?
Keep in mind in canada (or at least Ontario) free T test is not covered (~$70), SHBG not covered ($75), bioavailable T not covered (~$200)
I won’t have enough DHEA caps to run until the end of feb; would you drop these too? (I’m not sure what they’re supposed to do anyway).

Don’t waste your money on bioavailable T.

Bruh… I’m getting away with murder or somebody’s lying to you. Ottawa Civic Hospital on Parkdale/Carling. I pay for nothing except via our Marxist State exorbitant taxes. LOL

They just added shbg and calculated the rest of yours from that, didn’t actually check them (which isn’t necessarily a bad thing)

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Man, I experience the exact same thing. Zero effect. I was even beginning to wonder if somehow the ester had some type of interaction with Cialis. Obviously that’s not the case but the difference is so drastic I couldn’t help but wonder.

One of the little asterisks about TRT that is rarely mentioned before therapy is that for a notable number of men it can actually worsen or cause ED. The causes aren’t totally understood. So much more than Testosterone goes into erections. Its likely a combination of estrogen, cascade effects with the sympathetic nervous system(intoducing androgens into an unhealthy body doesnt magically fix the body and it creates new sometimes excessive demands on your system), activation of underlying mental health issues like anxiety and mania, pregnenolone and dhea disruption, and perhaps blood viscosity changes…

https://www.cvphysiology.com/Hemodynamics/H011

note the relationship between hematocrit(increases on trt) and blood viscosity. its non linear.

It’s not that non linear either, especially if only considering the range people tend to be in. IMO anyways.