T Nation

Is TRT the Only Solution in My Case? Low T, Erectile Dysfunction

Hello. Today, I got the latest results from my blood tests and my T is still very low.

Some of you know me from other thread, but I’ll say something briefly about myself -

I’m 30y old male, active in the gym since my 16. I have always been natural. I’m in a great shape and pack muscle mass easily, lift really heavy and have no other problem associated with low testosterone except my libido and poor erections.

Last 6 months have been agonizing for me. My girlfriend left me because of my erectile dysfunction and I’m battling my erectile problems since then. I’m getting depressed as I can’t find any solution. I tried everything possible to improve my condition in a natural way, with supplements, increased fat intake etc. Last 3 weeks I was on arimidex trying to lower my estrogen and condition improved a little bit but not significant.

I have scheduled meeting with my urologist tomorrow 10pm and I will discuss this with him. But I really doubt he will agree with me.

So, I would really like to know what would you do in my situation? I really did everything to avoid TRT but it seems inevitable.

I’v been thinking about clomid 50mg daily + Aromasin maybe before TRT? What do you guys think consindering my FSH and LH? Or maybe HCG?

Honestly almost no one feels good on Clomid so I don’t think that would help your situation. Lowering estrogen is not typically the solution either. Estrogen, in a reasonable ratio to testosterone, actually improves libido, not the other way around.

Have you tried Viagra/Cialis? I know it won’t help necessarily with libido but it could at least help with erection issues.

You really need to test free T and SHBG to get a better picture. Your total T isn’t horrendous but if your SHBG is higher then your free T could be low. Free T is what matters most and for whatever reason it wasn’t even tested.

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I tried taladafil with my ex gf and it didn’t help back then. I used it few times while masturbating to check if I’m capable to maintain erection and it only improves it a little bit.
I’m still waiting results for my free testo, they will be done in thursday.
However, I did my testosterone and shbg tests 3 weeks ago and they were:

Total testosterone - 15.1 nmol (8-29)
Free testosterone - 10.8 pg/ml (1-28.8)
SHBG - 22 (13-71)

My total testosterone dropped from 15 to 13 for some reason.
My free testo was 17pg 2 months ago, now it dropped to ~ 11, have no idea why. And I feel better now than I did 2 months ago.

Your testosterone levels are going to fluctuate everyday, so it didn’t necessary drop because tomorrow it could be higher again. Your Free T is on the bottom end. I have low-T at the moment and the Cialis barely works now, but was more effective when I was on TRT.

I also wonder about your low T3 and slightly elevated TSH, it would be nice to see Free T3.

How are your lipids? CMP? Prolactin? DHEA-S? I’d take a closer look at your thyroid as well.

What dose was the tadalafil, and the source?

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@highpull @systemlord
free T3 in december was 3.60 (2.7-6.4)
T4 total 81 (58-161
Lipids:
Cholesterol 4.12 (<5.20)
HDL Cholesterol 1,76 (1>)
NON-HDL Cholesterol 2.36 (<4.10)
LDL Cholesterol 2.14 (<4.10)
Triglycerides 0.48 (<1.70)
Arteriosclerosis index 1.2 (<3)
Risk factor 2.3 (<4.5)

I don’t have DHEA and CMP but I will do them as well next time.

All 3 endocrinologists told me I don’t need t4 hormone to lower my TSH and prolactin but I took them regardless and I managed to lower them to 1.2 tsh and prolactin to 124, but I did not noticed any improvements in my sex life, so I dropped thyroxin after 2 months. At this point, I feel better than I did when I was using T4 (my erections are a bit better at least).
So far I did my testicle and prostate screening and they are fine, pituitary screening and it is also ok, did thyroid screening and it is normal as well. Last week I was at cardiologist to rule that out and everything is good there as well.
I’m only taking Arimidex last 3 weeks or something, 0.25 mg twice weekly. I noticed some improvements as I said but it’s still not very good.
That’s why I thought, before TRT, to try with clomid + some AI maybe my testo will increase but the guy above said it wont work very well.
I wanted to try proviron at some point, but I’m afraid I will suppress my testosterone even further.

EDIT : Taladafil was 20mg but I’m not sure if source is good, I bought it online so it might be fake. Not sure If it against forum policy to say the name of the brand?

I dont think T is your problem. There are many other reason for low libido and ED other than low testosterone.

Do you have noctural/morning erections?

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Well blocking aromatase means that there is a portion of Free T not converting to E2 and instead is now adding slightly more T available to your tissue, but lower E2 also will cause problems with erections sooner or later.

You shouldn’t be having these low numbers at 30, your Free T levels are basically seen in older men who you would expect to see having erectile problems. The Free T testing isn’t very accurate and if we go by your Total T, it’s low compared to other men your age and everyone will experience symptoms at different levels.

This is what makes the diagnosis of low-T so difficult, instead everyone is treated the same even though we are all different. You can’t diagnose low-T by just looking at labs, you must weigh all of the symptoms. Your LH isn’t that great either, I’ve even heard the more educated state LH in the 1-3 range are typically where men are diagnosed with low-T.

Women are drawn to men with high testosterone and lose interest in men with low-T.

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@johann77 @systemlord I have nocturnal erections often. I thought my elevated tsh and prolactin were responsible for ED, but even when I lowered them, condition did not improve. It’s really weird, I have no idea what else I can try and doctor’s have no clue as well. They tell me to try with PDE inhibitors and to repeat tests in a month. I spent fortune on them and gain nothing for 6 months already.
I increased fat intake, vit D and aswagandha, I eat in a calorie surplus atm, not obese (i’ll post pic), my tits are not soft, beard, body hair I need to trim regularly, voice is deep, energy in gym/life activities is great, there is no any symptom of low T except sex drive and erections.
I came with high hopes here as I read some research how clomid + AI improved testosterone in a research group but I see you guys are against it? Or HCG solo, is it worth a try?
I guess I will end on TRT eventually as this is unbearable. Unless you have some other suggestion?
The only reason I don’t wish to jump TRT is fertility. I grew up in a big family, my younger relatives already have kids and I would really like to have kids in near future if possible.
I know it’s still possible with hcg but I didn’t read much about it.
Guess it’s time to start.
IMG_0297

Clomid 12.5 mg eod is an option to increase T and I personally had very positive experience with it. But honestly I dont think that you have a physiological issue.
SHBG is really low, freeT isnt that bad to account for low libido and ED, and your physical appearance is not that of a low T men - by no means.
If you have frequent noctural erections that points more towards a psychological cause for ED.

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HCG will suppress your HPTA (natural production), but the testicles will remain functioning producing testosterone.

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Like @johann77 said ED can be mental. The first thing you’ll think is “but mine’s not”. I have a buddy that went through a similar situation and everything he tried didn’t work. He finally as a last resort went to a Psychologist/Psychiatrist that specializes in sexual disfunction and is now much better. Sometimes the problem can start with a physical issue but morph into a psychological issue and I guarantee every person says their’s isn’t psychological. My buddy later on got on TRT which helped him as well.

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@johann77 @dextermorgan @systemlord
Last time I visited endo about 4 weeks ago, he urged me to speak with psychiatrist. He said he is almost certain that my ED is psychological.
If my lab tests were good I would accept his opinion. But my hormones are not in balance and my T is low, therefore I don’t think it’s performance anxiety or something.
Although I must admit, I had ED even when I was younger few years ago - It took several attempts to get an erection with my ex gf’s and I could never have erection the first night. But with my last, and I truly loved her, we tried several times and 0. Funny thing, I had crazy erections when I was meeting her in town, just kissing her in cafe or working out with her in gym. But in the bed, it was a disaster.
I know none of you guys are psychotherapist but feels good I can share my experience with someone, it’s a great burden to carry.
Anyway, I have a meeting soon with my urologist, I will speak with him about this clomid therapy 12.5mg EOD @johann77 recommended and I will seriously try and find some psychotherapist to talk to.
I will keep you updated with changes if you don’t mind.

Just telling you if it’s hormones you’re looking at about 4 months possibly before you get any relief. But the quote above is screaming psychological. The good thing is if it’s psychological you can fix it. Hormones is a fucking roller-coaster. It took me a year before I felt good. You have to play with dosages and wait 2 months between each change and during that time you don’t feel amazing. If you feel fine besides ED just make sure you’re aware of what you’re getting into with TRT. Of course once you get there it’s amazing.

I’d try the psychiatric route before clomid personally.

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I think there are some with psychological issues who do well with testosterone because they believe they will be fine now that they are on test. Therefore, they are. Good luck getting to the bottom of this. It can be very complex, a lot of moving parts with sexual function.

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I have scheduled a meeting for tomorrow morning with psychiatrist so we’ll see. I don’t have high hopes as I don’t believe in psychotherapy but it’s my last resort before TRT.
This urologist today was unreal, the least caring doctor I ever met - He just glanced at my lab tests and previous endo’s and urologist diagnosis, said it’s a psychological thing, to try and forget about it, and put me on taladafil 5mg eod + some l-carnitine/b complex and tribestan.
So I decided to visit psychotherapist tomorrow and see where do I go from there.
I will start today with 12.5mg clomid EOD.
@johann77 Do you think I should continue with arimidex/aromasin along with clomid or go solo clomid?

Thanks for all support boys, really hope I will get out of this mess somehow.

How often do you use porn?

This video is a cold glass of water over the head for anyone that thinks TRT can cure ED…But I think it is the most truthful.

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If you decide to test clomiphene, then stop the other stuff and only do clomi. I don’t think it will do much for you regarding ED, but I understand that you want to test it.

12.5 mg eod will raise T by 100 to 300 ng/dL. Give it 4 to 6 weeks, but if you don’t improve accept that it is psychological. Don’t go on TRT in the hope that it resolves your ED.

I agree with @dextermorgan that this strongly hints towards a psychological cause.

I had a similar experience in my early 20s for 6 months or so, no idea what happened. It sounds strange but it resolved on its own once I stopped trying to figure out what was going on and trying to control it. I knows that’s difficult to accept.

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@kandeman2 currently driving I will check the video once I get home. basically, I want trt only for my erectile dysfunction, don’t kill my last hope mate :upside_down_face:
I don’t watch porn, I have almost 0 motivation to watch porn or masturbate. I literally force myself to masturbate each other day to stay in shape but have no urge to do so.
@johann77 ok then, going solo clomid 12.5mg eod. if it boosts my testo and I still have these problems, I will know for sure its a psychological thing. If it boosts my T levels maybe it will have placebo effect on my mind as well, at least I’m hoping, because I’m preocupied with my low T levels atm. really curuous what psychotherapist will tell me.

Just want to say that it is good you are willing to try things out to feel better.

I will challenge you a bit on your stance against psychiatry. You say you “don’t believe in psychotherapy” before you’ve even seen the psychiatrist. I’m just going to say that this is like saying “I don’t believe in antibiotics” or frankly “I don’t believe in TRT.” It makes no sense. All three are evidence-based interventions that are proven to help specific issues. Open yourself up a bit more to possible help. If you go into a psychotherapy session thinking it is useless, that is like taking only half of your antibiotics, or trying TRT for a day or two before giving up. Are you trying to feel better, or just prove yourself right?

Anyway, just trying to challenge you a bit on your beliefs. Best of luck though and I do hope you start feeling better.

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