T Nation

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

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.


I’m older than you but in a similar situation…I want TRT to be the magic bullet but am learning more and more that for ED, it just isn’t.

I’m not willing to risk the side effects of TRT if it’s not a slam dunk that it cures ED…My Libido is fine, but what good is that without function?

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Thank you guys for all your effort in this thread and for your support, I will keep you informed of my status with psychotherapy and clomid cycle💪

It’s mental, man. I bet you are imagining it not working even before you start. Saying things in your head like “please let everything work this time”, “I need this to work”, “my relationship depends on this”, etc. This is what happens. It becomes a loop and a self-fulfilling prophecy. Do some mental work. For me daily meditation and visualization helped (there’s some good stuff on youtube). If you have a patient woman to help you through it, all the better. Start by being intimate without the expectation of penetration. Take the pressure off and eventually you will get out of your head. It is a process.

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I would strongly recommend not using clomid if the primary issue is ED.

I listed to Ruterbusch in the video and a few of my takeaways are …

He says that dosage for L-Arginine should be 3g (min) up to 9g per day. Other sites on the net do mention 3g per day. However, as a matter of reference, it would take 27 capsules of the highest dose of L-arginine in capsule form I could find PER DAY to reach 3g.

I looked at my capsules which I stopped using last month, and I was only taking in 2500mg per day – and it took me 4 capsules to get that.

[I posted two links to powders that provide 3g and 6g of L-Arginine per scoop. The links were removed, which is fine – but I don’t know why a generic reference to the availability of the powders wasn’t left in the thread. Since the links aren’t allowed, you can search for the products yourselves – but the point was to make clear that there are reasonable methods to obtain the suggested amount of L-arginine].

There is a research paper in the Journal of Sex and Marital Therapy that touts " While L-arginine alone may not treat your ED , the combination of L-arginine and an herbal supplement called pycnogenol may help"

There seem to be many references to this study but it appears that it hasn’t been recreated by others for validation.

One conflicting study "Oral administration of L-arginine in high doses seems to cause significant subjective improvement in sexual function in men with organic ED only if they have decreased NOx excretion or production. " I wonder how “nox excretion” is measured?

And finally, there are some stern warnings about the side effects of L-arginine relating to people with low blood pressure, and intensified herpes outbreaks.

One other comment the doctor made that I found interesting … and I am paraphrasing … TRT supplementation has worked best in his practice only for patients under 300 … TRT hasn’t helped the 500+ guys. That is an interesting statement to me.

I had total T of 575 pre-TRT and while I didn’t have total ED I did have not super hard erections and low libido. TRT couldn’t have worked better in my case. Borderline too good.

Care to explain why? I read on different places it can boost testosterone with minimal side effects on 12.5mg eod, and side effects are manageable.
Imo benefits outweigh the risks from what I read, but I will listen if you have some other info.

Anyway, I just got back from neuropsychiatrist, he diagnosed my case as:
DG Sy anxioosum F 41
Therapy : Fluoxetine 20mg each day
Zolpidem 10mg each day before sleep

He said he is convinced my ED is psychological. We had a nice chat, but I’m still not convinced it is a psychological thing.
I will start with therapy today, but I did some reading and it says ‘Fluoxetine’ (Prosac) can worse erectile dysfunction and it’s quite common (1 in 10) for this to happen. This scared me a little bit because I’m taking this medicine to counter it, not to do the opposite.
Hope he knows what’s he is doing, he is quite respected doctor in my area.

For anyone that is not going back to read original posts, this quote is from me – but it is NOT a statement that I made. The statement is an indirect quote from Dr Ruterbusch and was in the video. Just FYI

Clomid just never made me feel good. It blocks estrogen receptors, and can also act as estrogen receptor agonist. It can worsen ED. The main reason tho is that your ED is most likely not hormonal.

Ugh. Do not do zolpidem and fluoxetine. How bad is your sleep? Fluoxetine May worsen your ED. And it has a greater potential to kill libido. Tho if high anxiety is truly the driver, then it may work to relax you. I’d recommend Vilazodone over fluoxetine tho. It’s an SSRI that also acts as an agonist at the 5ht1a receptor. Which helps to eliminate some of the traditional nasty SSRI sexual side effects. And please don’t get on zolpidem. It’s a short term fix and the rebound insomnia can be horrible. Not to mention the potential for acting out in your sleep.

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Alright, I just called another clinic to schedule a meeting with new psychiatrist. I will go bankrupt in the end I swear.
I already took one pill of fluoxetine before I read your reply, I wont take it anymore then.
My sleep is not very good, I go to sleep and fall a sleep in 30-40minutes but I wake up regularly during night (2-4 times). Usually I sleep from 00:00-04:00 then I wake up and can’t sleep for an hour or so, thinking of my ex, ed and similar shit- I’m full of energy. Then I fall a sleep around 5am and wake up at 7:30am without alarm. So my total sleep is 5-6hrs I think, I never rest/sleep during daytime.
I’ll risk with clomid however, but will ask new psychiatrist tomorrow for the drugs you recommended. Thank you for informing me on time mate!

Just my 2 cents: everyone is different and unique, but if im not mistaken you have 600 total t and 100 shbg?

When I started TRT my total t was 560 and shbg around 50. Ny libido was worse than now and I had other symptoms like depression and anxiety. Things are much better now.

You should try everything possible to naturally optimize your free t now and yea these total t and shbg values can cause sexual issues in my humble experience

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That’s not too bad for sleep. It’s not too different from mine. Just work on it. Try magnesium glycinate before you go to bed. Don’t watch tv in bed. Zolpidem is the biggest one to worry about of the three things you were prescribed. It’s possible you could have success with fluoxetine. Personally, I had issues with SSRIs. Many men do. Tho It did help with depression and anxiety. There are better options out there now.

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You don’t necessarily need anew psychiatrist either. Just be proactive with your care. Say that you have concerns with a certain medication and there are other options you want to try first.

Yeah I wasn’t implying that. I read it as you didn’t necessarily believe it either.

I’m one of the men that had issues with SSRIs. I tried three different ones over many years and each one brought on heavy derealization and depersonalization - things I have never suffered from while not on SSRIs. Each time it took about 9-12 months to manifest, and when it did it was hard core. The withdrawal from SSRIs produced manic episodes twice, which I’ve also never experienced otherwise.

I have to believe that some people are telling the truth when they testify to the beneficial impact SSRIs have had on them. But for others, like me, they did an incredible amount of harm. Never again.

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Maybe try psychotherapy instead of going on any SSRI or alike. Drugs are short term solutions in most mental disorders (not in psychotic disroders!)

There are many different very effective forms of therapy available. Its not necessarily lying on a couch and analyzing your childhood and the relation to your mother etc. But is a process.

But the first thing I would do is to get off the internet. Often the answer is to let loose and getting away from needing to control everything. The problem/answer is not something you can understand and subsequently control using your cognitive ability.

I wish you all the best!

@vonko1988 I think it’s much lower. It fluctuates between 12-15nmol total testo (5-25 lab range), I can’t find the right converter on web.
@blizzardtest I’ll definitely avoid zolpidiem then, my sleep is not that bad at the moment. I take 10mg of melatonine before sleep, zma supplement and aswagandha.
Fluoexetine worries me mostly to be honest - I really don’t want to worsen my sexual problem with SSRI. I have already scheduled a meeting at 19:00h pm today so I will ask him to prescribe me vilazodone as you recommended.
I didn’t know much about serotonin drugs yesterday, I did some research meanwhile so I will be better prepared for today’s talk.
@johann77 I will discuss all possible treatments today.

This is so true, I think I became so obsessed with this. I overanalyze everything, and deep in myself, I don’t believe any drug can help me, guess part of my illness is psychosomatic.

I will report after a meeting with new psychiatrist today.

With such values and if SHBG is around 100 I would say the issue is 90 percent hormonal, your free test is in the trash and I wouldnt mess around with therapist, SSRIs and other bulshit. Many people try to compensate hormones with other things but that is not possible. Since starting TRT my life has changed a lot for the good.

I dont say you should immediately start TRT but focus on optimizing your testosterone levels one way or another

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