T Nation

On TRT, Experiencing Low Libido and ED


I have been on TRT for roughly a year now, started out on gels for 6 months now on biweekly injections of Tcyp. My original test was only for TT and it was 280. Since then I discovered this site and have also been tested for FT and E2. These are results from my last two tests.

This is my current TRT protocol:
.45 T-cyp twice a week

March 2012

Aug 2012

I feel great, lots of energy, losing weight, brain fog is gone, overall a better man than I was a year ago. But then comes the problem, Im experiencing ED and very low sex drive for last several months and seems to be getting worse. I would think with numbers like I have now, my sex drive would be awesome with rock hard erections. This is killing me cause I don't wanna quit the TRT, but somethings gotta give. Im considering dialing back the T-Cyp to .30 Twice a week and getting off the AI entirely unless my E2 really climbs in my next test. The only thing I started a few months ago was the .25 HCG, would HCG have anything to do with ED?

help me please!

Unique TRT Situation

I'm not 100% sure but my first thought is to cut out the adex. That is a really strong AI for a pretty darn low doese of test.


Would low E2 cause low libido? I thought it would be opposite, but yes, Im gonna cut the AI out for a while and see how the bloodwork goes in October, but this ED thing gotta get better soon.

And what is DHT? I see references to it in other posts, but I don't know if that might be something I need to look at too.


E2 being so low is just as bad as too high, and yes...it will kill your sex drive.
I way over respond to Adex, and take just 2 drops EOD, which amounts to less than .25mg per week.
Even at that dose I notice my drive falls a bit. If I take more, my e2 crashes, my joints ache, sex drive flops and I have no desire for sex.
You should drop the AI for 7 days to get it out of your system, than restart with .25 E3D.


OK. I hope that its my E2 being low and I will come outta this soon. I just started dating a really nice and really hot girl and im afraid when the time comes Im not gonna be gtg and thats gonna crush me. Before TRT my performance and drive was fine. Ive already been off the AI for about a week now, so far as of today nothing has changed.

Is there something I can get outside of a Dr visit to boost DHT? My dr isn't up on all the hormonals, I had to provide him the info to get him onboard with the TRT.


You don't even know that your DHT is low, so why are you worrying about something that may or may not be there? ED can be cause by probably hundreds of different factors--it is silly to pick one out of the hat to treat without confirming first.

I agree with others that you are probably killing your E2 with too much adex. PKNY's recommendation is a good one.

Also be aware that some guys (myself included) have reported negative libidio issues from adex. Switching to aromasin has solved the issue. Even with identical E2 readings, libido is better, indicating some other possible mechanism of action that our bodies prefer over adex. Something to keep in mind, but first i would focus on bring that E2 up....20-30 range is adequate for most guys.


Thank you VTBalla, I will take that into account. I have never had DHT tested, just picked up on some other threads about DHT causing loss of libido. I am going to read up more on it when I get a chance and maybe get tested for that just to see. I do think the Adex and low e2 may be the problem though. I hope that is the problem. I really wish I had a pre-TRT baseline on my E2. Do they sell aromasin without a script somewhere on the web? I might pick some up if my E2 goes up too high without an AI.


".45 T-cyp twice a week"

Just to clarify, are you taking 100mg/mL or 200mg/mL? Are you taking 90mg/wk total, or 180mg? Typical dosing of Adex is 1mg/wk split into as many doses as possible if you are taking 100mg/wk of testosterone. 1mg/wk can cover a lot of guys up to 200mg/wk of test, but depending on how your body processes the stuff you may need to add or subtract a little. I'm on 200mg/wk only take 1mg/wk, but there's guys who need 2mg/wk of Adex at 200mg/wk. I can take a little trial and error to get it perfect, and could span a few blood tests to dial it in.

That aside, VT and PKNY pretty much summed it all up. The symptoms of low E2 can be identical to the symptoms of high E2 - there's a ton of overlap.


"The only thing I started a few months ago was the .25 HCG, would HCG have anything to do with ED?"

I just started 250UI HCG 3X week and have spoken to a few non-forum members who all said the same thing about HCG - it really had a positive effect on them below the belt assuming the addition of the HCG wasn't enough to push your E2 too high.

Subjectively and I don't know where any of my levels are because I just started TRT I've been walking around at half staff night and day with a noticeable increase in libido. Could be in my head but hey what ever makes me feel better. I will say that before TRT and even with my test around 150 I never had erection problems...libido yes...ED no. When I initially started TRT my erections seemed weaker for a few days and the sensitivity of my penis seemed decreased but this went away before starting HCG. Now with the addition of the HCG I feel 16 years old again.

My wife's comment last night, "WHAT THE HELL HAS GOTTEN INTO YOU?!" She didn't know the 16 year old me....I think she liked getting to know him.

Anyway...we'll see if this continues (hoping!)


Do not post doses in syringe units. Use mg's T and anastrozole, iu for hCG.

Do not use "AI", as there are many aromatase inhibitors.

Try to get to E2=22pg/ml. Get to 1mg anastrozole per week in divided EOD doses, then repeat labs. After dose can be easily adjusted.

You need to read the stickies, all of this is there.


Ive read the stickys several times but some of that is just over my head. For some reason I had the anastrozole dose wrong. I was dosing the recommended .5mg EOD instead of twice a week as recommended. I do think I am an over responder though, since my E2 has never tested high even when I wasn't taking any in the beginning. As someone else stated the brand I used may affect my sex drive too. Im going off it completely for a few weeks to see how my libido responds. I may introduce it back doing just a few drops a week if I start feeling off.

Seems like the general concencus is that the low E2 was the problem, and I was overdosing adex so thats easily fixed. I hope that its that simple to fix.


E2 is tricky...too little and you have libido/ED issues.....too much and you have libido/ED issues.

The goal of all of this is to start at the recommended doses, give time for a steady state to be achieved and measure levels - adjust to get to steady state in the ranges that make you feel good. Sometimes it takes a little while to "dial-in" your doses but once you're done your individual protocol should be pretty easy to follow.


Went to a urologist and he looked at all my blood work from the past year and the first tests that were taken. He says I should never have been on TRT and that my body was functioning normally even though my initial test was 285TT. He wants me to quit cold turkey and gave me some viagra. I'd like to quit the TRT for a while to see how my natural T levels react and get some additional testing since this Dr thinks I'll do ok.

My question is, is quiting the TRT cold turkey ok, and how long would it take before my natural productions recover. Also should I continue the HCG for a period or quit that cold turkey also?


Functioning "normally" (and I don't really buy that at a tT of 285) and functioning optimally are two different things. You already stated you feel much better than 1 year ago....how does your MD account for the vast improvement in symptoms? Unless it's his belief that it's normal to feel bad, have no energy, gain weight, have brain fog, and overall be a worse man than you are right now?? Doctor thinks you'll do OK? OK shouldn't be the goal IMO.....feeling GOOD should be the goal!

IMHO your E2 needs tweaking and I would not discontinue TRT.......


You rarely quit anything from TRT to blood pressure medications cold turkey, your doc sounds like the cold turkey. Your natural T is shut down from the TRT, your E2 will probably go sky high when test suddenly vanishes. Read the yellow stickies at the top of forum topics for this info on continuing HCG.

Fire the urologist.


Yeah, thats what Im afraid of. I do wanna try to get off and do some more thorough testing this time before I restart TRT. I have read the stickies before, but I'll look again for some info on getting off TRT.


Your HPTA may not recover to a prior baseline. So the opportunity is lost. However, if your intent is to stay on TRT, that works in your favour.


I'd love to be off TRT, because I didn't know anything about it when I started TRT I've always questioned if I really needed to be on TRT. I am hoping to get off, and maybe in 6 months do some more thorough testing with a more qualified dr, and see if I really do have low T or if my initial test was not accurate.

My question at this point, is how to get off without killing my system and completely bottoming out for weeks or months? I can't find any comprehensive info on these forums so far, and Ive been reading for hours now. Everybody keeps saying to read the stickies, but I don't find info on getting off TRT in them.


Coming off TRT is going to suck, real bad. I had to when I switched doctors the last time. Think about how badly you felt and the symptoms you had that led you to seek treatment. Now, imagine it worse since your own T production is shut down, although with the HCG you may have a little going on.

If you really want to do it, you could consider a "test taper" method, where you basically slowly reduce your test dose until you are off or try a "restart". You can do SERM restarts or HCG restarts. There are topics here on both methods, do some digging.


You need to dose your SHBG. Normally the E2 must be at the same level as the SHBG. SHBG is ideal in 20, E2 is ideal in 20. However if u have SHBG in 40, everything changes in relation to your estradiol. Own experience. Believe me.