T Nation

On TRT for Two Years - Sudden Problems

27 yo
185 lbs
5’ 10"
32" waist

Never any finasteride or anything like that.

Basically at 23 I was dealing with a ton of fatigue and had it worked up by lots of doctors. Eventually they found I had low T. Tried clomid but didn’t get me high enough. For some reason the gels give me anxiety so I can’t use them (maybe DHT mediated). I was on T cyp. at 112mg per week, split into 2+ weekly doses. This worked fine for about 2 years. No issues with libido, erections, whatever.

Now, suddenly, I have massive ED, EQ issues, and no libido. At this time E2 was in the 30s and 40s…which it historically had been throughotu ALL of my TRT without a problem. I freaked out and tried a restart with hcg and low dose clomid. Worked for a few months (and libido and erections worked) until my T plummeted back down to 200. At 200 I had ED again. I went back on TRT due to advice from my then urologist.

I relocated and a prominent andrologist in Houston is trying me on hcg monotherapy at 5,000 iu 3x per week. I figured I hadn’t tried HCG in mono so maybe this would help. This puts my E2 around 45 and my TT at around 600. All other labs (prolactin, preg/prog, DHT, cortisol, DHEA, etc.) All perfect. For the first few weeks things seemed better, but then as E2 continued to creep up, things got worse again. I am now fiddling with stuff myself until my next appointment with him and trying to figure out a solution. I am currently doing 24mg T every other day, with a hcg shot thrown in once or twice a week at 250iu to keep my testes active. With this I have great morning wood but still have a very low libido and find it hard (if not sometimes impossible) to get an erection without viagra/cialis/etc.

What’s weird is this all started happening around a hernia surgery I had. Before the surgery my erections were getting weaker and weaker. After the surgery is when they went to complete shit. I am not sure if there is some sort of correlation there, but who knows. My uro wants me to do all sorts of tests to rule out physical causes…he basically told me he knows they will come back fine, but he wants me to SEE that they are fine. This was all fine and dandy before, but now I’ve got a high deductible insurance plan so I’d rather not pay for a bunch of tests to see that I am essentially normal and still need to figure out a solution to my problem.

My options, as I see them:

  • try another restart
  • try real hard to get some sort of TRT dialed into where my libido and erections are back.

Thoughts? Questions?

I should add some labs:

On 112 mg per week in 2011:
TT - 979 (300-1080)
FT - 231 (47-244)
SHBG - 26 (11-80)
E2 - 40 (12-41)

At this time I had good erections and libido.

Here are in late 2012 on 84 mg per week. I went down this low because the 112 wasn’t working anymore and I figured E2 was the culprit. Lower TT and lower E2 - right?
TSH - 2.0
DIHYDROTESTOSTERONE 403.0 106.0 - 719.0 pg/mL
DHEA-S 326 240 - 549 UG/DL
PROLACTIN 4.2 3.0 - 30.0 NG/ML
PROGESTERONE LEVEL 0.6 (0.15 - 1.15)
SOMATOMEDIN-C 280 SEE BELOW NG/ML (This is IGF-1)
ESTRADIOL LEVEL 36 <=63 PG/ML
TESTOSTERONE LEVEL 661 292 - 1052 NG/DL
SEX HORMONE BINDING GLOBULIN 44 16 - 94 NMOL/L
CALC FREE TESTOSTERONE 12.2 4.8 - 25.0 NG/DL

You have not been managing E2 levels and E2 management can be mission critical.
You have have more things out of balance other than T, you need a broader perspective.
Surgery can set one back, especially if your adrenals have been weak.

Read these stickies:

  • advice for new guys
    – pay attention to thyroid and adrenal issues
  • thyroid basics
    – check and posts temperatures as per the above
    – report iodine in supplements and use of iodized salt [TSH=2.0 is a concern]
  • estradiol sticky
  • protocol for injections

The above reading will take days. Try to get through it and then come back here with questions. Meanwhile, post for temperatures and iodine.

You have pregnenolone data? You can add to your post above via [edit].

Ask for this protocol:
100mg T cyp injected SC EOD with #29 1/2" 0.5ml [50iu] insulin syringe
250 iu hCG EOD SC with same size syringe above.
1mg anastrozole per week in EOD divided doses, easy with a liquid by the drop, difficult with tablets

5,000 iu hCG three times per week is criminally insane. That can down grade the LH receptors. So when you stop hCG and expect the HPTA to restart, how well will that work when the LH receptors are damaged? The high dose hCG thinking has been recognized as stupid in many circles. Does is have its place? Perhaps in some context where a healthy normal male has a fertility issue and one is not dealing with a broken HPTA.

High dose hCG or SERMs should not be used and combinations of hCG+SERM are dangerous as well. And these can create very high levels of E2 as well, which cannot be controlled with Anastrozole. Docs are not aware of that either and would probably have a hard time figuring out what that is an expected result.

Thanks for the response. I have read the first pages of the stickies…I will get through the threads and see what I can find out.

I"ve been at this on other forums for about 4 years so am familiar with most of the above…I have typically been of the “avoid arimidex at all costs” crowd. But, if it helps me regain my libido and erections, then great.

Temperature reading right now is 98.6 (2 pm) WIll do the morning. That protocol I can do with what I have on hand. I’ll see how it works.

Morning temperatures are 96.7. By noon they are 98.6. I have been on T4 in the past (synthroid) because of thyroid nodules. I decided to discontinue after two years after it didn’t make me feel any different and that the research shows that treatment of this type doesn’t even shrink the nodules. What sort of iodine (and dosage) should I try?

A story that I tell often:

My sister in-law [SIL] cooked meals for her grandmother who had heart problems and was put on a salt free diet. And of course, that made grandmother iodine deficient; but that is another story. So SIL learned to do without salt and she was then iodine deficient. Over the years, high TSH enlarged her thyroid and she developed nodules and some progressed to T4 producing without the influence of TSH. She now has TSH=0 and her thyroid hormones are workable and she has dodged the radiation burnout of her thyroid for now. Thyroid events have twice landed her in the hospital. Your nodules might have been triggered by low iodine. One then can progress from [subclinical] hypothyroidism to hyper.

If TSH is elevated from an iodine deficiency, it is important to take action.

See the new sticky: “thyroid basics” for iodine dose issues. Note the implications of clearance of bromides from your body. If you do not feel well, this can be from the bromides.