T Nation

Semen/Ejaculation Issues

I am new to TRT therapy. Just had my second pellet insert. My first insert put me at 1500 from 400 and had an estrogen blocker in it. Dropped my estrogen below pubescent levels and I definitely felt it. Joint pain, fatigue, emotions, and testes shrinkage. I went back to my provider a couple months later and asked for HCG after doing a little research on maintaining my teste size. I am currently doing 250 IU three times a week for about a month now. My testes have come back some but not back to normal size yet. My problem is I am having troubles producing semen. Discharges are small and never more than once daily. I am a sexually active person and have been for years. Never had issues with this. My wife and I were and are still very active sexually but since starting TRT I am not able to finish. My erections are great but i just cant finish. Anyone else facing these issues? If so, how have you combat this? More HCG?

It’s probably the “Estrogen blocker”. Whatever that might be. Low E2 screws up a lot of things.

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This last insert I asked for no estrogen blockers. Hopefully your right. Thanks

If I up my dose to push me to 1500 to 2000 TT it take me about 4-6 weeks for my ejaculate volume to come back. Initially it drops by about 80% and then suddenly comes back as I get used to the dose. Not sure the mechanism.

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Your levels are all over the place and might not be a problem for everyone, but I have noticed some guys don’t get good sexual function with super steady levels, some actually need levels fluctuating a little to have good sexual function.

You might just need time without the AI to resolves your issues.

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NHwatts
You use HCG or any thing like that to maintain your testes and fertility? Thanks

I do not. No need for me. T-Cyp only.

Are you on TESTOPEL custom compounded pellets?

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I would agree. Unless you are seriously high in E2, you shouldn’t need any type of control. It can really screw up your sex life. If you keep T within the normal range, conversion to E2 should follow.

Adding in HCG should help with semen production. The bulk of the ejaculate comes from the seminal verticals and they respond to both LH and T stimulation. 250 IU 3 times per week is a good starting dose. You may want to consider increasing it to around 1000 IU. There are 2 good studies that show that 1000 IU per week in divided doses is about the right amount to overcome exogenous T suppression of testicular function (intratesticular testosterone levels).

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Youthful55 this will be helpful thank you

Traveling man, my insert procedure paper only says pellets of bioidentical testosterone. There is a DX code. Says Testo. I emailed my provider to know for sure but I am think that the pellet is TESTOPEL

What you mean that you cannot finish? Your dick is numb? For what i know Low estradiol can resuce sensitivity in your gland and reduce orgasm.
One guy also told me that hcg makes his dick numb for whatever reason

Tenpiedad, no numbness, dick works fine, just cant finish/climax. Get to that point and the feeling disappears. This issue has gotten somewhat better since using HCG. I’m hoping that it’s do to my estrogen being to low. Also think I will increase my HCG too.

How long have you been using pellets?

Low E2 can cause all kinds of sexual issues so it wouldn’t surprise me if that’s the root of your issues. I had the same issue when I was low T & low E2 pre TRT. Very frustrating to say the least, though mine wasn’t as bad as some.

Ncsugrad, just had my 2nd insert on the the 24th. 1sr was early December. My provider had put a estrogen blocker in and it had me all fucked up. Estrogen of a child and testosterone of a super athlete. It really sucked because I really didnt gain much from that insert other than feeling mentally resilient. Other than that my joints hurt, I became emotional, super tired all the time, tiny balls and granite wood but unable to climax… This 2nd insert I asked for no estrogen blockers. I feel the hcg has helped a bunch in the 1 month I’ve been using it. Have been advised to try upping 250 iu to around a 1000 iu a week. Might try moving up slowly though. Maybe 500 for now…

You on inserts or injections?

Injections. You won’t find a lot of love for pellets around here… my opinion on them is I think people should at least try injections first and figure out what works for them, then switch to pellets if you still want to after that. At least then you have a good idea what you “should” feel like and that gives you something to compare to. Otherwise it’s hard to say whether you’re 50% better on pellets or 100%

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I’ve been talking to my provider about this but she is reluctant to put me on injections. I assume this is related to cost. Each pellet insert costs me 800. So I am looking for a more cost effective alternative

Yeah, pellets are supposedly highly profitable for doc offices, not so much with injections. Whether that’s specifically playing into her decision, I have no idea.

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By “cost” you mean profit. Doctors don’t make any money on TRT if their patient injects at home.

Check out @traveling-man 's blog too. He is an avid pellet user.

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Then it would be $2400 a year for the pellets, correct? Add the costs of labs, office visit co-pays, etc, if they are not included in the $800. Nothing wrong with pellets, if:

  1. they are the most effective way of delivering TRT for you, or the results are acceptable to you.
  2. they are the most convenient method for you, or the level of convenience is acceptable for you.
  3. other options are not available.
  4. they are the most cost effective. They are not, but balancing the above with the cost, is it acceptable for you?