T Nation

Time to Get Some Intelligent Feedback

I have been following this thread now for about a year, as I have been on my on TRT journey. My experience with doctors as related to low T thus far have been awful, but you guys have given me some hope. I have been essentially trying to manage things on my own up till now, but it is time to get some feedback from folks who might have something worthwhile to say.
I will keep the case history as brief as I can. I am a 43 year in reasonably good condition. I exercise several times a week. I’m 6’5" tall and weigh 250. My body fat is about 18%. I have hyper-tension treated with a 5mg/ed dose of Bystolic. I drink. I quit smoking 6 years ago.
It all began with my prostate swelling up about July of 2015. I went to my GP and he diagnosed me with a prostate infection and prescribed a heavy and long course of antibiotic. It took about 3 weeks for the “infection” to clear up. Then everything went to hell.
I became massively depressed (never occurred in my life before) and began losing erections mid-intercourse. Then my interest in sex tapered off. Then I could barely get an erection at all. This all occurred within a one month time frame. When I approached my doc with my erection and libido problem shortly after, he poo-pooed it and said that’s what happens when you get older, etc…
I began gaining weight. I started seeing a therapist. Nothing got better.

I finally got frustrated enough to strike out on my own and found a good urologist in town. He also waved it off, but after I pushed a bit, reluctantly tested my T (T and FT, nothing else). It came in around 386 and he reluctantly put me on cream. This boosted me to about 560, consistently but had no noticeable effect on my wood, my desire or my depression. After going on like this for about 5 months, and with the help of Cialis I reached a point where things were as good as they were going to get. Almost no desire, barely could get it or keep it up, unable to lose the weight I had been gaining, major loss of sensitivity.
I went back to the urologist for my follow-up (he had scheduled a follow-up after prescribing the cream for 6 months later!) and told him I didn’t want to do this anymore. He prescribed me 3 months of Clomid and said goodbye. No follow-up.
I went back to my GP and complained some more. I shared the info from my urologist. I refused to leave. He sent me to another urologist. They took blood and found my T low and my E2 around 96. He put me on injections 200mg/eow of Testosterone Cyp and 1mg Arimidex per week. (I had to insist that he test my E2.) The second week, for the first time in over a year I began to feel slightly like my old self again. Desire was back. Erections were there. Sensitivity was better. It lasted a few days and then tapered off again. More Cialis. A follow-up visit to the dos who told me that “this happens with some men.”
I finally got frustrated enough to strike out on my own. It was clear that no doctor around here was going to help or even knew what they were talking about. My research led me to find a lab that would run bloodwork for me without a doctor’s authorization and I used that to try and zero in on the correct treatment.
I’ll spare you the trial and error. Here is where we landed. I now inject subQ 20mg e3d of T Cyp and take .5 mg of Arimidex every day after I inject. Below are the results of my last set of tests, taken at the end of the three day cycle, before injecting. I got a full panel because it was on sale, so some of these results are not necessarily needed. I include them here for the full picture:
FSH - 0.9 L
LH - <0.2 L
T Total- 788 ng/dL
Free T- 137.4 pg/mL
Prolactin- 6.2 ng/mL
Estradiol- 36 pg\mL

My Cholesterol is a little high, which it has never been before, and my liver numbers are slightly elevated as well.

Using this regimen, I feel good. My brain fog is cleared up. My depression is gone. I have a healthy interest in sex. However my penis does not want to get on board. I have morning wood, but it is fairly soft. My sensitivity is fair. I am operating at maybe a third of where I used to be and I am getting tired.

I think my E2 is still too high, based on what I have read. It should be closer to 20 pg/mL. I have tried DIM but it does not seem to be helping. I loathe the idea of having to go back to the Urologist and have him up my Arimidex, but I don’t think I have any other choice. Thoughts?

I also want to add HCG to my injection routine (that will be another fun conversation) and would like your advice on dosing. Since I inject 20mg/e3d I figured I would substitute every third injection for 250 iu hCG as a starting place to see where that lands me. My reading suggests it will stop the aching in my testicles and also restore their size, as well as allowing my scrotum to stop hugging my body. My real hope though is that it will restore my libido as some have suggested it might. Up until my crash 2 years ago, I had the appetite of an 18 year old. Now I have one of a guy in his 80s. True, I can perform… but it would be nice to want my girlfriend (who has been with me throughout this whole ordeal and been nothing but supportive) viscerally as well as intellectually, if you get my drift.

Thanks for the patient read of all that back story. I hope this gives you a starting place and I welcome your questions, comments and suggestions. I know there is a way back from this and I’m hoping you gentlemen might have the key. Thanks again.

Your TT numbers look great! E2 looks alright, it’s not worth messing with an AI when you can reduce your dose a little. You’re missing the most important test, SHBG, any doctor that fails to run this test doesn’t understand male hormones. This is the holy grail sex hormone test. It’s could take several months or longer to regain your erection and sensitivity back.


Thank you for your reply. So, you are suggesting that:

  • my E2 level is not worth monkeying with
  • I need to get my SHBG level tested
  • Bystolic is part of my problem

I am happy to leave E2 alone. It’s a pain to dial in. However, doesn’t the fact that my first big dose yielded some good results for a few days suggest that I “drifted” through a good balance before the scales tipped back the other way? I understand from reading these forums, that this is not uncommon. If so, maybe E2 is worth another look?

The lab I found does not offer SHBG of course. However, in looking back to my first visit to the new urologist, I see he did test for it and it was normal. At this time, I had recently come off a round of Clomid (I think 2 weeks prior) Here is the entire panel he ran on 4/13/17 before starting me on injections, as cited above:
Total T - 732
Free - 14.9
E2 - 64.2
FSH - .8
LH - .44
Prolactin - 9.9
SHBG - 34.4

I found it odd that lh and fsh were so low. He said not to worry about it!
I also pointed out that this seemed to indicate that I was secondary hypogonadic rather than primary… He also shot that down.

Bystolic was, ironically prescribed by my GP at the beginning of all of this when I first complained about ED and impotency. He told me this was class of beta-blocker that did not have the usual sexual side effects. I reviewed the literature online, which seemed to bear him out somewhat. That said, lisinopril works just as well and has less reported effects that pertain to sex. Getting switched over should not be a problem. \

You say it could take several months to regain erection and sensitivity. Do you mean after stopping the Bystolic? I did try a month without it, which made no difference. Thanks!

You’re taking exogenous testosterone, your FSH and LH will bottom out. No need to check it as long as you are on TRT.

I would look into bringing E2 down and see if that helps your symptoms.

Here is your key. Get E2 sensitive completed. This number should be 24 pg/mL. A lot of men begin having “firmness” problems @>30pm/mL from what I’ve noticed reading on this board.

consider switching off the lisinopril. It increased my SHBG by 20 points (Its also documented in studies) . Losartan has worked well for me, but I suggest you do your own research to come to your own conclusions.

Went and saw my GP today and switched to lisinopril. I used to take it back when I was first diagnosed with hypertension. Will be interesting to see if it makes a difference.

On a side note, I was discussing T conversion to E and he told me that T is NEVER converted to estrogen.
I thanked him for his time and went home.