T Nation

TRT and ED Advice

Hi guys,

So, bit of background. 24 years old, 10 stone, workout most weekdays cardio and weights and eat a relatively healthy diet. Plenty of fish, plenty of nuts of seeds, fruit dark chocolate etc. About three years ago now I developed Gynaecomastia and ED. Shortly after I completely lost my libido, began gaining central abdominal fat and started getting hot flushes and severe mood swings.

Finally after three years of tests and about 10 different medical opinions, I have finally been diagnosed with secondary hypogonadism. My total testosterone hovers at a mere 15-17mnol on a reference range that goes from 10-28mnol. Prolactin and oestrogen are sky high (oestrogen 180pmol/L on a reference chart that goes from 72-150 and the prolactin was 315 on a chart that goes from 80- 110). Endo has given me Cabergoline to lower my prolactin and has instructed me to take 1mg of Anastrazole per week.

Question to guys on here is this: Will the combination of the Cabergoline and Anastrazole likely alleviate some of my symptoms, or should I consider adding TRT into the picture? My endo is a very progressive and liberal doctor( a rare find in the UK)! and has said that he is happy to give me a trial of Tostran or Testo Gel in conjunction with the other two medications if I so wish. My concern with TRT however is that it shuts off your natural production and can lead to your testes shrinking and significant reduction in sperm count etc etc. HCG is currently unavailable in the UK at the moment, and besides, at 24 I do not want to be taking 4 or 5 medications if two will suffice.

Any guys on here adopted this particular protocol? If so, did you see relief from your symptoms like the low libido and the ED? Have any of you on here experienced stronger and more frequent erections on TRT? I have been told by my endo that the ED could be caused by the high prolactin and the high oestrogen, and that by lowering these two hormones we should be able to alleviate the erectile difficulties I am having.

Would welcome your thoughts people!

Have you had a pituitary MRI to check for a prolactinoma? The standard treatment for that would be pharmaceutical intervention first if surgical excision isn’t possible

MRI is being booked and already on Cabergoline 250mcg tablet once weekly. However, my question really to the guys on here, was is it likely that TRT or Cabergoline or indeed both used together, will improve my ED or could my ED be due to something else?

There is no way to know until the root cause is Dx. For instance if it is indeed a prolactin issue only then over time the cabergoline alone will fix the issue. If it is something more then you’ll need other treatments ie testosterone therapy.

Also that dose should be .25 mg x2 a week for prolactin that high.

I’m UK as well, South England. I’m a newbie here, so can’t offer advice, just wanted to say hello.

The guys here seem to know their stuff, so follow their direction on investigating why your hormones are out of whack.

I will ask a question though - what is an optimal value for prolactin ?

T is necessary but not sufficient for a good sex life.
Good thyroid function is needed.
Good general health is needed.

With your levels of T, 0.5mg/week anastrozole may be sufficient and you do not want E2 too low!.

Lower prolactin and lower E2 may allow HPTA to get going again. You and your doc could the HPTA restart sticky if needed.

Please post all available lab data in list format with ranges. When needing to look for something it is difficult to scan prose to find these things.

Anastrozole is a competitive drug to T and needs to match T levels. You will need to take anastrozole twice a week. Getting pills split to 1/4mg is more than a challenge. You can dissolve 1mg/ml in vodka and dispense by volume or by the drop.

SERMs [clomid, nolvadex] can increase LH/FSH by blocking estrogens from been seen by the hypothalamus+pituitary. Dose can be 10=12.5mg per day, half pills. There can be problems with doses that doctors often prescribe. Some guys feel crappy with clomid while others do great. Nolvadex does not have that problem. Doctors often seem stuck on clomid. More in the HPTA restart sticky. This inexpensive oral can displace the need for hCG injections and travels well.

E2=80pmol/L is a good target.

Dostinex/cabergoline is probably better based in two doses per week. Typically, 0.5mg/week is effective and free of side effects. This can be for life.

Doses per week are based on drug half-life considerations.

Many in UK are iodine deficient as iodized salt is mostly not in the shops. Your iodine there is meant to be from eggs, dairy and fish. You can evaluate your overall thyroid function via oral body temperatures and this can often be better guidance than thyroid hormone lab work. Note that thyroid lab work lab ranges are mostly useless and most of the time we have guys here with thyroid problems that are lab range “normal”.

Prolactin secreting pituitary adinomas do have a non-hormone risk. The adinoma can get large enough to press on the optic nerves and then a common issue would be noticing that with of peripheral vision can be reduced - should be near 180 degrees. A MRI is often done to visualize the adinoma.

If your HPTA does not recover and T levels are low: T-gels are ~10% absorbed at best, often lower or ~zero. Thyroid problems can change skin’s ability to absorb T.

You can do TRT as T+AI+hCG or T+AI+SERM. hCG is a natural human hormone, SERMs are not. AI=aromatase inhibitor, almost always anastrozole.

At your age you must protect fertility with hCG or SERM.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

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