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TRT, Enlarged Prostate and Libido - Advice?

TRT for almost 2&1/2 years and libido has never really been good. 48 years old, pretty decent shape, try to exercise at least 3x week, not over weight. My current protocol is:
60 mg Test Cypo 2x per week, every 3.5 days (200mg/mL), ¼ tablet (.25mg) of Anastrozole 1mg the day after T injection (so .25mg (¼ tablet) 2 times a week).

Other medications are Singular 10mg, Lisinopril 20mg, Omeprazole 20mg all taken daily. Also have an enlarged prostate (BPH) and taking 2 Uroxatral 10mg and 1 Tadalafil 5mg daily.

I’ve had 2 UroLift procedures for enlarged prostate recently and still in recovery (1 in December and 2nd in February….issues with the 1st led to the 2nd). Still having issues with enlarged prostate so I don’t think increasing Test Cypo is an option.

Estrogen is possible too low but I’ve read test/estrogen balance plays a role in enlarged prostate and I need all the help I can get there. If estrogen is too low, what should it be? Doc says he doesn’t like to see anything above 30. Any advice and/or feedback would be greatly appreciated.

Latest test results (04/07/20) taken the day prior to injection:

Estradiol: 22.2 pg/mL (range Male is <47 pg/mL)
Testosterone, Total: 660 ng/dL (range is 150 to 684 ng/dL)
Testosterone, Free: 194 pg/mL (range is 47 to 244 pg/mL)
Prostate Specific Ag. (PSA): 3.38 ng/mL (range is 0.00 to 4.00 ng/mL)

TSH (Thyroid): 2.71 mlU/L (range is 0.46 to 4.68 mlU/L)
Ferritin: 12 ng/mL (range is 16 to 243 ng/mL) - Low
Vitamin D: 60.4 ng/mL (range is 30 to 100 ng/mL)

Hepatic Function Panel (Liver Panel)
Alk Phos: 73 U/L (range is 39 to 117 U/L)
ALT: 40 U/L (range is 10 to 45 U/L)
AST: 49 U/L (range is 13 to 39 U/L) - High
T. Protein: 6.1 g/dL (range is 6.4 to 8.9 g/dL) - Low
Albumin : 3.7 g/dL (range is 4.2 to 5.5 g/dL) - Low
T. Bilirubin: 0.6 mg/dL (range is 0.3 to 1.0 mg/dL)
Bilirubin, Direct: 0.2 mg/dL (range is 0 to 0.2 mg/dL)

Iron has been up and down. I’ve taken iron supplements and gotten it back up but I stopped and low again. AST levels have been high for a long time.

E2 is a little low, but not alarmingly so I suppose. Maybe go a few weeks without the adex and see if there’s any improvement?

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Omeprazole is known to cause erectile dysfunction and low libido. It’s also very possible your low libido is because you are using anastrozole, I’ll bet your estrogen is lower several hours after taking it, and recovers somewhat (22.2 pg/mL) when you get closer to your next injection.

If this is the case, your estrogen is lower half the time and could explain the low libido.

That’s a shame because some men need estrogen 35> to have a good libido on TRT. You can’t always compare natural men hormones levels to those on TRT. Your doc is probably afraid more estrogen/testosterone/DHT will exacerbate your prostate problems.