T Nation

TRT Failure + Restart Protocol

So I’ve been on TRT for about a year and 3 months now. I’ve posted on here a few times about how everything’s been awesome besides my erection quality. It seems as if I’ve tried everything to help with the quality of hardness but for whatever reason, it is the only problem I’ve had. However, its a big problem and one I don’t think I can live with anymore. I’ve tried pregnenolone, DHEA, EOD shots, pretty much everything I’ve read. I’ve supplemented with Iodine and gotten labs pretty regularly. My endo and clinic doctor don’t really know what the issue is as they’ve said my numbers look really good, which I’ll post.

At this point, I’m looking for some last minute pointers before I make the final decision to come off. I have a very busy life and I’m stressed about coming off, taking clomiphene which I have on hand as well as HCG. My current protocol is TRT 75 mg 2x per week (150 total), HCG 400 mcg 2 x per week (cycled to prevent any kind of desensitization, I can’t really tell the difference it makes TBH), AI aromasin 6.25 mg 2x per month (I’m super sensitive to ai’s and I’ve crashed my e2 before but this protocol keeps me between 20-30 ng/dl. I usually take the e2 sensitive array but this time I took the normal test, I’ve never noticed a difference between the 2 tests as they are always in the same range.

My plan is to take clomid 25 mg per day up to 50 mg per day for 6 weeks with HCG, if/when I come off. I wanted to take nolva but my doctor said clomid works way better for HPTA restart. will this protocol work to get off? I’d REALLY rather not but I can’t seem to get to the bottom of this issue and it sucks. Otherwise, any other tips would be helpful, thanks.

Couple of things to note and a few questions.

  1. Your Free T isn’t on the list, but based on your SHGB and total T, I’d say that your numbers are FAR from ideal.

  2. E2 is too low. Drop the AI altogether.

Questions…

  1. Do you watch porn and/ or masturbate frequently?

  2. Can you maintain an erection with stimulation?

  3. Do you notice if your joints click/pop any more than normal?

So judging by my total, shbg and albumin, my free test would be 15.1 ng/dl and bioavailable would be 361 ng/dl. These numbers definitely aren’t far from ideal in any sense. If anything, they’re slightly too high, although my total test has been as high as 1000 without having any effect on erection quality. That 579 is one of the lowest its been, which isn’t that bad.

1.) I probably do so about 3-4 times a week, less than i did before I started the T.
2.) I can maintain an erection for like 5 seconds until it dwindles, the main problem is the initial part of getting it up and once it is, it is about 85% of the hardness it ever was before I started. Note that before I started, my e2 was extremely low and my total T was at about 300 on average, sometimes around 280.
3.) No joint clicks, just my ankles which have always done that.

IMO. Try 60 twice a week. Stop all e2 control. See how you feel in 2 months.

Take some Viagra a few times a week even if you just jerk off with it. Viagra temporary

Really that low? I tried 140 at the lowest but I feel the best mentally at 150. The highest was 160…But yeah, now that I’m on it I’m up to try any protocol. Getting off it seems painful from what i’ve heard lol. Maybe someone else who’s tried a restart could elaborate on how bad it really is. My T was just so low before and I’m only 30, in good shape, so I don’t see it improving naturally…

Ideal Free T would look closer to 20-26.

Masturbation can desensitize the penis, and porn will desensitize the mind (the real thing rarely lives up to the fantasy, and over time even the fantasy can become somewhat boring) making it very hard to maintain erection. Try cutting that out altogether for a few months and see if your condition improves.

You could have felt better at 160 cause your e2 May have been higher. You were taking aromasin

a few months!?!

I had very little libido and couldn’t get fully hard the first 5ish months of trt. I did the same as you regarding E2 around 22. When I finally dropped the AI my libido went through the roof. It took a good 2 months though so it may not happen over night. My E2 was 77 (sorry I feel like I say this 8 times a day) last I checked and my libido is as high as libido gets now. If be willing to bet that’s likely a big part of your issue.

I feel your pain though. This might be TMI but about 2 months into trt I had the hottest girl I’ve ever been with basically force herself on me and she was into some wild & crazy stuff and it still took a while to get hard.

Penis sensitivity can take a while to recover if the nerves are damaged (the severity usually depends on how often and how aggressive you are normally, and the aggressiveness progressively gets more and more as the nerves become less sensitive). You may see improvements in 2-3 weeks which would be great, but it could take longer.

Cialis/viagra can help restore this.

When your hormones are straight. I can have sex in the morning. Jerk to porn And then have sex again in same day. My porn use is light. Not everyday.

yeah its weird, since going on, my libido and confidence have gone through the roof, but I get weird boners…its like some kind of sick joke. I went like a month or two off the AI and it was at like 45 E2. So my doc’s like go back on. But I’m so sensitive to it, its really hard to gauge, I’ve crashed my E2 2-3 times off a very small amount of AI (exemestane and anastrozole) , and each time is terrible…

Yeah there are a ton of recent studies showing that trying to control E2 can cause more harm than good. Listen to some of Dr Rozier’s stuff. Very enlightening.

Now I’m not in the “no AI , ever ever ever” camp because I believe that there are certain circumstances, say like a guy who is extremely overweight who is starting TRT and aromatase can tip him over the edge of insane, where an AI can be useful for a short period of time. Also, when changing protocols and levels fluctuate wildly before the stabilization period has passed (although I recommend dim over AI in this case). As a general rule though, low E2 can completely sabotage your protocol, and cause more health issues than any one person cares to deal with.

So are you saying that after you stop taking Cialis / Viagara, everything continues to work just fine?

If the answer is no, then I would argue that they fix nothing, but rather just mask the symptoms of another problem.

I remember reading studies that it can repair/restore tissues in the penis.

HCG is known to cause ED and libido troubles in some men, HCG supports adrenal function, causes trouble when support isn’t needed.

Going from EOD to ED shots was a game changer for libido and erections for me. Total T looks alright, no way to know if Free T is sufficient.

Without Free T testing you’re lost. Your CBC levels doesn’t look like typical men optimized on TRT.

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YOur total testosterone is like mine, I’m not optimized and I plan to start TRT. Your free Test is not tested and your E2 is too low. Of course your libido will be not great. You need higher E2 and free test at the top of its range.

Free T can be calculated by my above numbers? I’m not sure what you mean by that…Also what’s wrong with the CBC?

Some good answers, some not so good answers but I appreciate it…I guess porn could be potentially an issue but I definitely don’t go overboard by any means, and its not like I don’t have any libido. Its been the same issue for almost a year. Like my total T has been 1000 with my e2 at 30, there’s been higher numbers in almost every regard but its just super weird the hardness isn’t there like it was when I was at 273 ng/tl total T with low sex drive but still rock hard…One other theory I have is that my dick literally grew after going on, I’ve heard of it happening with others and I’m wondering if its somehow not getting enough bloodflow? I workout all the time but maybe I need to start running marathons lol I take citrilline with beet root and viagra for sex which works okay but its just not the same, really wish I could get to the bottom of it.

Sure it can, but the calculators are inaccurate because they were created long before the testing methods were finalized. Your CBC labs are mid-range, the average man on TRT will see CBC levels higher, when I see hematocrit mid-range or lower I can’t help but wonder how you can be optimal.

Athletes train at high altitude do to the increases of hematocrit/RBC carrying oxygen rich blood to tissues. You are only testing the inactive portion of testosterone without testing the active form and CBC labs are lower than what we are used to seeing of men on TRT who are optimized.