TRT Hasn't Worked for 2 Years. Help?

Hi all,

Great forum and have enjoyed reading about all your expert opinions. Before I go into my story, a little about myself to give some context;

33 year old male
5 ft 7"
225 pounds
Circa 16-18% BF
BP - normally around 125/80ish
Training - Bodybuilding type training - 4 x weight sessions per week / 2 x light 20min cardio sessions
Nutrition - Again bodybuilding style nutrition - 4/5 meals per day - Carbs - between 300 - 500g per day (depending on goals) - Protein 220g per day - Fats 70g per day

Now for my story…

Life was going well until I hit 30/31 and this is when my symptoms started. Libido nosedived, I was extremely tired after the gym but the main thing I noticed was a complete decline in erectile function. No nocturnal activity, and when the time came for it to be used I either experienced no activity or I was able to get one with much work, however the quality of the erection was way off.

Long story short the journey led me to my primary care dr who wanted to see my hormone panel. Bloods came back 3 times with Total/Free T and E2 on the floor. My total was 6nmol (6-29nmol), and my free 0.2nmol (0.2 - 0.6). After much too-ing and throw-ing I eventually started my TRT journey in Jan 2019.

Now I am at a loss, as we are now 2 years down the line and the quality of my sexual function has not improved in the slightest. I can get one if I really try, however this takes a lot of work and the quality is just not right and not where it needs to be. I am constantly trying to work with 60/70% function which I struggle to maintain. This is regardless of whether with my partner, alone or nocturnal.

My Dr and I have made so many protocol tweaks during these 2 years to try and get it to work, but to no avail. I cant list them all as there are so many! But the gist of things we have tried over the 2 years are…

Testosterone Cyp - Range of dose from 70mg to 125mg weekly - Tried daily and EOD administration
HCG with and without
AI with and without
Transcrotal cream with and without
etc etc

We typically make a change, wait 6/8 weeks or so and have bloods, it doesnt make a difference with symptoms and then we try another tweak - this has been going on for 2 years now.

so as of 1 year ago I decided to go back to basics, drop the HCG and everything else and try and just dial in T. I tried 115/125mg a week, nothing else and let it run for 3 months. Erectile function was awful. I ran labs and everything was over range Total T 40nmol (6-29nmol), Free T 1.5 (0.2-0.6) and E2 260pmol (59-159). So we dropped everything down to 105mg a week and added in 50mg Proviron daily, to see if my issues would improve with a DHT boost.
I ran this for 2 months (no improvement in symptoms) and went for blood work, this is my latest set of bloods on the following protocol;
105mg Test Cyp via daily administration
50mgProviron daily
5mg Tadalafil daily

Total T - 27nmol (8 - 29)
Free T - 0.6nmol (0.2 - 0.6)
E2 - 185pmol (41 - 159)
DHT - 2.34nmol (1.14 - 4.13)
SHBG - 26nmol (18 - 54)
Prolactin - 165 (86 - 324)

Everything looked good, with the exception of the skewed Test to E2 ratio, so suggest micro dosing Aromasin at 1mg E3D to bring E2 back into a more favorable ratio to Testosterone. I have been on this for 4 weeks now, and at this present moment in time there have been no improvements.

Other lifestyle factors, as you can see I am active with a bodybuilding style training plan. Sleep is good, limited alcohol and no smoking or recreational drug use (that got binned many years ago!).

I am at a loss now as to what to do or try, I have probably made 20 protocol adjustments over the past 2 years with no avail and I really am started to get desperate now, I cannot continue like this it is all encompassing and it feels like this has ruled my life for over 2 years now. I’m not looking to be superman, I just want to be strong, healthy and above all, happy.

My Dr has mentioned it may be worth trying Bupropion next, I’m not sure why or how this would help erections, but I feel like it may be a case of throwing stuff at a wall and seeing if something sticks.

If anyone could shed some light on this or offer some help, I would really appreciate it.

Thank you anyone for your time in reading this.

Matt

Sorry to hear bro. Seems like you’ve covered a lot of the typical bases. What is your e2 like now? You mentioned it’s been high in the past. I am convinced that the type of ED you describe is often connected to reduced arterial stiffness. It’s been proven that increases in e2 softens the arteries which is typically good. In the case of a dick though, if tissue lacks the stiffness to control blood flow then erection will be weak per the inverse relationship between pressure and flow rate.

Would you consider 200IU e3d HCG and reducing test to something like 75mg/week no AI as a baseline trial? I always keep in mind that a healthy man producing high end test naturally produces between 7&10mg per day. That’s about 100mg of Cypionate accounting for the ester loss. If you are using HCG as well you could easily be producing significant amounts of test and therefore e2 on top of that which could cause issues.

Also, have you tried viagra? I found cialis to be less effective when I suffered similar issues. FYI, I have been off TRT for a few months now and e2 is mid range. I still take 5mg daily cialis but erections are really good now even without it. I’d speculate that much of the time prolactin and e2 are to blame for ED unless there is a physical issue like leakage or a psychological issue like depression, stress, too much porn etc…

That would be a protocol adjustment every 5 weeks, roughly. Whatever you try next I’d suggest waiting 6-8 weeks at least before adding/removing/changing anything

Thanks for your reply man, appreciate it.

I haven’t tried Viagra for a few years. I have been battling just on 5mg Tadalafil daily, but I’m thinking maybe whilst I’m sorting this out I should lean on larger doses of PDE5s for quality of life.

I haven’t tested my E2 since starting 1mg Aromasin E3D (I have bloods booked next week) but I inagine in that case E2 may be still too high.

I havent tried HCG for over a year but willing to give anything a go. What is your reason for adding HCG out of interest? Curious to know how you think it may help?

Thank you

Are you secondary or primary?

Secondary mate

Some report libido boost with HCG but that’s not across the board. To be honest you’ve tried all kinds of combinations, I don’t think it’s the compounds that are the issue. You need to get that e2 in check as high e2 seems to have remained high throughout your treatment and HCG will only make that worse.

I really don’t have much else to offer you from my experience other than I think you’ve got a good chance of seeing improvements with 100mg Viagra on an empty stomach half an hour before you do the business. I would advise aspirin and paracetamol at the same time and maybe even again 4 hours later as headaches are common. Additionally, use something like Sudafed nasal spray to avoid stuffiness which can induce headache.

That combination was a winner for me when I was struggling with high e2 and ED like you describe.

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Most ppl i read about, including myself, who don’t seem to get the libido/ED things right with TRT, are secondary.

There has got to be something else wrong in the HPTA axis/pituitary. I can take monster doses of test and still feel nothing. It’s bizarre. And yes, it’s pharmacy test.

The components upstream of where test production begins might play a role but I’ve never really researched it much, DHEA and Pregnenolone spring to mind? My ED always coincided with either above or below reference e2 or prolactin.

After starting TRT, my Preg was way low outside of range (to be expected). SO i do 25mg sublingual daily. Doesn’t do much though other than i notice a TON of precum prior to sex. DHEA is in range.

It’s just the more i read stories about libido and ED, it’s always the secondary people. I believe i asked @highpull on here his thoughts, and he said he sees both primary and secondary with issues.

Your HPTA is responsible for so many things, and if damaged, a lot can go wrong (secondary) in comparison to primary, where its just the testes (responsible for just testosterone… for the most part)

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A lot of men are diagnosed with low-T and never know why, usually its some underlying disease and left untreated TRT may not cure all your symptoms.

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Interesting. Ive never liked how TRT fucks with the consistency of your stuff either. Light hearted humorous story, I remember this one time a girl thought I had pissed on her because my cum was so watery. I’m sure I was on HCG at that time too. A truly WTF moment for her that I’m sure she will remember.

TRT simplifies the process compared to what our bodies can accomplish. I’ve made the point before that I’m of the opinion that mid level test naturally, might be better than above average levels while on TRT. Your body basically does blood work and adjusts protocol instantaneously multiple times throughout the day. Theres no comparison between that level of fine tuning and the 3 times per year bloodwork and a couple times per week injections. It’s a grey area for borderline guys that are looking for optimisation and not symptom relief IMO. They might no have quite the cost to benefit ratio as their truly hypogonadal comrades.

Very good point. Having had ED and libido issues in the past I appreciate its intricacies. For example a bout of very high e2 induced ED could trigger psychological ED which can’t be resolved no matter how many protocol changes occur as it’s psychological. No doubt when a lot of guys present at their initial consultation with low libido, low energy etc they are actually depressed somewhat. This is obviously psychological so the TRT won’t help them unless they address the root cause. TRT might help some get out of a rut, in the gym, looking good and therefore feeling better.

Point being yes, a lot of guys now presenting with libido issues are actually presenting an unaddressed pre TRT physiological or psychological issue.

I actually think there are a LOT of men with porn induced ed/libido issues.

Constant overstimulation and rewiring of the brain to only release dopamine with whatever porn they like, may be destimulating the real thing.

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What up mate, u sound like me but I have been going since 2017.

U see how ur e2 is always above the range? This might be the issue here.

I had the exact same problem, but I had pretty good libido BEFORE trt, with a test of 266ng/dl natty.

What worked for me:

  1. Zero test, NPP only, 600mg a week. Great libido, great erection.
  2. 10mg test E, EOD, IM. That gives me “decent” libido, decent as … well I can do it, however the desire is kinda meh, but atleast i can fucking bang.

I can get hard, however, 10sec of no stimulation, it starts to go soft. The “tip” of my cock is not full with blood, got it? Its like half-full, not that fucking blue-ish tip of raging boner when I was natty, that super arousal shit. Nooo, the gland is often just “semi hard” and dry-ish, very weird.

I just dont get that “arousal response”, and whenever I do, I dont stay aroused, I need to fucking force myself, its very weird.

What I do know is, its fixable.

Ive had great libido 3 times during these years:

  1. When I did NPP only, as I said.

  2. When I tried 0.5mg of caber, that very night EVERYTHING came back, supreme arousal, supreme cock. But I got so got so damn tired i discontinued it. Next time I tried caber, it did nothing for my libido.

  3. Another weird occsation: So I had been doing 125mg IM a week. I decided to try subQ, 30mg EOD.

I waited 14 days after my 125mg IM shot of test E, then I did test E 30mg subQ, within 5 days I had super strong arousal, It was like I got “reminded” how it actually feels to have that raging desire, I thought I had finally found the solution. Unfortunately this fucking protocol had me so damn tired, sluggish and demotivated I couldnt continue for long, I could not fucking function, I was GONE mentally, It was like I had no test in my body … but the libido was there tho.

Thats it.

You may be working out too much. 225lbs/ 5’7” I hope you have lots of muscle, and big boned structure. And if you do, were you running cycles before your issues began? Deca? Tren? Otherwise you’re overweight which may be the reason why you aromatase more than what I would expect with daily shots. I also think you’re all over the place expecting a protocol to work within weeks and then switching on to another when things dont go as planned. Which is a nice way to always be fluctuating with no way for your body to settle into a routine. So yes you’ve tried everything except being patient with one protocol that gets you good values and into a stable spot.

Thanks all.

I do not believe my issue to be porn induced or psychological, just based on the fact that I have issues even when trying to ‘perform’ by myself. The erectile quality of nocturnal erections is also poor, not just when I am ‘trying’ to get one.

@equel It sounds like a has a similar issue, it’s almost as if it does not fully fill with blood so to speak. My E2 has always been on the higher end since starting TRT. I have tried on numerous occasions to try and get off the AI and let E2 do it’s thing. this method just seems to make everything worse.

@middleages you’re right. Whilst I do carry a fair bit of muscle, it is fair to say that I am also carrying my fair share of body fat. I am probably around 20% BF at present. I have often wondered whether the ‘bodybuilding’ style of training is hurting me and whether I should adopt more of a ‘healthy’ training split, dropping some of my weight training for cardio to have a nice blend, and just eat well instead of forcing another 100g of carbs because I need to ‘gain’. Regardless of the fact there is some muscle there, I do believe 225 lbs for 5’7 is heavy. Are you saying that carrying alot of BF is affecting my issues because my body is over aromatizing and that is the issue, or are you saying that being this heavy for my height is also causing an issue?
I have never ran any cycles prior to my TRT journey, just TRT

Many thanks

Dude being patient wont work with this one, it is something going on here, his e2 is too high or some shit, “waiting it out” will NOT work, he already tried several ones 6+ weeks, Ive tried that shit, doesnt work. Theres something going on, he prob need way lower T levels (or E levels).

Overweight, doesnt matter, its the hormones, nothing else. You can be fat as fuck and horny as hell as long as ur hormones are “good” for you.

He needs to find a protocol that works for him.

Thanks @equel . I am also inclined to think this must be a hormonal issue. Yes I am overweight, but could that really be causing this issue. Seems like its more hormonal.

Blood pressure and cholesterol are mildly elevated, but nothing to suggest a cause for ED.

One thing I havent tried as you say is dropping dose right down, so that rather than being high on the T side and therfore high on E2 side also, dropping to mid range T and E2 then should fall down also. Failing that shed this bodyfat and I should find my E2 drops without needing an AI?

Thanks

Weight has lots to do with performance. If you dont have good bloodflow and your Nitric oxide levels are low, you will have issues. So eat properly, I say strength train for 3 times a week, and shed some weight. Forget the Bodybuilder lifestyle. Its not a healthy one. Lean out, and start with 100mg of T/wk. since you have done dailies before get on that again and stick to it. Supplement with Citrulline or eat the watermelon rind any time you can eat watermelon. Gotta increase Nitric Oxide too. Folks seems to forget that you need it for great boners.