TRT Hasn't Worked for 2 Years. Help?

Yes its hormones, 100%. Dont listen to ppl talking bout weight, blood pressure, santa claus, whatever. Its HORMONES, I can assure you.

I had the same shit before when i asked about this, “uuh hows ur diet” blabla, it has nothing to do with it, some times the hormones align perfect and libido comes back raging, then next day GONE again.

All u need to do is to find that sweet spot, which is fucking difficult, but achieveable.

Try small small dosages, VERY small, try fucking 5mg a day, then up it, slowly.

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I would love to see a pic of this.

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To be honest I think I undershot that. I was 16%BF 6 months ago when leaner, and have put on weight so guesstimated around 18%. To be honest its likely more like 20% at the mo

Still would like to see. Thats YUGE.

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Can you post your thyroid labs and report your waking underarm temp? Everything you have posted points towards subclinical hypothyroidism, which can directly cause ED/libido issues you are experiencing.

Thyroid is also responsible for oestrogen clearance rates (low thyroid slowing this process), regulation of enzymatic activity (5-alpha reductase, aromatase, etc), water balance, etc.

TRT/testosterone can mask underlying subclinical hypothyroidism because testosterone can increase the conversion of T4 to T3 through iodine re-uptake.

Thanks for your post. I dont have any recent thyroid tests, but my bloods back in March showed the following:

TSH - 1.26 mIU/L (1.26-4.20)
Free T4 - 17.2 pmol (12-22)
Free T3 - 5.28 pmol (3.1-6.8)

Forgive me I dont know much about thyroid, could there be soemthing untoward here?

Many thanks

Thanks middleages, good advice there.

When supplementing Citrulline, would you recommend daily and higher doses? Will cardio help too, as I only do very minimal cardio atm low intensity 20 minutes maybe twice a week if lucky

Thanks equel - yes I am thinking as soon as my E2 goes high I have issues. So in the long run I need to lower bodyfat to lower aromatization, but in the short term reduce test/get my AI dialled in

How would you even test the strength of his arteries to confirm that this could even be a possibility to consider ?

Sens I have been on TRT I have always heard people say 6-8 weeks. I even heard some people say longer and some say less time then that. One thing i am confused about is that the medication is intramuscular so is should not take longer then 30min to be absorbed. Even with a medication like vancomycin we test the peaks and troughs pretty often in the hospital. I honestly think for a medication like testosterone I would give the body about two weeks if the dosing is not working by then it most likely will not work. Even if we’re looking at this from a differnt angle let’s just say other hormones that testosterone may have an effect on. That maybe we want to give those other hormones time to adjust to get to homeostasis the body is so advanced it will do this relatively quickly. Unless someone can really explain to me why we wait almost two months to see if one particular dose works ?

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The oil is absorbed but the ester controls the release. They make different ester formulations that will enter bloodstream slower or faster than others.

Common test ester is 7 day HL so 5 HL to peak & stable concentration, 35 or so days, or 5-6 weeks.

You want a fast release? TNE or prop are available. Slower (so less injections) enanthate and Cyp. I don’t recommend the super long esters tho.

Makes sense?

Hormones aren’t like drugs, affects aren’t immediate, hormones take time to affect tissue.

Healing takes time.

Yes this makes sense. The ester for cypionate is about 14days and the half life is about 8 days. Like you said cypionate will enter the blood stream a lot slower. So the medication will be completely out of your system in 14 days. So for the people that inject daily they are injecting before the first dose has even reached half life. I inject daily my self. Why does someone like my self benefit more from smaller doses ?

Don’t know there the 14 day comes from, but pretty accepted HL of 7 days roughly. That means 1/2 is gone by day 7, not the full amount, hence the 5 HL rule.

Depends on your SHBG and tolerance for fluctuations. Most guys inject daily or EOD to keep the peaks and troughs more manageable

I’ve discussed my views on this before I’ve pasted part of the thread below.

In short - a stiffness index can be defined as the ratio of diastolic and systolic blood pressure divided by the change in artery diameter examined by ultrasound.

Stiffness index = pressure ratio/change in diameter

Study: Estradiol Inhibits Penile Erection, Particularly at the Penile Base

This is a long one stick with me…

I see two mechanisms for the e2 and ED relationship.

  1. High e2 affecting the brain and not signalling adequate NO production.
  2. High e2 affecting the dick veins that carry the blood to an erection and the veins that allows the blood to exit the erection.

To address point 2 only- it’s been proven in the papers listed above that higher e2 is correlated with reduced arterial wall stiffness. This means that for a given pressure, a less stiff arterial wall will distend more than a stiffer one.

To define stiffness in terms of materials science where in this case the material is human tissue which exhibits viscoelastic characteristics(stretches under tension over time)- stiffness is defined as the ability of a material to resist deformation when subjected to a given force.

To describe an erection in some physical sense. There is an inlet, volume chamber and an outlet.

Blood flows in through the inlet, the larger the diameter of the inlet the easier the blood will flow. This is good for erection obviously and is the essence of PDE5 inhibitors.

The pressure in the chamber I.e the penis, will increase and expand until final volume is reached only if the rate of flow at the inlet is greater than the rate of flow at the outlet.

I would like to focus on the rate of flow at the outlet.

If oestrogen can change the material strength of the exit vein tissue, might it become too weak too control the flow out of the penis? If so, this could easily lead to an increased outlet flow rate and an inversely proportional decrease in erection pressure inside the chamber.

I am attempting to present food for thought and merely a hypothesis as to why some people do well with higher e2 numbers and some don’t. Giving the above, it’s quite clear that our veins and arteries will all have different material properties namely stiffness. A primary cause of ED in older guys is a plaque build up in arteries which makes them stiffer. It might simply be a case of TRT and an increase e2 helps guys achieve erection if they have stiffer arteries to begin with. This also ties in with properly managed TRT that yields adequate e2 levels is a good thing for the cardiovascular system as a whole as stiff arteries is not good. Pulse pressure can be an indicator of arterial stiffness.

Younger guys for example or anyone who’s arteries are below a certain stiffness might have issues. The increase in e2 might make their outlet vein too ductile and unable restrict flow to adequately maintain and erection.

Like I said just a hypothesis, you can find papers on everything I’ve discussed individually but I’ve not seen anything investigating the bio mechanical relationship with e2 and dorsal vein stiffness directly.

If you think the hypothesis is utter nonsense please do let me know….

PubMed

Pulse pressure, an index of arterial stiffness, is associated with androgen…

PP is an easy method to estimate and quantify patient arterial stiffness. We demonstrated here for the first time that elevated PP is associated with arteriogenic ED and male hypogonadism. The calculation of PP should became more and more familiar in…

PubMed

Viscoelastic dynamic arterial response - PubMed

The investigation presented in this study reveals the effect of each material parameter on the viscoelastic arterial response. Thus, a better understanding of the behavior of viscoelastic arteries is achieved.

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Your hypothesis make logical sense.

But I have a question or I should say questions

  1. So do you think that E2 on targets the arteries and veins just in the penis ? Like you said in older me the have plaque build up but that plaque build up is dispersed through out the vascular system mainly in the arteries. How would E2 only be able to target vascularity in the penis and no where else’s?

  2. Let’s say one gets a ultrasound done and know there stiffness index. Base off of that information how would they know if they need a higher or lower E2 in there blood to reduce or increase vascular stiffness. Then how would they figure what range they need to be in to maintain adequate errection?

I don’t know the answer to this but like you say we know from research that plaque deposits itself throughout the cardiovascular system. We know from research that Oestrogen softens the main arteries in our bodies. I’d be happy making the assumption that generally speaking the full cardiovascular system is affected by oestrogen (including the penis) not just locally in the main arteries. I know that the veins in my arms and temples distend more when my e2 is higher and those are surface veins not deep ones.

Again I’m not sure if this has ever been done. I’m really just presenting that there is a the cause and effect of e2 on arterial tissue. It would be handy if research was done on optimal tissue stiffness for erection quality but I don’t see it. The optimal tissue stiffness for erections could be sub optimal for other processes though.

Assuming there is sole level of accuracy to this deduction my main point is, if you are a healthy male you should keep your e2 in range for best chance of good erections. If you have stiffer arteries (high blood pressure is an indicator along with pulse pressure but in no way conclusive) a higher e2 level may bring your arterial tissue stiffness back into a desirable range improving erections. Running high e2 has other drawbacks so this might not be advisable in many cases.

Everybody keeps telling me different ranges of E2. What range do you go buy?

For natural men, 20-35 pg/mL, this is Labcorp’s E2 sensitive test and this range is for adult males.

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Does that rang go for men that are on TRT?