T Nation

Zero Sex Drive, No Erection Without Stimulus, High E2, Low T


#1

High, I have been suffering from low libido and no erection since end of 2015. A bit of information. I had bilateral Varicoscele in the past (When I was 15 and now I am 30) and made the surgery and had a veery slow recovery. In the last spermogram I made, I am considered fertile, but still on the very low range. Anyway I never payed attention to my Test results over the year as I had good libido (still I don’t remember having much morning woods). After my problem started I made a blood analysis and had 530 of Test (no estradiol and cant remember LH and FSH). I thought that was very low and than I looked my past Test tests and all they were very low (like 350 range). During that time when the problem started I was in good shape and going to gym. I started doing everything I could find from Peak forum. I tried to increase my NO taing garlic with vitamin C, L-Arginine, L-Citruline, and so on during 2016. At the time I had a strong wood druing night after taking a bag of argula and lot of beet juice, but after that night, nothing. I started using very low doses of cialis to give some help in the bed. There weeks some weeks I had some improvement and had morning woods and so on, but others were terrible. To complement the Year of 2016 was a Hell on Earth to me as I as finishing my PhD so I took A LOT of Energy drinks, bad sleep, heart palpitation and so on… in the end of the year I made a blood test and Total Test was around 450 and Free Test around 12,5 (still, no E2). When 2017 started, with the PhD over, I started having a better live, still my sleep was a garbage since the end of 2016. In the end of 2016 my heart was accelerated when I was going to bed (due to the cumulative stress). The accelerated heart gone away, but the crap sleep stayed for much longer. In the beginning of 2017 I tryed to stop with cialis and started using yohimbine + Mucuna Puriens and Kegels. That helped me to have good erections when having sex without stimulation, but still was much worst than before of 2015. Now at May, I had a very stressful month and stopped kegels ad the problem came back as before. Now, past week I got back to the gym and started doing kegels again. I did a Bloot test yesterday and the results were the following (there is much more, but just showing the relevant part):

Total T: 354 ng/dL (241 to 827)
Free T: 8.96 ng/dL (3.4 to 24.6)
SHBG: 21.1 nmol/L (10.0 to 57.0)
Bio T: 210.03 ng/dL (82 to 626)
Prolactine: 9.07ng/mL (2.10 to 17.70)
Estradiol: 42.6 pg/mL ( <39.8)
FSH: 1.8 uUI/mL (1.4 to 18.1)
LH: 3.4 mUI/mL (1.5 to 9.3)
TSH 2.066 uUI/ml (0.4 to 4.3)
Free T4 1.35 ng/dL (0.7 to 1.8)
25 OH Vitamin D: 39,4 ng/mL (30 to 100)
Iron 145 ug/dL (59 to 159)
Ferritin 233 ng/mL (22 to 322)
Creatinine: 0.99 mg/dl (0.5 to 1.3)
Total Cholesterol: 208 mg/dl (<190)
HDL - Cholesterol 52 mg/dL (>40)
Non HDL - Cholesterol 156 mg/dL (<160)
LDL - Cholesterol : 139 mg/dL (<130)
VLDL - Cholesterol : 17 mg/dL (none)
Triglycerides 83 mg/dL (<150)
Insulin: 4.9 mU/L (3.0 to 25.0)
Potassium: 4.2 mEq/L (3.5 to 5.5)
Sodium: 140 mEq/L (138 to 145)
Magnesium: 1.9 mg/dL (1.6 to 2.6)
Glucose: 93 mg/dL (70 to 99)
Thyroid peroxidase antibody <28 UI/mL (<60 UI/mL)
PSA 1.4 ng/mL ( < 4.00)
PTH 3.41 pg/mL (14.0 to 72.0)
Bilirubin Total 0.77 mg/dL (0.3 to 1.2)
Bilirubin Direct 0.22 mg/dL (<0.2)
Bilirubin Indirect 0.55 mg/dL (0.1 to 1)
Gamma-Glutamyl Transferase 22 U/L (15 to 63)
Transaminase Oxalacetic 36 U/L (15 to 40)
Pyruvic Transaminase 26 U/L (10 to 40)
Folic Acid 21.2 ng/mL (>5.38)
Vitamin B-12 541 pg/ML (211 to 911)
Antithyroglobulin Antibody <30 UI/mL (<60 UI/mL)
HbA1c 5.6% (<5.7%)
Estimated Mean Glucose 114 mg/dL (none)

My T is even lower than before, and the E2 (that was never measured) is pretty high. LH and FSH seems to be low to me.

All the Doctors I went past year and told about my problem told me that it was due to stress… but my libido was not back and neither the erection this year after my stress went away and the problem started before the high stress.

In my opinion I may have a standard low T due to Varicoscele (even after fixed) and the E2 started to raise and my libido went away and now is crashing my system as the LH and FSH are reducing and my Test is going even lower.

Any help and directions. I have Endo and Uro in the following month, but I am not sure they will do anything as in the past. Now the high E2 might help the Endo take some action, but not sure.

Regarding my lifelong low T due to varicoscele, do you believe is possible to increase that with clomid/hCG restart protocol? I am 30 but a read in a lot of Forums that lot of people had good results after the surgery. But as mine was 15 years ago I am not sure it can help.

Thank you!
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#2

Please edit your post to add lab ranges to the results.

E2 is way too high. E2 is from FT–>E2 and with low FT, the problem is not the rate of creation, clearance is poor and that happens in the liver. A liver problem, or drug interference may be a factor.

Please list all supplements, meds Rx and OTC. Do you apply any skin products?
You could use 0.25mg anastrozole twice a week to reduce E2 and that would improve LH/FSH, FT and TT to some extent.

Post more labs? CBC, hematocrit, AST/ALT?

You have low-T, secondary hypogonadism, and thyroid issues. Your stress may be contributing to thyroid issues.

Please evaluate your thyroid function via last paragraph in this post.

TSH should be closer to 1.0
Thyroid lab ranges are quite useless.
fT3 and fT4 need to be tested, fT3 is the active hormone.

Not using iodized salt causes thyroid problems.
Low energy - yes
feel cold easily?
outer eyebrows sparse?

You are a little bit Vit-D deficient, find 5000iu Vit-D3, tiny oil based capsules.

Where are you located?
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.


#3

Thank you. Just added lot more data from my test and the ranges.

In the past year when I was in good shape my cholestorel tests were better than today, but the problem was present.

I never had nothing in the Liver, how can I check that?

Supplements changed a lot over time. Before the problem started I was just using Whey, Casein and Creatine (not every day and less than 5mg) and Centrum. After the problem started I tried lot of stuff over time. L-Arginine, L-Citruline, L-Carnitine, ZMA, Magnesium alone, Vitamin C, Garlic, Yohimbine, Mucuna Puriens, Ashwagandha, Ginseng. Now I am just using Centrum, ZMA, Garlic, Vatamin C, L-Carnitine and i Started using Condrohitine + Glucosamine as my knee started having a very small discomfort. I also tried Tribulus for one week but stoped after feeling nothing. Also I was taking every week an extra of 5000 UI of Vitamin D (Centrum has 1000 UI)

Regarding the thyroid. My endo never told me that but I cant remember the test I made past year. fT4 is there. I could not find fT3. I live in Brazil, and we are supposed to have iodine in the salt.

Low energy - less than 3 years ago but not the bottom that I ever felt
feel cold easily - No, in fact I feel hot sometimes.
outer eyebrows sparse: They seems to be fine.

After the test I started taking 5000 UI of Vitamin D but is not oil one. Thtas the one (https://www.amazon.com/gp/product/B01L83X3X8/ref=oh_aui_detailpage_o03_s00?ie=UTF8&th=1)

My PSA is a bit high for my age as it is usually lower than 1.0, but last december it was 1.40 and neither the endo and the uro told me that this was fine. Usually the problem is not the value but the rate it is growing. It seems to be fine after 6 months.

Finally I am 1.73m and have 77kg… last time I measured my % of BF was 20%.


#4

I am strongly considering an HPCA restart if it is not a thyroid or liver problem. Few questions. Should I start eith hCG or go to the clomid/Novaldex. Should I use some AI during the hCG cycle? Some people say that clomid is better as Novaldex is harder on the liver but clomid has more bad effects. If I would go o clomid I would go for 12.5 mg EOD… what would be the Novaldex equivalent dose? I am considering adding a transition week between hCG and SERMS cycle. The idea is to avoid the testicles to stop working as the SERMS take time to build up. I would stack borh hCG (250UI) and SERMs for one day… afrer 2 days I would half the hCG … after 2 days half again and stop and keep just with the SERMs (and the AI). Is there any danger of the restart cycle?


#5

AST/ALT are basic liver tests.

Iodine availability varies over time and country.

“Brazilian legislation, since 1955, failed to achieve its objectives because the issue was not pro-perly addressed: iodized salt was only available in endemic areas, at a low amount of 10 mg Iodine/kg salt. Lack of surveillance and cooperation were common errors. From 1982 to 1992,
the INAN distributed potassium iodate to the industry free of charge, but it was abolished in 1991. Only four years later (1995) was a new law enacted effective in determining that all salt for human use should be iodized at levels established by the Health Authorities.”

You may have been iodine deficient when younger. Perhaps sea salt is available and not iodized.

There has been a lot of thyroid autoimmune disease in Brazil. This can be a combination of iodine deficiency [in the past] plus selenium deficiency. Selenium deficiency cause problems with enzymes that need selenium in their structure. This enzyme is required to prevent problems that lead to these autoimmune problems.

Is there selenium in your Centrum? Iodine?

SERMs with the low doses suggested and durations do not present any urgent health concerns. Many of the side effects listed for these drugs are with women who have cancer and are post-menopausal and many reported issues may not be from the SERMs. Which to use? I do not have anything to add other than stated in the HPTA restart sticky. hCG does have the advantage of a human hormone, but is expensive and may not be available.

Switching hCG<—>SERM can be next day as there is a fade in-out there from drug half-life. No need for a gap or an over-lap.


#6

Well,

We do have Brazillian Nuts… that have a lot of selenium… I dont eat them always. Have to check the centrum…

Regarding hCG … my doubt is if it will make any permanent damage to my own LH production as TRT does to the testicles. Probably LH and FSH will reduce… any chance it will stay low forever?


#7

Most of the time we are dealing with guys who have low LH/FSH already and that is the problem, then TRT is giving up on the HPTA. When trying to restart the HPTA, there are options in the HPTA restart sticky. Non are perceived as harmful. Low dose hCG is just like the LH that guys used to have, how harmful was that. When you were in your mother’s womb, you were exposed to very high hCG levels.


#8

My question is as the endogenous LH will be suppressed, if it can come back again as before after stopping the hCG? I know the SERMS will help with that, but just wondering if it is there any danger of permanent supression (as TRT does on Test)


#9

When recovery is required, there is a risk that one might not get back to where they started. Too many individual variables and other variables to make a blanket statement.