Erection, libido, etc

[johnhenry]

I have been on TRT for 2 yrs approx.Total T was around 400ng/dl - erections were not reliable, bit of brain fog etc. I was (and still am pretty motivated, as I was married again 3 years ago to a lovely woman who enjoys the playtime. Anyway, talked the doc into prescribing TRT after reading a lot here before taking the step, as it's one you can't go back on.

Protocol has been 80mg of T/wk (2 x 40) - sub q in two spots, one in each glute/ bum cheek ie. 0.45 ml Primoteston depot/wk (T enanthate = 70% t). 1000iu hcg /wk (300 eod), and 0.25 mg Adex/wk (2 x 0.125).
The reason hcg has been 1000iu/wk is that earlier on, I experienced testicular pain. Now that are smaller that they used to be before trt.

From the last blood test, Total T is 33 nmol/l = 950ng/dl. Free is 779pmol/l and E2 is 40pg/ml. They look pretty good numbers, but erections are hit and miss. Very disconcerting. I am thinking to drop T to 70 mg/wk, drop hcg to 750iu/wk and maybe hold the Adex where it is - or maybe try Aromasin which I see some like better. I do find the E2 hard to manage - seems fickle. Cialis helps a bit but not reliably. I also take caber @ 0.25 mg every two weeks which keeps prolactin at the low end of the range.

I notice that 100mg/wk T is spoken of a lot, but that would end up as past the top end of the range. I think I would like to be mid range ie. 750 ng/dl and the free 2% of that number - as I understand that more is not necessarily better.

Anyway, any thoughts or advice is welcome. JH.

[Low Testosterone]

Several points to address:

1. You mentioned you want to be at a certain level, I hear that regularly, men saying they want to be at the top of the range, mid range or whatever else. The problem with this is the desire to be at a certain point in the range is based off of nothing. People just decide in their head for this or that reason that a certain point in the range must be best. The best place for you to be is wherever the best place is for you to be. Don't worry about the numbers; in fact, I'd go as far as to say that the numbers mean absolutely nothing. Worry about how you feel and your overall health. Those are the only two things that matter.

2. It seems unlikely that your erection issues are related to where your testosterone and E2 levels currently are. I've said this many times on here so hate to beat a dead horse, but not all issues that can be testosterone related are always testosterone related. This means that while testosterone levels affect erections they are not the only thing that affects erections. The most common reason a man will still have ED when on TRT is because there's an existing blood flow issue. Even if all your hormone levels are perfect, if a blood flow issue exist you will still have ED. You may be someone that needs low dose daily Cialis. Or you may be someone that needs to try another type of ED med. Personally I think Cialis is the best of the big three that are available but sometimes some men respond to Levitra or Viagra better.

3. This will go against popular belief or even reason, but it's worth at least considering. I've spoken with several men over the past years that develop ED issues that go away once they stop using HCG . These men are not in the majority, but they do seem to exist. There are men who seem to have a difficult time controlling E2 when using HCG, which would be one reason for the issue. But there are others that while E2 is controlled they still have ED issues that goes away without HCG. Unfortunately, I do not have a good explanation for this but it does seem to be a factor in some cases.

4. Do any of the following apply to you? If so they could be contributing to your ED issue:
High blood pressure
Atherosclerosis
Diabetes
Heavy alcohol consumption
Tobacco use
Various prescription meds

[johnhenry]

Several points to address:

1. You mentioned you want to be at a certain level, I hear that regularly, men saying they want to be at the top of the range, mid range or whatever else. The problem with this is the desire to be at a certain point in the range is based off of nothing. People just decide in their head for this or that reason that a certain point in the range must be best. The best place for you to be is wherever the best place is for you to be. Don't worry about the numbers; in fact, I'd go as far as to say that the numbers mean absolutely nothing. Worry about how you feel and your overall health. Those are the only two things that matter.

2. It seems unlikely that your erection issues are related to where your testosterone and E2 levels currently are. I've said this many times on here so hate to beat a dead horse, but not all issues that can be testosterone related are always testosterone related. This means that while testosterone levels affect erections they are not the only thing that affects erections. The most common reason a man will still have ED when on TRT is because there's an existing blood flow issue. Even if all your hormone levels are perfect, if a blood flow issue exist you will still have ED. You may be someone that needs low dose daily Cialis. Or you may be someone that needs to try another type of ED med. Personally I think Cialis is the best of the big three that are available but sometimes some men respond to Levitra or Viagra better.

3. This will go against popular belief or even reason, but it's worth at least considering. I've spoken with several men over the past years that develop ED issues that go away once they stop using HCG . These men are not in the majority, but they do seem to exist. There are men who seem to have a difficult time controlling E2 when using HCG, which would be one reason for the issue. But there are others that while E2 is controlled they still have ED issues that goes away without HCG. Unfortunately, I do not have a good explanation for this but it does seem to be a factor in some cases.

4. Do any of the following apply to you? If so they could be contributing to your ED issue:
High blood pressure
Atherosclerosis
Diabetes
Heavy alcohol consumption
Tobacco use
Various prescription meds

LT, thank you for such a comprehensive reply. The answer to point 4 is none of the above - not overweight, blood pressure good, no atherosclerosis, not diabetic, don't smoke, consume less than a beer a month, consume a diet of low sugar, fruit and veg dominant.

I understand the numbers are just a guide. The tricky bit is while doing everything the same there are patches of 'gee, that's pretty good' and others 'so-so', and others definitely sub par, like erection not holding up for the duration. Yet early morning erections can be very firm. Bemusing.

Thank you for your comments. JH.