ED after 3 Months on TRT?

Pharma / TRT Testosterone Replacement
1

T Nation, I started TRT 3 months ago injecting 0.5 mLs of testosterone cypionate IM 1x per week. (My prescribed dose is 0.5 mLs of 200 mg/ml Testosterone cypionate) My doctor approved the therapy because I had a five year history of sub 200 natural testosterone levels. Also had low libido and low energy. Almost immediately the injections made me feel better, lots of positive effects. I did have some spicy nipples and a little anxiety along the way. My sex drive was off the charts and erection quality excellent.

After the honeymoon period at about week eight I felt so good I decided on my own to slightly increase my next dose to (0.6 mLs) thinking I might even feel better. (I only deviated from my prescribed dose this one time). Two days later I started having poor erection quality (soft erections) and couldn’t get hard for sex. I still have high libido but my unit isn’t cooperating. Before TRT I had low libido but never erection issues. I returned to my regular dose of 0.5 mLs for the next three weeks and I’m still having issues. The crazy thing is that I’m waking up in the middle of the night with erections but still can’t get hard enough when I want to have sex. I can still ejaculate normally. I’m starting to have performance anxiety now. I don’t look at porn. Did I totally throw off my hormone balance from one deviation of my regular dose???

Here’s my week 9 blood test results (taken 4 days after injecting)
Total Test: 984 ng/dl
Free Test: 323 pg/ml
Testosterone free %: 3.3
SHBG: 15
Estradiol: 35 pg/ml
Hemoglobin: 15.6 g/dl
Hematocrit%: 47.2

My blood test didn’t include checking prolactin, thyroid, or cortisol. I know my SHBG is low but it’s always been pretty low even before TRT (prior to TRT it was 23).

Im 50 in excellent health. I lift weights 4 days a week and do cardio HIT training 3 days a week. I eat clean and avoid alcohol. I’ve never even considering taking an estrogen blocker. Im pretty desperate for an answer.

Should I try a smaller dose, injecting 2x per week? Any suggestions would be greatly appreciated. I have a consultation with my doctor in a few days to discuss the blood test results.

Thank you so much for the help!
Howee

2

Since the dose increase seemed to bring this on, it makes sense to try lowering it further.

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3

you SHBG is low. your dosing is on the low end anyways. you need to inject 3-4x a week as a start.

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4

Yes, thank you. I’ve been considering an increased dosing schedule. I’m wondering if my problem is E2 related and my hormone levels are just off balance. I appreciate your assistance, thank you.

5

your body will adjust the E2 where it needs to be. do not take an AI that can mess it up.
E2 blood levels are only a serum snapshot and are irrelevant.
you are on 100mg/week i would try 140-160 range (maybe try 3x week by 0.25ml, m/w/f)
good luck!

6

Thank you!

7

I would expect hemoglobin to be higher with these Test levels. It wouldn’t hurt to check ferritin and iron saturation.

I thought this for years, I was wrong. I have had my E2 anywhere between 28-90 and feel the same in between.

Men on exogenous T use up more iron stores than someone not on replacement therapy.

For some men who are sensitive to changes, a little is all it takes to throw things out of balance.

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8

I really appreciate your advice, thank you.

9

Any evidence to justify that frequency?

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10

Please stop this nonsense myth already. NO.

11

Zero evidence, I hate that myth, it makes no sense, got no science behind it and it just doesnt work. The test is attached to an ester for a freaking reason. And NO, “splitting it up” do not neccesarily decrease estrogen. For me personally, it increases it.

So many myths and BS nonsense in this community.

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12

This is just inaccurate. Your body isn’t used to added testosterone, and the byproduct estrogen.

Estrogen may need to be higher or lower depending on symptoms.