I’m a 30-year-old guy, standing tall at 6 feet and weighing in at 210 pounds. I keep active in the neighborhood, maintaining good overall shape. Despite this, I’ve been grappling with frustrating issues related to erectile dysfunction (ED) and my overall sex drive. Three years ago, I embarked on testosterone replacement therapy (TRT) due to symptoms arising from a seriously low testosterone level of 7.8 nmol/L caused by a prolactinoma, which was driving up my prolactin levels.
My concerns about ED have been falling on deaf ears with my endocrinologist, and no significant action has been taken. Currently, I’m on a TRT dosage of 160mg per week, split into two injections of 80mg each, administered every 3.5 days with intramuscular injections in the belly. According to my endocrinologist, the likely culprit is elevated estrogen levels, currently sitting at 174 pmol/L, while my testosterone is at 23.3 nmol/L. Despite shedding some pounds, my estrogen levels persistently remain high.
Frustrated with the ongoing libido issues, I took matters into my own hands and obtained Arimidex from the black market. I started with a dose of 0.25, taken 24 hours after each injection (every 3.5 days). After two weeks with no improvement, I increased the Arimidex to 0.5, following the same schedule. Unfortunately, my libido not only failed to improve but actually worsened.
When I ran blood tests, here were the results:
- Prolactin: 111.7 ug/L (reference range: 3.8-20.6 ug/L) – SUPER HIGH
- Estradiol: 40 pmol/L (<162 pmol/L)
- US Reference - 10.89 pg/mL
- Testosterone: 19.6 nmol/L (reference range: 8.4-28.8 nmol/L)
- US Reference – 565 ng/dL
I suspect I crashed my estrogen, my testosterone was lower than expected, and, of course, my prolactin is high due to the prolactinoma. I reached out to my endocrinologist but won’t be able to get an appointment until July 2024, thanks to the joys of the Canadian healthcare system. So, I’m looking for answers on what to do next.
From my research on prolactin, it indirectly impacts libido by reducing testosterone. However, since I’m taking testosterone it doesn’t matter (shrug), I’m not sure what to tackle first. Here are my thoughts:
- Pin more frequently and increase the Testosterone dosage, as my levels are still low. Pin every 2 days with 60mg and start pinning subcutaneously instead of intramuscular. I’ve read that it helps with absorption and regulates estrogen levels, preventing spikes. Remove the AI and maintain this frequency for 2-3 weeks. Take blood tests to assess libido and estrogen levels.
- If libido remains low due to elevated estrogen after stopping the AI, reintroduce the AI. If I’m pinning every 2 days with 60 mg, how much Arimidex should I use and how often should I start with? I need help with that.
- If both levels are ideal, should I start looking into prolactin? Maybe it plays a bigger role than I think. I’ve heard it can impact Free testosterone (SHBG) or even affect libido via dopamine. As I know it makes an impact as well.
I’m also considering additional blood tests. It’s challenging to get blood tests in Canada, so I might have to do it privately. I’m thinking about SHBG, but is there anything else that could explain libido issues?
I’m quite lost on what to do next and the best way to approach this. Any help and recommendations would be hugely appreciated.