Takes too Long to Orgasm

Pharma TRT
1

Been on TRT for about 10 years. Use ~16 units from a 1/2 cc insulin pen EOD (200mg/ml) and 1/2 of a 1 mg anastrazole 6 times/per wk (Doc put me on 3 per week a couple of years ago). Had an afib episode 1 1/2 years ago due to decongestants. No occurrence since since stopping them, but heart doc put me on beta-blockers not knowing I was asthmatic. Took me off of them and put on diltiazem (180mg) and Lotensin (10 mg 2xD), but shortness of breath still an issue. All stress and other tests normal, but not exercising. Long time to orgasm makes normal sex with wife impractical for me because of my breathing and for her because of length of time (up to 30 minutes at times). Also take cialis for daily use for about 4 years (5 mg). Lab results below. High T3 due to I forgot and took my armour thyroid the morning of test.
Order: ESTRADIOL (82670)
Notes:

Name 	Date 	Value 	Units 	Range

Estradiol 11/6/2018 <20 pg/mL 0-47
Notes:
Reference Range(s): Males <20 - 47 pg/ml Non-Preganant Females: Mid follicular phase 27 - 122 pg/mL Mid Luteal phase 49 - 291 pg/mL Peri-ovulatory phase 95 - 433 pg/mL Postmenopausal Females: <20 - 40 pg/ml
Reference Range(s): Males <20 - 47 pg/ml Non-Preganant Females: Mid follicular phase 27 - 122 pg/mL Mid Luteal phase 49 - 291 pg/mL Peri-ovulatory phase 95 - 433 pg/mL Postmenopausal Females: <20 - 40 pg/ml

Order: TESTOSTERONE, FREE/TOTAL WITH SHBG
Name Date Value Units Range
TESTOSTERONE 11/6/2018 1115.00 NG/DL 300-720
SEX HORM BIND GLOBULIN 11/6/2018 64.20 NMOL/L 19.3-76.4
CALC FREE TESTOSTERONE 11/6/2018 176.20 PG/ML 47.0-244.0

Order: CBC/PLT AUTO DIFF, Reflex Anemia Panel (85025)
Notes:

Name 	Date 	Value 	Units 	Range

WBC 11/6/2018 6.20 3/uL 3.8-10.8
RBC 11/6/2018 4.85 6/uL 4.20-6.10
HGB 11/6/2018 15.80 g/dL 13.2-18.0
HCT 11/6/2018 45.20 % 38.5-52.0
MCV 11/6/2018 93.20 fL 80.0-94.0
MCH 11/6/2018 32.60 pg 28.5-32.5
MCHC 11/6/2018 35.00 g/dL 32.0-36.0
RDW-CV 11/6/2018 12.30 % 11.0-15.5
PLT 11/6/2018 183.00 3u/L 130.0-400.0
MPV 11/6/2018 9.20 fL 7.4-12.0
NEUT% 11/6/2018 58.50 %
LYMPH% 11/6/2018 26.90 %
MONO% 11/6/2018 10.60 %
EO% 11/6/2018 3.10 %
BAS0% 11/6/2018 0.60 %
NEUT# 11/6/2018 3.60 3/uL 1.50-7.80
IG% 11/6/2018 0.30 % 0.0-1.0
NRBC% 11/6/2018 0.00 % 0.0-0.0
IG# 11/6/2018 0.02 3/uL 0.00-1.00
NRBC# 11/6/2018 0.00 3/uL 0.00-0.01
LYMPH# 11/6/2018 1.66 3/uL 0.85-3.90
MONO# 11/6/2018 0.65 3/uL 0.20-1.00
EO# 11/6/2018 0.19 3/uL 0.00-0.50
BASO# 11/6/2018 0.00 3/uL 0.0-0.2

Order: METABOLIC PANEL, COMPREHENSIVE (80053)
Notes:

Name 	Date 	Value 	Units 	Range

Sodium 11/6/2018 137.00 mmol/L 135-144
Potassium 11/6/2018 3.90 mmol/L 3.5-5.0
Chloride 11/6/2018 102.00 mmol/L 98-111
CO2 11/6/2018 26.00 mmol/L 22-32
Anion Gap 11/6/2018 9.00 mmol/L 3.0-11.0
Glucose 11/6/2018 98.00 mg/dL 65-99
Calcium 11/6/2018 9.20 mg/dL 8.6-10.3
BUN 11/6/2018 8.00 mg/dL 8-26
Creatinine 11/6/2018 1.09 mg/dL 0.60-1.30
eGFR 11/6/2018 73.00 >60
Total Protein 11/6/2018 6.30 g/dL 6.1-8.6
Albumin 11/6/2018 3.70 g/dL 3.5-5.0
Globulin 11/6/2018 2.60 g/dL 1.7-4.2
A/G Ratio 11/6/2018 1.40 calc 1.0-2.5
Total Bilirubin w/reflex 11/6/2018 0.80 mg/dL 0.2-2.0
AST 11/6/2018 30.00 IU/L 12-41
ALT 11/6/2018 34.00 IU/L 8-63
Alk Phos 11/6/2018 67.00 IU/L 32-126
Magnesium 11/6/2018 2.00 mg/dL 1.8-2.5
Phosphorus 11/6/2018 3.90 mg/dL 2.5-4.6

Order: TSH and if Abnormal/Reflex FT4(with FT3 in-house) (84443)

Name 	Date 	Value 	Units 	Range

TSH3 11/6/2018 <0.010 uIU/mL 0.340-4.500

Order: FT4
Notes:

Name 	Date 	Value 	Units 	Range

FT4 11/6/2018 1.00 ng/dL 0.54-1.24

Order: FT3
Notes:

Name 	Date 	Value 	Units 	Range

FT3 11/6/2018 5.10 pg/mL 2.75-4.29

2

Is that anastrozole dose correct? Three milligrams a week seems like an awful high dose, your E2 may be bottomed out.

2 Likes
3

That’s what I thought. I do go without it for a couple days every so often. I noticed estradiol was really low, but having had it very high in the past, I want to be careful with it. I used to just take a 1/4 dose of 1 mg every other day. Is there a chance the anastrazole dosage could be my problem?

4

I almost fell out of my chair after reading your anastrozole dosage, say it isn’t so. You can expect orgasims to take longer when E2 is lower, an E2 under 20 is likely too low for a high SHBG guy do to the majority of estrogen being bound to SHBG, estrogen is lower and not much is bioavailable.

You need a dexa scan to check bone mineral density, low bone density its common in men who take high AI doses long term. I’m assume you are injecting EOD in order to control estrogen.

Free T3 suggests hyperthyroidism, this may be causing some problems with erections, shortness of breath and rapid heart rates.

5

Yes, low estradiol can increase the strength of erections, but decrease sensitivity.

I hope you have been lifting heavy.

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6

High E2 is way better than low E2. High E2 although sometimes problematic is still protective.

2 Likes
7

Yes, and as systemlord mentioned, bone density, but also joint health, and lipids are all negatively impacted with low E2. You should probably check lipids while you are at it.

I would try to get anastrozole as low as possible.

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8

I wish I had checked here sooner. Thanks to you and highpull both for the feedback. I’m going to drop my anastrazole to 1/4 mg EOD again and go back to my thyroid doctor. Should I lay off it completely for a week or so? I forgot to mention I’m also doing 30 units (in a 1/2 cc insulin pen) of HCG EOD as well. 3 grains of armour is my dosage for the last couple of years. I’m supposed to be testing next Friday. This time I’ll be fasting and won’t take my medicine first.

9

Anastrozole can have an E2 rebound when stopping it, it would be best to just reduce the dosage for now because it doesn’t sound like E2 is crashed. You can skip your next dosage and start at the lower dosage.

10

I wouldn’t mess with thyroid. You know why it came back a little high and you know the cause of your breathing issues.

Regarding anastrozole, it would make sense to gradually step it down. After a couple of years, a sudden increase in E2 may be a little much to tolerate.

Good luck.

11

Thanks so much, guys! Once again, this forum has saved my bacon!

12

Not orgasming is a function of estrogen. Too high usually. But too low can hamper too.

Estrogen affects serotonin, which is what puts the brakes on orgasm.

SSRIs also affect it.

13

When my E2 is high, my erections get worst

14

Along with your TT and FT being raised or are we talking about just raised E2. There seems to be ratio where the best overall function lives and it appears to be between 15 and 25.

15

What dose of Testosterone are you taking per week?
You’re overdosing the Anastrozole. And you are also currently hyperthyroid. This is evidenced by your high SHBG level relative to high Testosterone (TRT should bring SHBG to mid-range)
-Decrease the Anastrozole to 1/2mg three times per week
-Decrease thyroid by at least 25%
-Cialis also has a slight effect on reducing Estradiol, so labs will dictate what is going on.

Retest. The less anastrozole you use the better you will feel. Have you tried TRT at 100mg per week in 2 divided doses? You may not need the AI.

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