T is necessary but not sufficient for a good sex life.
Good thyroid function is needed.
Good general health is needed.
With your levels of T, 0.5mg/week anastrozole may be sufficient and you do not want E2 too low!.
Lower prolactin and lower E2 may allow HPTA to get going again. You and your doc could the HPTA restart sticky if needed.
Please post all available lab data in list format with ranges. When needing to look for something it is difficult to scan prose to find these things.
Anastrozole is a competitive drug to T and needs to match T levels. You will need to take anastrozole twice a week. Getting pills split to 1/4mg is more than a challenge. You can dissolve 1mg/ml in vodka and dispense by volume or by the drop.
SERMs [clomid, nolvadex] can increase LH/FSH by blocking estrogens from been seen by the hypothalamus+pituitary. Dose can be 10=12.5mg per day, half pills. There can be problems with doses that doctors often prescribe. Some guys feel crappy with clomid while others do great. Nolvadex does not have that problem. Doctors often seem stuck on clomid. More in the HPTA restart sticky. This inexpensive oral can displace the need for hCG injections and travels well.
E2=80pmol/L is a good target.
Dostinex/cabergoline is probably better based in two doses per week. Typically, 0.5mg/week is effective and free of side effects. This can be for life.
Doses per week are based on drug half-life considerations.
Many in UK are iodine deficient as iodized salt is mostly not in the shops. Your iodine there is meant to be from eggs, dairy and fish. You can evaluate your overall thyroid function via oral body temperatures and this can often be better guidance than thyroid hormone lab work. Note that thyroid lab work lab ranges are mostly useless and most of the time we have guys here with thyroid problems that are lab range “normal”.
Prolactin secreting pituitary adinomas do have a non-hormone risk. The adinoma can get large enough to press on the optic nerves and then a common issue would be noticing that with of peripheral vision can be reduced - should be near 180 degrees. A MRI is often done to visualize the adinoma.
If your HPTA does not recover and T levels are low: T-gels are ~10% absorbed at best, often lower or ~zero. Thyroid problems can change skin’s ability to absorb T.
You can do TRT as T+AI+hCG or T+AI+SERM. hCG is a natural human hormone, SERMs are not. AI=aromatase inhibitor, almost always anastrozole.
At your age you must protect fertility with hCG or SERM.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- 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.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.