TRT Regimen Help - ED Issues

Pharma / TRT Testosterone Replacement
1

Hey guys, hopefully can shed some light on my situation. Ive been on TRT for almost 2 years and still struggling to get dialed in. TRT started out fine and now struggling with ED issues.

I was on anastrozole for the first year but started experiencing ED issues, delayed ejaculation or unable to finish, dry skin, hair loss, lethargy. So decided to stop everything for a few weeks which seemed to resolve ED issues but felt terrible and depressed. Was probably driving my E2 too low.

Decided to start over with no AI. Was feeling great for 2 months but still having ED issues.
On doctor recommendation I started taking .5 of anastrozole 2x weeks at injections. Its been 2 weeks and feeling terrible with the AI and still having ED and now no libido at all.

According to my labs my E2 is high but so is my total test.
Not sure if I need to keep taking the AI to let me body adjust or no AI and lower my dose of T?
Any insight would be appreciated. Attached most recent labs before taking the AI.

Protocol:
Test 250 Cyp - 160mg week (Split Sun & Wed)
HCG 250 3x week (Mon / Wed / Fri)
No AI

Labs:
LIPID PANEL, STANDARD
2093-3 Cholest SerPl-mCnc 140 <200 mg/dL EN
2085-9 HDLc SerPl-mCnc 43 >40 mg/dL EN
2571-8 Trigl SerPl-mCnc 125 <150 mg/dL EN
13457-7 LDLc SerPl Calc-mCnc 76 mg/dL (calc) EN

9830-1 Cholest/HDLc SerPl 3.3 <5.0 (calc) EN
43396-1 NonHDLc SerPl-mCnc 97 <130 mg/dL (calc) EN

FSH AND LH
15067-2 FSH SerPl-aCnc L <0.7 1.6-8.0 mIU/mL EN
10501-5 LH SerPl-aCnc L <0.2 1.5-9.3 mIU/mL EN
COM PREHENSIVE M ETABOLIC PANEL
2345-7 Glucose SerPl-mCnc 90 65-99 mg/dL EN

3094-0 BUN SerPl-mCnc 14 7-25 mg/dL EN
2160-0 Creat SerPl-mCnc 0.94 0.60-1.35 mg/dL EN

COM PREHENSIVE M ETABOLIC PANEL
77147-7 GFR/BSA.pred SerPlBld
M DRD-ArVRat
mL/min/1.73
m2
107 > OR = 60 EN
48643-1 GFR/BSA pred.black
SerPlBld M DRD-ArVRat
mL/min/1.73
m2
124 > OR = 60 EN
3097-3 BUN/Creat SerPl NOT APPLICABLE 6-22 (calc) EN
2951-2 Sodium SerPl-sCnc 138 135-146 mmol/L EN
2823-3 Potassium SerPl-sCnc 4.7 3.5-5.3 mmol/L EN
2075-0 Chloride SerPl-sCnc 102 98-110 mmol/L EN
2028-9 CO2 SerPl-sCnc 30 20-32 mmol/L EN
17861-6 Calcium SerPl-mCnc 9.3 8.6-10.3 mg/dL EN
2885-2 Prot SerPl-mCnc 7.5 6.1-8.1 g/dL EN
1751-7 Albumin SerPl-mCnc 4.8 3.6-5.1 g/dL EN
10834-0 Globulin Ser Calc-mCnc 2.7 1.9-3.7 g/dL (calc) EN
1759-0 Albumin/Glob SerPl 1.8 1.0-2.5 (calc) EN
1975-2 Bilirub SerPl-mCnc 0.6 0.2-1.2 mg/dL EN
6768-6 ALP SerPl-cCnc 51 40-115 U/L EN
1920-8 AST SerPl-cCnc H 43 10-40 U/L EN
1742-6 ALT SerPl-cCnc 29 9-46 U/L EN
IGF 1, LC/M S
2484-4 IGF-I SerPl-mCnc 227 53-331 ng/mL EZ
73561-3 IGF-I Z-score SerPl 1.0 -2.0 - +2.0 SD EZ

DIHYDROTESTOSTERONE
1848-1 Androstanolone SerPl-mCnc 45 16-79 ng/dL EZ

CBC (INCLUDES DIFF/PLT)
6690-2 WBC # Bld Auto 5.0 3.8-10.8 Thousand/uL EN
789-8 RBC # Bld Auto 4.97 4.20-5.80 Million/uL EN
718-7 Hgb Bld-mCnc 16.0 13.2-17.1 g/dL EN
4544-3 Hct VFr Bld Auto 46.7 38.5-50.0 % EN
787-2 MCV RBC Auto 94.0 80.0-100.0 fL EN
785-6 MCH RBC Qn Auto 32.2 27.0-33.0 pg EN
786-4 MCHC RBC Auto-mCnc 34.3 32.0-36.0 g/dL EN
788-0 RDW RBC Auto-Rto 12.7 11.0-15.0 % EN
777-3 Platelet # Bld Auto 250 140-400 Thousand/uL EN
776-5 PMV Bld Rees-Ecker 10.3 7.5-12.5 fL EN
751-8 Neutrophils # Bld Auto 2540 1500-7800 cells/uL EN
731-0 Lymphocytes # Bld Auto 1760 850-3900 cells/uL EN
742-7 Monocytes # Bld Auto 550 200-950 cells/uL EN
711-2 Eosinophil # Bld Auto 110 15-500 cells/uL EN
704-7 Basophils # Bld Auto 40 0-200 cells/uL EN
770-8 Neutrophils/leuk NFr Bld
Auto
50.8 % EN
736-9 Lymphocytes/leuk NFr Bld
Auto
35.2 % EN
5905-5 M onocytes/leuk NFr Bld
Auto
11.0 % EN
713-8 Eosinophil/leuk NFr Bld Auto 2.2 % EN
706-2 Basophils/leuk NFr Bld Auto 0.8 % EN
DHEA SULFATE
2191-5 DHEA-S SerPl-mCnc 434 106-464 mcg/dL EN
PSA, TOTAL
2857-1 PSA SerPl-mCnc 0.5 < OR = 4.0 ng/mL EN

TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,M S
2986-8 Testost SerPl-mCnc 1051 250-1100 ng/dL SLI
2991-8 Testost Free SerPl-mCnc H 199.7 35.0-155.0 pg/mL SLI

ESTRADIOL,ULTRASENSITIVE, LC/M S
35384-7 Estradiol S erPl High
S ens-mCnc
H 62 < OR = 29 pg/mL EZ

2

Quit thinking of E2 as a bad thing, it isn’t. Stop taking the AI, you even said yourself you improved when you stopped taking it.

My E2 is 73… unless you have gyno, stop the AI for good, ride it out for a month or two, and you’ll be better than you ever were while on it.

E2 SHOULD increase as TT and FT go up… It is normal

1 Like
3

No gyno, just had a some bloat and no erection. Even Cialis was little help. AI seemed to help with erections a bit but felt horrible otherwise. Lots of anxiety and depressed after restarting the AI.
You think I lower my T dose or my body may need some more time to adjust to current dosing?

4

You are probably one of those that will not do well on AI’s, which can cause hair loss. There are some men who are AI over-responders who can’t handle at little bit without crashing estrogen. It seems your levels are in excess and estrogen is double the reference ranges, no wonder you have ED, then you took an AI and wrecked your estrogen and ended up on the other end of the ranges.

This explains why you are having problems, this protocol is driving estrogen high along with testosterone. Your T-cyp dosage is on the high side and you are on HCG which also increases estrogen. In fact for those with chronically low estrogen on TRT, HCG is perfect, but for someone struggling with excess estrogen, it usually causes problems.

You need to lower the T dosage and stop HCG or I expect you will continue to struggle with ED. You could also break up your shots and inject smaller doses more frequently which will lower estrogen.

You’re going to have to make a choice, ED and low libido in order to have full size testiles while maintaing some level of fertility or a strong libido and no ED while having possibly slightly shunken testiles and perhaps losing some degree of fertility.

You can always revisit HCG if you so choose to have children in the future.

Your doctor should have started you out on .125mg anastrozole 1-2x week as your dosage is excessive, but would have been better to adjust injection frequencies with no AI.

5

Thank you for the response @systemlord

I dont think I crashed my E2 since Ive done that several times and know what that feels like. I just didnt know how bad anastrozole was making me feel mentally for the first year until I just restarted it.

Do you think cutting the HCG to 200 2x week would help or just ditch it all together?
If I decided to test it out and stop the HCG, how long do you think it would take for the body to adjust and notice the effects?

As for my T dosage being too high, wouldnt stopping the HCG also bring my test levels down?
Id rather not make too many changes at one time.
So maybe stop the HCG and after 2 weeks drop my dosage a bit or switch to EOD injections?

6

HCG reaches a stable state in 10 days, so at least that long to notice a significant difference. You may even notice improvements sooner. Stopping HCG will have a minimal effect of T levels, more importantly it will have a greater effect on estrogen.

You want more T, inject more T, HCG isn’t needed. Also note AI’s can’t affect estrogen produced inside the testicles.

1 Like
7

Lower the dose I think.

I’m still not on board the “let E2 run rampant” train.

Lower the dose and see if boners improve.

2 Likes
8

I switched to .2 of T sub-q EOD and 200iu of HCG EOD. Injecting T and HCG on different days. Dont love injecting daily but things have seemed to improve on every front. I did this after reading many of your other posts so thank you for that. Life has greatly improved thanks to your input.

1 Like
9

Every issue you mentioned in your original post is either thyroid and/or progesterone related. Can you post your thyroid labs here?