Long Standing ED/TRT and Androgel

[Sketch2000]

Hi,

I'm a 32 y/o male with a history of long standing ED (since at least 2000).

I also have a history of fluxuations in my Test levels from the low to low normal range.

My endo has diagnosed me with Secondary Hypogonadism (I also have Subclinical Hyperthyroidism). My endo is probably the best I've seen in my life, and very reputable in my area.

To make a long story short - I've suffered from Erectile Dysfunction and lack of libido since 2000!
Its horrible!

In 2005 I was placed on Testim and began feeling great! However, within 8 months the treatment was discontinued as my Test levels reached the "limit" (within range) but no PCT was implemented. Again, I went "limp".

I did have some Androderm treatment in 2009 (I believe) - which again, helped, But that too was discontinued due to insurance issues.

From 2012 to just recently. I used Clomid as TRT. This was primarily due to my insurance issues (my insurance not covering Androderm, Androgel, etc.) It worked VERY WELL at first - I'd say the first 3 months I was "back".

My lab reports reflected an increase in Total Test. My Free test stayed about where it usually does which is 50% of the range.

But over time the Clomid wasn't as effective. I was also concerned as Its not a drug used for TRT (although it can be) and if i use Androderm or something in the future I would need the Clomid to "restart" (natural production) and didn't want to risk it not being as effective as I've used it for so long.

So....My insurance finally covered Androgel. I discontinued the Clomid and began Androgel last week on the 12th. LAST WEEK WAS GREAT! My energy, Mood, Focus, and Libido were back! I exercised 3 days, ran a mile on my days off! I felt incredible!

But on Friday my libido was gone! I've seen Sex Therapists and been thru all of that BS and the bottom line is if i take TRT and feel good then that's what i need. My energy and motivation is still pretty good, I've just been feeling down because the libido returning has always been my main concern and now that i don't feel like i did last week Its made me a little depressed.

My initial thoughts are that since I'm now getting Test externally my natural production has shut down and therefore it'll take a while for the Androgel to get my levels to a point where I feel like i did the first week - What do you guys think?

I'm scheduled for labs in 4 weeks since the start date.

Anyway, the reason I put "Does Total Testosterone Matter" in my title. Is because yesterday morning I created a "Hormone Log Spreadsheet".

I literally went thru ALL MY LABS since 2002 and listed them (all hormone labs).

Thyroid, Test, Free Test, LH, FSH, Cortisol, SHBG, The whole gang!

What i found after i finished the log (took a few hours) is that my Free test has always been "normal" - Its actually been HIGH in some cases. But its my Total Test that has been fluctuating from low to low normal and when i use TRT - its my Total Test that increases (before i began Clomid for TRT my Total Test was around 360, within a month it was over 600!)

So....Since Total Test is bound to SBHG and "they" (even my endo) has stated its not "Free" in the body to be used - does it really matter? Because it definitely seems to matter in my case!

As for the Androgel - I apply it every morning - try to keep it as close to the same time everyday. I don't always shower before i apply it, because I've showered the night before. Biggest draw back is not being able to workout, sweat, bathe, swim, etc. for 5 hours - I live close to the water. I'm curious if i can apply it at night??

Any info would help. I have long standing ED issues and this is the only thing that has a track record of helping. I'm unsure what happened for me to lose that "drive" last Friday (I've thought of everything from Food to Supplements, etc.). My erections have also not been as full as they were the first week - my only logical explanation is natural test production is (or already has) shut down and i need to wait.

Also, I'm still taking my Tribulus. Should I stop?

I'm currently using 5g (1%) daily.

Sketch

 

[brundel]

What is your estrogen doing?
Where is prolactin?

Are you taking any medications aside from the androgel/testim?
Any rec drug use?

Feel free to PM if uncomfortable answering in public.

 

[Sketch2000]

What is your estrogen doing?
Where is prolactin?

Are you taking any medications aside from the androgel/testim?
Any rec drug use?

Feel free to PM if uncomfortable answering in public.

Thanks for your response.

Yes. Taking Psychotropic Medication (Antidepressants and such) for a neurological condition. Unfortunately, due to the nature of my condition - I can't stop the medication. I know this contributes to things like ED. But my ED precedes using medication.

Haven't checked Estrogen or Prolactin in some time.

Prolactin has been checked since 2003 with various Endo's and Urologists. All results normal besides 1 (slightly high on one test in 2004 due to medication). However, last time it was checked was 2008.

Estradiol last checked in 2004 - normal.

No REC Drug use besides Alcohol which is about once every other week. No hard alcohol - about 6 beers.

Thanks again bro.

Sketch

 

[brundel]

10 years is a long time to go without comprehensive bloodwork.
Especially when your taking drugs known to elevate prolactin or estrogen. Either of these being elevated can cause ED.
Especially when an SSRI is also on board.

High prolactin
high estrogen
high serotonin = floppy dick.

Even borderline elevated prolactin can cause some nasty sides like...ED. Unfortunately the drugs and supps used to combat elevated prolactin can interact with psych meds as they seriously increase dopamine.

Clomid can cause psychological disturbances and for you its probably a poor choice.
An AI like Formeron, or aromasin will lower estrogen and raise test levels without causing these sides.

At least then youll know estro is in check and test will be high.
Wont do much for the prolactin. So in your case Id try 200-300mg pyridoxine/vitb6 twice a day. Try for a week or so and see how you feel.

Have you tried PDE5 drugs like viagra?

Also any suggestions I make are for research purposes only. I am not a dr.

 

[Sketch2000]

10 years is a long time to go without comprehensive bloodwork.
Especially when your taking drugs known to elevate prolactin or estrogen. Either of these being elevated can cause ED.
Especially when an SSRI is also on board.

High prolactin
high estrogen
high serotonin = floppy dick.

Even borderline elevated prolactin can cause some nasty sides like...ED. Unfortunately the drugs and supps used to combat elevated prolactin can interact with psych meds as they seriously increase dopamine.

Clomid can cause psychological disturbances and for you its probably a poor choice.
An AI like Formeron, or aromasin will lower estrogen and raise test levels without causing these sides.

At least then youll know estro is in check and test will be high.
Wont do much for the prolactin. So in your case Id try 200-300mg pyridoxine/vitb6 twice a day. Try for a week or so and see how you feel.

Have you tried PDE5 drugs like viagra?

Also any suggestions I make are for research purposes only. I am not a dr.

The labs have been done (I do them quite frequently - 3 or 4 times a year), its just that all of the hormones are not included. That's why the prolactin was done last in 2008 and estrogen in 04, but i can easily get that done when i do my labs in 3 weeks (4 weeks post starting androgel).

I know elevated prolactin (and estrogen of course) can cause some issues. So I'll be sure to add that to my lab routine constantly. Again, Prolactin has been monitored 3-4 times per year until 2008. Estrogen until 2004. But i'll add it to this years regimen.

When i used Clomid for TRT (due to insurance issues) people (on the forum) talked about depression and such but I didn't feel any psychological disturbances. Nonetheless I'm done with the Clomid now.

I have tried Viagra and Cialis in the past.....didn't do anything for me.

The AI you suggested is probably a better choice - your right.
As for the suggestion I'll do some research and look into it.

Thanks again bro.

Sketch

 

[threeFs]

Antidepressants lower sex drive. More from me in your other thread

 

[brundel]

The labs have been done (I do them quite frequently - 3 or 4 times a year), its just that all of the hormones are not included. That's why the prolactin was done last in 2008 and estrogen in 04, but i can easily get that done when i do my labs in 3 weeks (4 weeks post starting androgel).

I know elevated prolactin (and estrogen of course) can cause some issues. So I'll be sure to add that to my lab routine constantly. Again, Prolactin has been monitored 3-4 times per year until 2008. Estrogen until 2004. But i'll add it to this years regimen.

When i used Clomid for TRT (due to insurance issues) people (on the forum) talked about depression and such but I didn't feel any psychological disturbances. Nonetheless I'm done with the Clomid now.

I have tried Viagra and Cialis in the past.....didn't do anything for me.

The AI you suggested is probably a better choice - your right.
As for the suggestion I'll do some research and look into it.

Thanks again bro.

Sketch

Any idea what your cholesterol levels are? ED can sometimes be caused by atherosclerosis.
Since it was present before SSRI this may be a cause.

Also may be psychological in nature. Often placebos even will cure this kind so its odd that PDE5 inhibitors do nothing.

 

[Sketch2000]

Any idea what your cholesterol levels are? ED can sometimes be caused by atherosclerosis.
Since it was present before SSRI this may be a cause.

Also may be psychological in nature. Often placebos even will cure this kind so its odd that PDE5 inhibitors do nothing.

No problem with blood flow so Viagra and Cialis did nothing for me - especially if theres no "drive" to begin with.

Cholestorol is fine. As is CBC and Metabolic Panel. I also have that done every 6 months. They've been pretty consistent. The only thing thats been off is my liver enzymes slightly being elevated from time to time.

I know it could be psychological, but I'm seeing a Therapist (who is also a licensed Sex Therapist - but I"m not seeing her for that) who could obviously chime in on any problems psychological in nature, and she does see some underlying "performance anxiety" there...but she also sees a great response to TRT (as does my endo) and that's why its been prescribed over the years. My therapist doesn't see any psychological problems that would cause this kind of long standing ED.

To be honest, I don't think its mental or a placebo at all. But I can understand why others would.

Its tough to convince Dr.'s that because I currently take medication for a condition which include SSRI's.....and that's the main problem. I've been going in circles for 10 years now with some doctors saying - its the meds - others saying - ****, your hormones are all over the place - and others (like my current endo of 6 years) saying - look, regardless of if its the SSRI or the TEST (I do have documented fluctuations in my TEST and low TEST for my age) she has stated in her dictation "even if this is a placebo type effect and there is a psychogenic component, the increase in Mr. ------ quality of life is enough to warrant that he take this type of treatment long term".

So I finally found a Dr. that understands it could be caused by a number of variables - both psychological and physiological in nature.

Sketch

 

[Sketch2000]

Antidepressants lower sex drive. More from me in your other thread

My ED precedes my SSRI use.

I know SSRI's will make the problem worse. Unfortunately I'm not in a position to get off of the medication regimen I'm on (if i could i would trust me!) and even whilst off of medication the ED hasn't improved.

Sketch

 

[Sketch2000]

10 years is a long time to go without comprehensive bloodwork.
Especially when your taking drugs known to elevate prolactin or estrogen. Either of these being elevated can cause ED.
Especially when an SSRI is also on board.

High prolactin
high estrogen
high serotonin = floppy dick.

Even borderline elevated prolactin can cause some nasty sides like...ED. Unfortunately the drugs and supps used to combat elevated prolactin can interact with psych meds as they seriously increase dopamine.

Clomid can cause psychological disturbances and for you its probably a poor choice.
An AI like Formeron, or aromasin will lower estrogen and raise test levels without causing these sides.

At least then youll know estro is in check and test will be high.
Wont do much for the prolactin. So in your case Id try 200-300mg pyridoxine/vitb6 twice a day. Try for a week or so and see how you feel.

Have you tried PDE5 drugs like viagra?

Also any suggestions I make are for research purposes only. I am not a dr.

Feeling a bit better in my 3rd week of Androgel.
I recently made a "Hormone Lab Spreadsheet" listing all of my hormone labs done since 2002!
And highlighting all the discrepancies in them.
I've had a LOT OF labwork (since i have subclinical hyperthyroidism) and these fluctuations in Test.

Must have taken me about 2 hours to finish it.

What i found is that my Free test is always within range (in a few cases its been high) but its my Total T that is usually low normal or low.

Which is interesting given the debate on "Does Total T matter"

There has also been low FSH, slightly high prolactin, I've had azospermia once (no sperm count), and some low TSH here and there (the subclinical hyperthyroidism - which is really not treatable, its better to not treat it since your other thyroid hormones are normal) - so it was interesting to go over and see.

I'm scheduled to have labs done in about a week so i can guage one month of androgel and will be requesting a more comprehensive set of labs other than just test / free test / thyroid / shbg / lh and fsh....

Anyway, do you think i could use the Androgel at night?
I hate using it in the morning and having to wait 5-6 hours to hit the gym.

Sketch