(Very) low on testo - trt help needed

[Fourtytwo00]

Hi mates,

In short: 9 months ago my insomnia became drug resistant (benzodiazepine) so I quitted cold turkey an hypnotic I used to take - things worsened. Btw in this stressful period my testo went from 450 to 160 in a matter or three months.
Tried HCG monotherapy for 3 months (actually a little bit less after some hints by Simbarm - thanks you gave me food for thought) , stopped two months ago and now testo is back at 160.

At such low level it's hard to have any erection for me and PDE5 do not work.
This situation is lasting from months. I want to ask if this could endanger my penis organically because sometimes I have feeling of numbness / cold glans. It seems to me, but I can't be completely sure because my rare erections are never 100% that I'm starting to lose something on girth/length (sort of turtle/coffin effect) also because tumescence in the spongiosum worsened recently.
As you can imagine I feel depressed about it.
I'm 42, quite young for impotence and for a life on TRT.

Any advice is appreciated.

[solvingadream]

I believe 160ng/ml (if that's the scale you are referencing your total T number) needs to be treated. If nothing more than for emotional well-being, and for support of estrogen.

I'll explain my reference to estrogen. When I was around 50, I pressured my medical group to test my "T" level, I have been suspecting it was low for years. After some foot-dragging I got them to test, and the result was 230ng total T, but of great concern was my total estrogen level of only 9ng. Estrogen is responsible for bone health in women ....and men as well. If I didn't do anything about my low "sex hormones" level, it causes a downward health cascade over time. With such a low estrogen level, I would have been left with extreme osteoporosis later on (like if I fell, broken hip, broken back, slumped shoulders of a broken old man, etc)

So, fast forward, I'm 63 now, my total T is around 800 plus, and my estrogen is around 25 to 30. That level of estrogen for me is ideal. I notice that when I restored my T to a level of a healthy, young man, I don't sweat the small stuff, feel emotionally well balanced and confident, libido is strong (although I do have ED that I also treat).

I inject testosterone cypionate, 25 units on a standard insulin syringe (30ga, 1/2 syringe) on Monday, Wednesday, and Friday into the belly fat. It's easy, and not really painful at all.

[Simbarn]

Tried HCG monotherapy for 3 months (actually a little bit less after some hints by Simbarm - thanks you gave me food for thought) , stopped two months ago and now testo is back at 160.

At such low level it's hard to have any erection for me and PDE5 do not work.
I'm 42, quite young for impotence and for a life on TRT.

Any advice is appreciated.

Hi, I have just replied to another recent post which may benefit you also. Not sure if I mentioned Enclomiphene to you previously.
viewtopic.php?f=3&t=17781#p162509

You do need to get your T up to a healthy level without doubt. It is not good for the penis to be deprived of T for an extended period, nor your mental health!

[Fourtytwo00]

I read it thanks. What if in my country only Clomid is available?
Another question how is it possible that I went from 450 to 160 in just 3 months?

I still didn't resolved my insomnia (4-5h taking zolpidem and trazodone 100mg).
Could it be a pituary failure stress related?

Now I'm looking for a good endocrinologist for a better view. Urologist told me to double down and start a 6 months cycle of HCG (2000UI per week, injections). But I'm not satisfied by this approach.

Last but not least: I guess 160 at 42yo is quite low. How such a bad low test could be? I read people need a minimum of T for being responsive to PDE5. Could low T influence stuff like lost erections, less sensitivity, less glans engorgement?

[Martin6469]

Good advice from the FT guys regarding testosterone. For insomnia, I find that 0.25mg melatonin an hour before bedtime, another 0.25mg when I wake in the night, and another 0.25mg around 5 or 6 am (if I want a little more sleep), works fairly well. Do not use larger amounts because this will overload the melatonin receptors in your brain, and do not use melatonin with added vitamin B6. Trazodone never worked for me: gave me a half-day hangover. Zolpidem works but only once a week; more often and it loses effectiveness. My other remedy: I use a little FM radio tuned to a vacant frequency, put a little earphone in one ear, an earplug in the other ear, and the white noise has a sedative effect.

[Simbarn]

I read it thanks. What if in my country only Clomid is available?
Another question how is it possible that I went from 450 to 160 in just 3 months?

I still didn't resolved my insomnia (4-5h taking zolpidem and trazodone 100mg).
Could it be a pituary failure stress related?

Now I'm looking for a good endocrinologist for a better view. Urologist told me to double down and start a 6 months cycle of HCG (2000UI per week, injections). But I'm not satisfied by this approach.

Last but not least: I guess 160 at 42yo is quite low. How such a bad low test could be? I read people need a minimum of T for being responsive to PDE5. Could low T influence stuff like lost erections, less sensitivity, less glans engorgement?

You have the same problem as me. I am trying to find a way to get Enclomiphene (EC) where I live so I can at least give it a try. I suspect in my case I may need to use both testosterone and EC due to my age and length of time that I have been on TRT.
If you can only get Clomid, as I talked about in the other post it should preferably only be used for a few months to try and give the Pituitary a kick start and then slowly discontinued. Hopefully the higher T level will stay in place. If yours has only recently dropped from some type of shock to the body, this has a greater chance of working than if T levels are low due an idiopathic cause.
As your T level has plummeted in only three months, I feel you have a very good chance of reinstating normal levels with a course of Clomid. But be aware it is extremely important that it is tapered off very slowly when discontinuing. Sudden withdrawal can cause another shock to the HPTA which will most likely cause the same issue.

IMO, what your urologist has suggested with regard to using 2000 units of HCG per week for 6 months makes no sense at all. This will firstly overdose the leydig cells in your testes with such a strong dose. HCG is much stronger than many doctors realise. This amount of HCG per week will also cause estrogen side effects, possibly gynecomastia. Secondly it will only further suppress the HPTA from functioning as it should. It does NOT stimulate the HPTA into action if it has become sluggish or shut down. The only time it needs to be used for what we term a ‘RESTART” is if the testicles have atrophied after many months of steroid abuse and they have completely shut down and shrunk, or someone has been on TRT for some time for the very same reason. Even in these cases 2000iu is absolutely excessive.
I personally would never consult with an urologist about hormone issues. It is not their specialty. If you can find a doctor who specialises in male hormones and sexual dysfunctions, they may or may not be a Endo, it will help a great deal.

Yes I agree, you most likely do need a minimum of T to be responsive to PDE5i. Testosterone is needed for good erectile function, mostly indirectly. Low T can interfere with sexual sensation in the penis itself.

[silverdude]

I inject 20 units cypionate on a mwf schedule, subcutaneously. My uro agreed, as it levels me vs the every2week jab intramuscular. I have noticed better erections with pde5s, and trimix. If I inject on Monday, tues delivers a great romp, with trimix. Romp meaning high libido or horniness, great erection, acceptable length and girth, and wonderful duration, vs a romp on wed, before another injection of cypionate. Also for example on Tuesday, can romp a second time, with help of 100mg sildenafil and ring, and no trimix. If my mrs is super horny, i will inject a second time with trimix, allowing 8 to 10 hours apart, but on rare occasions. We are not on a schedule, but have kept some notes for observation.

[tomas1]

I inject 50 units once a week and don't notice any change in libido or anything else.
It would be nice to use a smaller diameter needle though.
I assume you use an insulin type needle?
I tried using a 30 gauge needle once, and it blew the needle off the syringe when I tried to inject.

[dg_moore]

I inject 50 units once a week and don't notice any change in libido or anything else.
It would be nice to use a smaller diameter needle though.
I assume you use an insulin type needle?
I tried using a 30 gauge needle once, and it blew the needle off the syringe when I tried to inject.

My T has been in the low 100s for years. At one point I was able to raise it to over 600 on Axion but, like you, it had no effect on me at all. Since it wasn't working and is not without risk I discontinued it. My T is back to the low 100s like before and nothing has changed.

[Simbarn]

I inject 50 units once a week and don't notice any change in libido or anything else.
It would be nice to use a smaller diameter needle though.
I assume you use an insulin type needle?
I tried using a 30 gauge needle once, and it blew the needle off the syringe when I tried to inject.

I would guess that your 50 units is 100mgs? This would be a typical weekly dose. You may find splitting the dose in two works better.
For some men when on TRT they also need adequate levels of LH and FSH and the other upstream hormones to feel an increase in libido. As I have discussed previously T replacement shuts down these hormones.
All the hormones the constitute sexual function contribute to libido and sexual sensation, not just testosterone. This is why T replacement on its own does not work for some men. It can in these men cause erectile issues for this reason.

I use a 27g needle and inject 50mgs into my thigh where the body-fat is very thin, twice weekly. I use a 21g to draw up with. It is difficult to draw up with a fine needle with an oil based solution. I therefore use a syringe that you can swap the needles over, not an insulin syringe where the needle is permanently fixed.
I also use Ovidrel to substitute for some of the lost LH and FSH due to HPTA suppression. Libido will be negatively affected for me if I do not use this alongside T replacement as I am one of those men that needs the upstream hormones.
Subq T injections into the abdomen do seem to be the best method when using an injectable testosterone for a very even stable flow of T into the body. I found I bruised with this technique so it doesn't work well for everyone, maybe this was due to my not having much body fat there as I am very lean. I have no issues with injecting the Ovidrel subq into my abdomen, this is water based.