Testosterone

[Appellatelaw]

I’m 35. I did a long post in young members recently about my situation, but I was hoping to get some input on stopping injecting testosterone.

I was diagnosed with low T in 2014 (between 150 and 200, typically around 170). This was discovered bc I went to a urologist due to ED.

I originally started with androl gel, however it smelled/ruined my sheets /shirts. I now inject 200 mg/ml ever week into my ass. (In the last 10 years I’ve been to three urologistists who have continued to proscribe the above. I went to multiple urologists due to insurance changes).

Using the 200 mg/ml injection ever week, my testosterone is in the low 700s.

I moved to TN in January and went to a new urologist in TN. The new urologist told me I was taking a high dosage in T and told me I should stop taking it.

He asked me if I ever got benefits from it, like help with my ED, and I stated I didn’t think so. Because the only way I can get an erection is from a 20 mg pill of Cialis with a lot of stimulation.

Has anyone here stopped taking testosterone? Where there any effects?

Has anyone believed taking testosterone helped them get an erection? I don’t think it has really helped me

Do you guys think this Dr is a quack? The reason I ask, is I’ve been continuously prescribed testosterone for 10 years by multiple Drs.

I was just wondering your thoughts.

[vinnylid]

To be healthy it is wise to target testosterone around 500. Testosterone below 200 is not healthy according to Life Extension Foundation. The men's clinic I went to agrees with that value, but the doctor said that it would not improve my erection issue. Erectile dysfunction happen for other reasons. In my case, scar tissue from trying to force in an inadequate erection was a complication issue in my 60's. The scar tissue gave the appearance of Peyronnies. Because of the damage my penis was unable to contract to trap blood. I currently use Quadmix injections and a cock ring with good sucess. I also use viagra and Yohimbine 1 hour prior to injecting.

[tomas1]

I agree that testosterone won't improve ED.
I also found (but I'm much older) that when I stopped taking it for a short while, my libido crashed, and I didn't feel a sense of well-being.

I think your level of around 700 is good.
I don't know how to interpret your formula.
Mine is:

C-Testost Cyp
200ml/ml in Sesame Inj
10ml vial

I inject .45 to .5ml each week in the butt.

A side effect is shrunken testicles which I have.

[ape1100]

i also have low T, and all doctors say it had nothing to do with ED, just libido. my levels were just on the low end of the normal scale. rather than injections, i was given rapid release tablets taken daily. i raised my levels way above normal but did nothing for ED. every uro just checked levels, no one wanted to really manage it, so i myself reduced the amount i took to wean myself off. when i did that, i really noticed a drop in libido and well being. now i take enough to keep it in center of normal, but again, no change in ED.

[gjmjoe017]

It does two things for me,overall energy level is a LOT better and so is sex drive.I don’t think it helps erections much at all,especially with ED.

[Simbarn]

I will start by saying that I agree with your new doctor that you are most likely taking too much testosterone. 200mg a week is a very high weekly dose. The regular dose for most men is 80-100mg per week of injectable T. Thus the amount of T in your system could be contributing negatively to your erectile function. At what point after your shot was the blood drawn for a level of 700 to be the case?

There are many complex reasons why most men on testosterone replacement do not experience substantial improvement in ED.
There is evidence to suggest that testosterone positively affect’s levels of PDE5 in the penis and the expression of adrenergic receptors. It is therefore conceivable that excessive levels of T over a period of time may increase these enzymes and receptors so that erections become more difficult to achieve. The penis also requires a certain amount of T to remain healthy. If this is not there for an extended period of time, nocturnal erections decrease and other physiological changes occur in the erectile tissues, this can cause ED in itself and may only be partially reversible with subsequent T replacement if the deficiency has been experienced for a long period of time.
The problem with testosterone replacement is that it can be a double edged sword with regard to sexual function. On one hand it is good to replace the deficient T to help sexual function and penile health, but on the other it shuts down many other hormones that are important for sexual function. These other hormones positively affect erectile function as well.
When these other hormones; LH, FSH,GNRH are absent or very low, sexual function does not work the same way as it would if these are present. So for many men, especially younger men, the loss of what I call “upstream hormones” from exogenous testosterone can cause sexual dysfunctions. The degree of these dysfunctions can vary greatly from one male to another depending on the level of shut down they experience and the way they may be “wired’, so to speak. Some men do get an improvement in erectile function, especially nocturnal erections from T replacement, but not perfect function and many get little to no improvement. I feel much of this is to do with the above.

The amount you are taking could also be causing a significant amount of T to be converted into excessive amounts of other hormones, the most notable being estrogen. This can have a very detrimental effect on sexual function if in excess. Being able to determine what an excess of this hormone is, is also controversial. Can I ask why your urologist put you on 200mgs per week, what was the rationale behind this?

For a young man in my opinion, it is best to try every option to not be on TRT. That is trying whatever means are available to try and improve natural levels or using a medication that can raise natural testosterone such as Enclomiphene citrate. If there is no other option but to be on TRT due to very low T levels that will not improve, TRT can then be acceptable, but it will not be the same as natural function. Using too high a dose will not improve its shortfalls as is often tried by inexperienced doctors. Using either HCG or Ovidrel alongside injectable T, can substitute to a point for the loss of one of the “upstream hormones” being LH. This can help improve sexual function for some young men on TRT, restore testicle size and function to a degree, improve ejaculate levels and sexual sensation. Unfortunately it can also cause estrogenic like effects for other men and this over time can cancel out some or all of these good effects.
Taking more testosterone to try and remedy the loss of these other hormones will never work, it will just cause more side effects. Each of us has a level of T that is optimal, which is programmed into our genetic makeup. Altering this causes the body to go into damage control.

From my experience, it is usually older men that find testosterone replacement to be a very positive. This is because it helps to ameliorate the effects of aging in the whole body, stimulate higher levels of dopamine (we lose 10% of dopamine per decade of adult life), increase muscle mass, improve energy levels, improve libido and nocturnal erections and reduce the effects of oxidative stress in the vascular system. It can also have a boosting effect on the immune system. Young men don’t notice most of these effects because their cells are young and already functioning very well, what they do notice is an improvement in mental libido, muscle gain and sometimes mental clarity and drive. Sexual function can be quite hit and miss and this can be a deal breaker for many young men taking testosterone for low normal levels. If they are taking testosterone because they have extremely low levels the downsides are less noticeable because any improvement is welcome, similar to older men.

As you have been taking T for over 10 years at 200mgs per week, your system will be firmly shut down and your testes I would imagine are well and truly atrophied (unless you have been using HCG during this time as well). Stopping the therapy without a well-designed restart protocol will not be good for your health, especially your mental health. What has this new doctor in mind for you when he said you need to stop? Your T levels before treatment were quite low, below what I would call low normal. This might indicate that your ability to recover natural function at an acceptable amount may be difficult. However, running a restart protocol with Enclomiphene citrate with HCG (not at the same time) is always worth a try in a young man. It may be that after 10 years of taking testosterone, your pituitary may never produce adequate levels of gonadotropins again.

I found it interesting that you indicated in your post that you have felt no benefits from being on T replacement, especially seeing you had such a low level of T before treatment. What symptoms of low T were you experiencing before replacement? I would think at a level of 170, there would have been more than just ED?

[Appellatelaw]

I will start by saying that I agree with your new doctor that you are most likely taking too much testosterone. 200mg a week is a very high weekly dose. The regular dose for most men is 80-100mg per week of injectable T. Thus the amount of T in your system could be contributing negatively to your erectile function. At what point after your shot was the blood drawn for a level of 700 to be the case?

There are many complex reasons why most men on testosterone replacement do not experience substantial improvement in ED.
There is evidence to suggest that testosterone positively affect’s levels of PDE5 in the penis and the expression of adrenergic receptors. It is therefore conceivable that excessive levels of T over a period of time may increase these enzymes and receptors so that erections become more difficult to achieve. The penis also requires a certain amount of T to remain healthy. If this is not there for an extended period of time, nocturnal erections decrease and other physiological changes occur in the erectile tissues, this can cause ED in itself and may only be partially reversible with subsequent T replacement if the deficiency has been experienced for a long period of time.
The problem with testosterone replacement is that it can be a double edged sword with regard to sexual function. On one hand it is good to replace the deficient T to help sexual function and penile health, but on the other it shuts down many other hormones that are important for sexual function. These other hormones positively affect erectile function as well.
When these other hormones; LH, FSH,GNRH are absent or very low, sexual function does not work the same way as it would if these are present. So for many men, especially younger men, the loss of what I call “upstream hormones” from exogenous testosterone can cause sexual dysfunctions. The degree of these dysfunctions can vary greatly from one male to another depending on the level of shut down they experience and the way they may be “wired’, so to speak. Some men do get an improvement in erectile function, especially nocturnal erections from T replacement, but not perfect function and many get little to no improvement. I feel much of this is to do with the above.

The amount you are taking could also be causing a significant amount of T to be converted into excessive amounts of other hormones, the most notable being estrogen. This can have a very detrimental effect on sexual function if in excess. Being able to determine what an excess of this hormone is, is also controversial. Can I ask why your urologist put you on 200mgs per week, what was the rationale behind this?

For a young man in my opinion, it is best to try every option to not be on TRT. That is trying whatever means are available to try and improve natural levels or using a medication that can raise natural testosterone such as Enclomiphene citrate. If there is no other option but to be on TRT due to very low T levels that will not improve, TRT can then be acceptable, but it will not be the same as natural function. Using too high a dose will not improve its shortfalls as is often tried by inexperienced doctors. Using either HCG or Ovidrel alongside injectable T, can substitute to a point for the loss of one of the “upstream hormones” being LH. This can help improve sexual function for some young men on TRT, restore testicle size and function to a degree, improve ejaculate levels and sexual sensation. Unfortunately it can also cause estrogenic like effects for other men and this over time can cancel out some or all of these good effects.
Taking more testosterone to try and remedy the loss of these other hormones will never work, it will just cause more side effects. Each of us has a level of T that is optimal, which is programmed into our genetic makeup. Altering this causes the body to go into damage control.

From my experience, it is usually older men that find testosterone replacement to be a very positive. This is because it helps to ameliorate the effects of aging in the whole body, stimulate higher levels of dopamine (we lose 10% of dopamine per decade of adult life), increase muscle mass, improve energy levels, improve libido and nocturnal erections and reduce the effects of oxidative stress in the vascular system. It can also have a boosting effect on the immune system. Young men don’t notice most of these effects because their cells are young and already functioning very well, what they do notice is an improvement in mental libido, muscle gain and sometimes mental clarity and drive. Sexual function can be quite hit and miss and this can be a deal breaker for many young men taking testosterone for low normal levels. If they are taking testosterone because they have extremely low levels the downsides are less noticeable because any improvement is welcome, similar to older men.

As you have been taking T for over 10 years at 200mgs per week, your system will be firmly shut down and your testes I would imagine are well and truly atrophied (unless you have been using HCG during this time as well). Stopping the therapy without a well-designed restart protocol will not be good for your health, especially your mental health. What has this new doctor in mind for you when he said you need to stop? Your T levels before treatment were quite low, below what I would call low normal. This might indicate that your ability to recover natural function at an acceptable amount may be difficult. However, running a restart protocol with Enclomiphene citrate with HCG (not at the same time) is always worth a try in a young man. It may be that after 10 years of taking testosterone, your pituitary may never produce adequate levels of gonadotropins again.

I found it interesting that you indicated in your post that you have felt no benefits from being on T replacement, especially seeing you had such a low level of T before treatment. What symptoms of low T were you experiencing before replacement? I would think at a level of 170, there would have been more than just ED?

My wife injects me every Sunday. I try and do the tests mid week, so Wednesday or Thursday.

I went from being able to have sex 3+ times a day at 24 to 1-2 time a day 25 to not being able to achieve an erection sufficient to have sex at 26ish. It was a rough downfall.

I don’t think there were any other symptoms other than Ed. I was fit, went to the gym, had energy, friends, excellent bench press, good job, nice salary, and enjoyed life. My only issue in life was my ED. Which is a big issue to a guy in his early to mid 20s.

At 26 I went to a primary care dr and asked for viagra. She told me I had to take a blood test. I took 4 tests at quest diagnostic over a year and a half, and they were between 150 and 200.

I was referred to a urologist and he prescribed me androgel….. terrible… smelled ruined sheets\shirts…. Girlfriend at the time would complain how much I smelled…. (She was a real bitch, but incredibly incredible hot)…. Backney…. He also prescribed me viagra and Cialis. I preferred Cialis bc it had less of a headache.

He did a MRI with ink of my pituitary gland. It came back normal.

We moved and I started seeing a new urologist at a research hospital in the city. He continued to prescribe me cialis and started injections for the testosterone. I think I was 27 when we started at 100 mg every week, and after a year or so, I went to 200 mg/ml ever week. The reason we went up, was I don’t remember exactly why we went up, but it was due to still being on the low end and to help improve erections.

A couple years later, my wife who is a nurse, got a job at Kaiser Permanente. I went on her insurance (hmo) and switched Drs again to one within the hmo. He continued prescribing me 200 mg/ml ever week. He checked my testosterone a couple times a year (for the 2 years I was with him) and it was 700.

I, like many Californians, moved to Tennessee (just south of Nashville). I looked for a urologist at a hospital that claimed to specialize in sexual health/Ed. He stated I obviously have a blood flow issue in my cock, due to all the records I brought him. He stated that I should go off the T and start running or doing some form of Aerobic exercise. He explained that there are several studies when you do aerobic exercises for 45 to 50 minutes a few times a week, it will repair blood vessels and most guys will stop needing pills or be more successful on them. He stated to come back with in 6 months

About 6 months ago, my Ed got really rough… I now dread having sex and take two 20 mg cialis and pray I get hard enough to have sex, after shaking it forever.

I don’t know if T ever really gave me any benefits. I don’t think it has increased energy or muscle mass. I don’t know if it ever helped with my Ed. The only thing that ever gave me an erection was pills. I haven’t had morning wood in years. In fact my Bis, tris and chest have gotten smaller over the years.

[Simbarn]

My wife injects me every Sunday. I try and do the tests mid week, so Wednesday or Thursday.

I went from being able to have sex 3+ times a day at 24 to 1-2 time a day 25 to not being able to achieve an erection sufficient to have sex at 26ish. It was a rough downfall.

I don’t think there were any other symptoms other than Ed. I was fit, went to the gym, had energy, friends, excellent bench press, good job, nice salary, and enjoyed life. My only issue in life was my ED. Which is a big issue to a guy in his early to mid 20s.

At 26 I went to a primary care dr and asked for viagra. She told me I had to take a blood test. I took 4 tests at quest diagnostic over a year and a half, and they were between 150 and 200.

I was referred to a urologist and he prescribed me androgel….. terrible… smelled ruined sheets\shirts…. Girlfriend at the time would complain how much I smelled…. (She was a real bitch, but incredibly incredible hot)…. Backney…. He also prescribed me viagra and Cialis. I preferred Cialis bc it had less of a headache.

He did a MRI with ink of my pituitary gland. It came back normal.

We moved and I started seeing a new urologist at a research hospital in the city. He continued to prescribe me cialis and started injections for the testosterone. I think I was 27 when we started at 100 mg every week, and after a year or so, I went to 200 mg/ml ever week. The reason we went up, was I don’t remember exactly why we went up, but it was due to still being on the low end and to help improve erections.

A couple years later, my wife who is a nurse, got a job at Kaiser Permanente. I went on her insurance (hmo) and switched Drs again to one within the hmo. He continued prescribing me 200 mg/ml ever week. He checked my testosterone a couple times a year (for the 2 years I was with him) and it was 700.

I, like many Californians, moved to Tennessee (just south of Nashville). I looked for a urologist at a hospital that claimed to specialize in sexual health/Ed. He stated I obviously have a blood flow issue in my cock, due to all the records I brought him. He stated that I should go off the T and start running or doing some form of Aerobic exercise. He explained that there are several studies when you do aerobic exercises for 45 to 50 minutes a few times a week, it will repair blood vessels and most guys will stop needing pills or be more successful on them. He stated to come back with in 6 months

About 6 months ago, my Ed got really rough… I now dread having sex and take two 20 mg cialis and pray I get hard enough to have sex, after shaking it forever.

I don’t know if T ever really gave me any benefits. I don’t think it has increased energy or muscle mass. I don’t know if it ever helped with my Ed. The only thing that ever gave me an erection was pills. I haven’t had morning wood in years. In fact my Bis, tris and chest have gotten smaller over the years.

I do find it unusual that your only symptom was ED from a diagnosis of what appears to be very low testosterone. If you indeed felt at the time that everything else was quite normal, energy levels, strength in the gym, muscle mass, mental drive, libido etc. and the only issue you were experiencing was erectile dysfunction, I would be questioning whether low testosterone was your problem. Perhaps there were other symptoms but you just didn’t notice them. Only you will know this.

When you were 26, and had all those tests done, why was the decision made to put you straight on testosterone rather than attempt to increase your natural hormones with a restart protocol? I say this especially given the sudden downfall in your sexual performance ability.
Resigning a young man to a life on testosterone replacement should not be undertaken lightly. A good experienced sexual health doctor would not throw you onto T replacement straight away. If you were in your 70’s and above, this would be more likely, but not a young man in his 20’s!

“and after a year or so, I went to 200 mg/ml ever week. The reason we went up, was I don’t remember exactly why we went up, but it was due to still being on the low end and to help improve erections.”
This is what I mean by doctors increasing testosterone trying to improve erectile function, when they do not understand that high levels of T do the exact opposite. As I said in my first post to you it causes many side effects which hinder or make ED worse. Perhaps read my post again a couple of times to understand this.

Having your blood drawn midway during the week does not give you the peak level of T after your shot. Most likely it will at that time be supraphysiologic and your body will be trying to convert T into other hormones, increase levels of aromatase enzyme, and possibly desensitise the androgen receptors due to what it sees as a unnatural high level of T. These undesirable effects take time to occur. The exact same thing happens to anabolic steroid users who are using higher levels of injectable T. In their case it is just more pronounced and occurs faster due to the amounts they take. After a few months the receptors for T stop responding to the very high levels of T, so they have to stop taking it for many months in order for these receptors to return to normal, hence why they do cycles. The same thing happens to men on TRT that take higher than normal levels of T. Slowly over a period of 6 months to years this can occur. You need to understand that the body produces testosterone naturally in a very specific way daily in order for these things to not occur. It has two peaks of T every day and also low points. These low points ensure receptor sensitivity to testosterone is maintained. The peaks are at a level that do not cause excessive aromatisation of T into E2 or other hormones as well.

I would guess that your natural healthy level of T could be on the low side compared to other men, given how you felt on just 170-200. Not all men have levels in the 700 range or were designed to have levels in the 700 range. 700 could be way in excess for your body. As I have been researching and studying this over 20 -30 years, I have had many of my friends test their T levels as a matter of course, so they had a record of what their T level was while they were healthy and relatively young. The results of this was very surprising for me. These levels were all over the ranges. Some were in the high 700’s some low 300’s.
200mg a week of T can be considered a beginner dosage of an anabolic steroid usage. Testosterone is the strongest steroid out there, all other anabolic steroids are derivatives of the hormone with androgenic properties removed from the molecule. It is no wonder you are experiencing issues after taking such a high dose for all the years you have.
I’m not surprised you have not had morning wood for years as your hormone milieu will be all over the place given how much you are taking. It could also take more than a year for your T receptors to regain the sensitivity to testosterone after being in this state for many years.
Guys that take steroid courses for very long periods, that is they never actually come off properly after 3 months of usage, can have major issues with this when they eventually stop abusing these drugs.

If you are injecting T just once per week (which could be improved upon by injecting twice per week) having a low point at the end of the week is IMO very important to maintain some sensitivity to the hormone.
Ensuring that you do not have excessive peaks after the injection is also very important. This is why injecting more frequently with smaller amounts can be a much better method.
If you would like help with a restart protocol and what I have learnt from doctors who know how to do this properly send me a PM, I will also recommend a clinic that may be a lot better at managing HRT for men than most urologists are.
I would never personally see a urologist for a hormone issue. At least the one you are seeing now recognises the fault of the others.

[Simbarn]

I am posting a PM reply to the OP I made, here, as I think it be of help to other men in a similar situation.

"When you had your original diagnosis by the doctor for your low T, was it determined that you were either primary or had secondary hypogonadism? If you do not know what this means: Primary refers to a determination that the testicles are at fault as they are not producing high enough levels of T, even though they are getting ample stimulation from the pituitary from high levels of LH and FSH (gonadotropins). Secondary refers to a determination that the Pituitary is at fault as it is not producing high enough levels of LH and FSH. This will be evident from the testing they did. If you were primary, there may be less to no chance of the below restart working for you. If you were secondary, much better chance. Most men suffer with secondary hypogonadism, not primary so there is good chance this is what you have.
The younger you are, the better the chance you have of this working. Older men in their 40’s and 50’s will probably do better on T replacement.

Given that you have been shut down for many years now, it would most likely be necessary to give your testes a kick start first with HCG or Ovidrel. Dr John Crisler (more on him further down) was very good at restart protocols for guys who had been on steroids for many years. He often said that the testes were the slowest to respond when compared to the pituitary when trying to get the HPTA running again, especially if they have atrophied considerably. HCG will give them the stimulus that is sometimes required to literally wake them up quicker than if just a SERM is used on its own.
Typical dosages for this would be from 250 to 500iu 2-3 times a week. The course of HCG is run for around 4 weeks, during the last week SERM treatment usually begins.
Be wary of doctors who suggest using more than 500iu per shot of HCG. Dr Crisler said that injecting more than this each time was not needed and could actually desensitise the leydig cells in the testes to your own LH. Not what you want to do!

SERMS are drugs classed as selective estrogen receptor modulators. They if used correctly can stimulate the pituitary and hypothalamus to start producing higher levels of GNRH and therefore LH and FSH. These gonadotropins tell the testes to start producing testosterone and sperm.
So as HCG has already turned the testes back on so to speak and they have grown in size which is the important part, they will be ready to accept the stimulation very well from your own natural gonadotropins: LH and FSH. Sometimes if SERM treatment is started on its own without HCG, the restart protocol can take much longer to work (or not work at all) as they testicles can be quite stubborn due to the degree of atrophy (shrinkage). As you have been on a relatively high dose of testosterone for many years, I would suspect they are quite atrophied.
The hypothalamus and the pituitary have not atrophied due to your testosterone replacement because they produce other hormones which are not affected to any great degree. They start to produce GNRH, LH and FSH fairly quickly given the stimulation from a SERM.
Have you noticed that your testicles have shrunk considerably from before you undertook TRT?
Did your ejaculate also diminish markedly?
Has your refractory period also increased noticeably (the time period that you are able to ejaculate again as in hours, days for example)?
Have you noticed a loss of sexual sensation in your penis since being on TRT?

The most common SERM used for this is Clomid, or its drug name clomiphene citrate. It has been around for a long time. It’s a tablet so it is much easier to take than HCG which is a subq injection. Dosages are typically around 12mgs per day (A doctor who has experience and consults with you, will know best with regard to dosage). This course may need to run for much longer; 3-4 months with a very slow taper at the end. The TAPER is VERY IMPORTANT so as to not shock the HPTA by sudden withdrawal of the stimulus of the drug.
During this treatment it’s a good idea to get testing done to see where your levels of T and LH and FSH are at various times. Because of the nature of Clomid, most guys do not feel as you think they should with a higher level of T and the other hormones as a consequence of treatment. This is because these drugs also stimulate the estrogen receptor and cause issues there. Sexual function can be all over the place and some men can also feel moody or emotional at times. Some guys do not get these side effects as strongly as others.

There was a newer SERM developed by a company called “Repros therapeutics”, who tried for many years to get approved by the FDA for the use of stimulating higher levels of natural testosterone on a permanent basis. This drug was called Androxal and it is Enclomiphene citrate.
Clomid which is Clomiphene citrate is made of two parts: Zuclomiphene and Enclomiphene citrate. It is considered that the Zuclomiphene part of Clomid is the part which generates most if not all of the undesirable side effects Clomid can have. So Repros simply removed that part from the compound. Androxal raised natural testosterone in individuals with secondary hypogonadism quite well, comparable to that of T gel administration. However, the FDA after many years of trials, did not give them approval, so the drug never came to market even though it was safer to use than Clomid. Some doctors still prescribe Clomid for HRT in men on a permanent basis, which maintains fertility and natural T. Dr. Crisler said he was never comfortable using Clomid long term due to its estrogenic properties.
Many men who have tried Clomid for permanent HRT purposes do not stay on the drug because they do not feel any better whilst on it owing to the side effects even though their T level is much improved.

I have heard that Enclomiphene citrate is being compounded in the US now and is available. I am in Australia and do not have access to it, but you may do. Enclomiphene has all the same properties for a restart drug as Clomid does, very possibly without the side effects of Clomid.
If once you have tried a restart protocol and your HPTA does not respond as hoped, i.e. your T levels remain very low after discontinuation, which is a possibility given the time you have been on TRT. There is also a possibility that you could remain on Enclomiphene permanently to keep the stimulation at the pituitary to produce higher levels of gonadotropins. The dosage needed for this may be less that what is needed for a restart.
One thing to be aware of is that proper sexual functioning can take some time to return properly after a restart protocol has been performed. It takes time for the body to find homeostasis again if it can.

I think it always preferable as I mentioned in my posts to you, that for a young man, everything should be tried first before undertaking TRT. It appears the doctor who saw your originally decided to put you straight onto T replacement without any attempt to improve your natural T.
TRT will never replace the optimal functioning of a healthy hormone system in a young male. It can attempt to, but things will not be quite the same. If that is all that can be had, it can be better than having very little to no testosterone at all!

Defy medical in the US is where I have heard that you may be able to get Enclomiphene prescribed and supplied and they also specialise in HRT for men. So if the end result is that you do need to remain on testosterone replacement, they may be better equipped to help and advise with this.
https://www.defymedical.com/

Unfortunately Dr John Crisler passed away 2 or more years ago, otherwise I would have suggested him for you without hesitation. Many of his protocols and techniques have been carried on by other doctors who followed him. He ran an online forum for many years called “All things male” which I was a member from its inception. I learnt a great deal from him and other members, some being his patients who were dealing with testosterone replacement. Many guys came to this forum who were having considerable issues with doctors who were using outdated methods to manage low T.
He did write a book on the topic which you may find useful:
https://www.amazon.com.au/Testosterone- ... B00UPN8JFU

I hope this helps you. Testosterone replacement for men is a very tricky endeavour which some doctors are not very good at navigating.

There is also another forum, that seems to have taken the place of “All things male” since. There are some good people posting there with considerable knowledge on the topic who may be able to help even further that I can. Frank talk is much more concerned with ED.
https://www.excelmale.com/forum/
There is even a sub forum on that site, just for restarts and SERM therapy and discusses drugs like Clomid in detail. https://www.excelmale.com/forum/forums/ ... -low-t.89/
Try and not get to overwhelmed by all the information on that site, take your time and possibly talk to and read the posts of one very intelligent member there called “Cataceous”. Nelson Vergel is the founder or the forum and you will see a great deal of posts by him.

One point I should make after mentioning all that I have to do with hormones, is that your ED may not resolve after the successful reinstatement of your natural hormones. Your ED issues may be from another cause than what was originally thought to be low T.
However, I do not think the very high dose of T that you are on is helping matters with your ED and may have even made it worse as I discussed in my post to you. So it could be that after your natural hormone milieu is in place again, you may have a better response from PDE5i at a lower dose.
I would think even a better managed TRT protocol could also encourage this."

[frank66665]

@Appellatelaw it was never mentioned by you about estradiol levels, from personal experience when you get estradiol even if you have testosterone at 1000 it's like you have it at 200, could you tell how high you have estradiol? adding the min and max value of the reference value?