sirgawain wrote:@Simbarn - great post and questions. I was having this issue, and almost no libido, prior to the TRT. TRT was my hope of fixing it. It has fixed my body comp issues, and my energy, but the damage from the surgery and loss of sensation hasn't changed. They were hopeful that my nerves might heal, but it's been years and nothing has improved.
So, the Trimix at least lets me stay stimulated long enough to (a) give her enough time to have pleasure and (b) stay hard long enough to have an orgasm myself. Without the trimix, I get hard for a period of time, but rarely long enough to orgasm. The TRT might be delaying my orgasm -- that I would be believe, but it's not the cause of the erection problems -- they predate this.
My TRT number we set based on results -- we haven't moved them since starting last year. He keep trying to get me to take an AI, and I have fought that. He wants my estrogen to be down below 20, which I think conflicts with a lot of other people I have talked to about this (including other doctors). It amazes me that there are so many opinions on protocols...you'd think at this point, they would have this pretty well understood....
Thank you guys.
I am sorry that TRT did not fix your issues, it rarely fixes all sexual dysfunction issues men get and often creates some of them!
Yes, testosterone is great for mental libido, energy and giving you a younger looking physique, if you do some exercise and resistance training. However, as I mention it can be not so great for the libido we experience in the loins. That urge we get for sexual release that centres all around the genitals and which seems to build as the days go by if we do not have that release. I find TRT can dampen this considerably, or not improve it if it has been absent before TRT. After all the decades I have been researching all of this, feeling the effect TRT has on my own body and trying many different protocols, I am quite certain now that most of this is caused by the loss of our “upstream” hormones. One of the personal experiences that helped me come to that conclusion was owing to when I took HCG for the first time. I had an incredible response to it. The unforgettable sexual urge in the loins returned and sexual sensitivity was much improved, erections were also surprisingly, more responsive, even ejaculate levels increased substantially. This stayed with me for about a month, then gradually went away so that I had a moderate improvement from taking no HCG at all. It never came back again to that degree. I have had periods whereby I stopped HCG for some time, upon restarting I would feel some of this strong sexual urge again for about 2 weeks, then the same thing would occur. I now know this is because for many men, we become desensitised to HCG quite quickly. Put simply, our body sees it as not the same as our natural LH and FSH. The way in which and how often it stimulates the receptors is different. HCG is produced in males in very small quantities, when it is used for HRT purposes very large amounts compared to what we produce are injected. This could present saturation problems.
It sounds like it was 3 years ago that you had the surgery and a year after that you began TRT. As I mention, the nerves may have healed somewhat, but you may not be able to notice much improvement due to what TRT could be doing to sensation loss. Believe me it can cause the penis to go quite numb. Did you have the ED before the surgery? Did you also have loss of libido before your surgery? It may be that your ED cannot be improved substantially by a change in TRT protocol, but sensation and sexual urge may improve. Or you could try reinstating natural function with a SERM such as Enclomiphene. Prescribing TRT to someone with a normal level of T of over 400 is questionable. It is almost to the point of using it as a bandaid, attempting to fix issues not caused originally by low T. Metabolisms slow down as we age, which can be a separate issue to low T, libido wanes also too, which can be caused by a multitude of factors, not just low T. As I have no idea what the extent of your health issues have been, I cannot really comment on why you lost your libido completely. However, with a T level that you had before replacement I would doubt this would be the cause of a complete loss of libido.
However, if you are feeling a lot better on the T, perhaps it is the right course for you, lowering the dose as I mention may improve sexual function enough so that the Trimix works even better for you. It can take time for your body to feel the benefits of a lower dose too, quite a few months if not more. You may feel worse initially as your receptors will have been desensitised due to high constant levels. I understand this very well, because I did the same thing to myself many years ago, taking too much T than what my body needed. It took a long time to re-sensitise myself to the amount of T that my body needed almost a year in fact. I see it so often, with regard to guys taking too much testosterone, it is one of the most common mistakes with regard to TRT.
Unfortunately with erectile function, once it is damaged past a certain point (for many complex reasons) reinstating perfect hormone function will not be enough to repair it. If your issue is neurological from the surgery, that is the signals stimulating erections (parasympathetic and or reflex) to occur has been damaged it may be that you will need IC injections to maintain erections if the nerves do not fully heal. But the good thing is these do work for you! Interestingly, I have a very similar issue as you, where I can get a strong erection in the initial stages of sex (and even masturbation) and then at some point all of sudden it is akin to someone flipping a switch and my erection fades quite quickly and all sexual sensation stops. With some intense concentration, I may or may not be able to get it back. I have had no injury to my nerves as you have, this is in my opinion, much to do with hormonal dysfunction, positively affecting sympathetic inhibitive neural activity in the penis itself. Excessive testosterone can also cause this.
My everyday low dose of Tadalafil helps this greatly, but it can still occur during “stressful performance anxiety” producing sexual activity’s such as penetrative sex, whereby I need to increase the dose.
I am also not very keen on the use of AI’S as they are very powerful drugs and can be unpredictable. It’s very easy to drive estrogen to low and this can make you feel much worse than when its slightly too high. It is far better to lower the T dose so that conversion of T to E is more appropriate. This is how I do it. I tried very low dose Arimidex only for a very short time many years ago and it made me feel terrible. You can also get some estrogenic stimulation from HCG unfortunately. This is one of the undesirable side effects of HCG and can be more pronounced in some men, whilst others not so much. An AI will be useless preventing this as it is not a case of more T being converted into E, it is the HCG directly affecting the estrogen receptor. What dose of HCG are you taking?
I also agree with you that driving E below 20 seems excessive. It can take some time to correct a low estrogen problem from an AI. The correct level of E is also very important for our health. Too little estrogen is not a good thing!
It is very true as you mention that TRT for men seems to be so varied and not standardised. This is because it is still in my opinion, in its infancy. Doctors have many different opinions as some have only studied the older methods at medical school and not delved further into the topic to see what is new with regard to better methods of HRT, even with regard to the combination of HCG with T therapy. Some still advocate injecting esters like Cypionate every 3 weeks! Many prescribe Reandron, which I feel is one of the worst forms of T replacement.
This may interest you:
There is a gentleman who posts regularly over at Excelmale who has performed a revealing experiment on himself whilst being on testosterone. He has over the years while being on TRT and trying different protocols, come to the same conclusion that I have regarding the above. So he tested a protocol which he designed, that stimulated the HPTA to still function quite well while still taking exogenous T. He used Gonadorelin (GNRH), injecting it subq 6 times a day (to replicate some of the daily GNRH pulses we get as it has a very short half-life). He also used Enclomiphene citrate to block the estrogen receptor at the pituitary (which is one of the negative feedback points). He also changed the testosterone he was using to a very short acting ester and a very low dose of one longer acting ester injected daily so that the exogenous T he was taking would not build up and cause excessive negative feedback at the hypothalamus (long acting esters of T, injected in higher dosages more infrequently will cause the hypothalamus to further inhibit the pituitary).
He was successful at reinstating production of natural gonadotropins, doing the above after 2 months of therapy. The subjective benefits he noticed were: much improved sexual urge in the loins, improved sexual sensation, increased ejaculate levels and an increased need for sexual release more frequently. This protocol seemed to replicate normal sexual functioning far closer to any other he had tried previously. This protocol, unfortunately being very cumbersome is not something that could be realistically done by men needing HRT, but as an experiment it demonstrated to him (and me) the importance of gonadotropins to sexual function. Out of interest, he is still using the protocol and having the same consistent results. I think he also considering trying to experiment with another protocol that uses much less injection frequency of Gonadorelin with Natesto (nasel delivery short acting testosterone) and Enclomiphene to see if this still provides most of the benefits, with an easier protocol to follow.
The above is why I think a method of encouraging the HPTA to produce higher levels of gonadotropins and thus testosterone, will be the superior form of HRT for men in the future, if they suffer with secondary hypogonadism. Even men who suffer with primary hypogonadism, I feel will still benefit from having some upstream hormones in place.
The HPTA is a very delicate mechanism, finely tuning specific amounts of hormones to be delivered a specific times of the day. When large lumps of testosterone are administered into the body artificially it can throw this mechanism into chaos and the body literally goes into damage control trying to recreate some form of homeostasis. It is extraordinarily clever at doing this, as it has also an ability to adapt. However sometimes it is just too hard and substantial issues occur. It is easy to see why most forms of T replacement are quite crude and do not come close to replicating this mechanism which has evolved over millions of years. We still have much to learn and thus be able to develop medications or even gene therapy that can restore lost function.
Sorry for the length of my reply. I can get carried away sometimes! Hope it helps you understand a little more.
