TRT and orgasms

2

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  • never_againnever_again CanadaSilver Member Posts: 1,372

    So I called my dr. today and asked for a referral to a new endo.  I told him I didn't like the dr. he had referred me to, due to her rigid views on the issue (if you come back anywhere within "normal" range, no treatment required).

    He'd previously mentioned that his former med school roommate focussed on men's health issues, so hopefully he'll send me there.

    The man who gives his woman everything ends up with nothing. Not even the woman.
    Serenity
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Saw a dr. who specializes in men's health today.  Did a good assessment, checked all my past blood work and a physical.  He put me back on testosterone with a followup blood test and exam in 4 months.  No aromatase inhibitors as he says there's not a lot of evidence that they make much difference.  

    BTW, he made similar comments about endocrinologists not seeming to "get it" when it comes to andropause.  He said it's more about how you feel than about what your numbers say.
    The man who gives his woman everything ends up with nothing. Not even the woman.
    Angeline
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Update on this.  3 weeks and no noticeable improvement in drive or function.  I did tell the doc that before I was taken off it I was at 2 tubes of Androgel a day just to get my level to 18.  He didn't agree to that dose right off the bat but I'm guessing that's what will have to happen when I see him again in January.
    The man who gives his woman everything ends up with nothing. Not even the woman.
    Angeline
  • RangerJohnRangerJohn God's CountrySilver Member Posts: 179
    I was taking testim and got up close to 350. Dr put me on 1.5 ml injections of 200mg/ml every 2 weeks of testosterone cyph. Stated they like men to be above 1000. I'm at 1033 last test. I can like wise go 1  hr at times PIV before ejaculation.
  • Mr_BrownMr_Brown east coastSilver Member Posts: 3,636
    I requested that my doc give me monthly tests... He agreed and it has sped up some of my treatment adjustments... 4 months is a long time to go between visits... On 4 months I would be good for 2 months then I could feel the drop. (I'm on testopel). More data has proven some of my points. What sucks is that he won't treat unless I'm below 400. With the last dose I'm hovering around 450. He wants me to be between 600-800. It seems he's not treating for insurance reasons. 
    Been an uphill battle, both ways, in three feet of snow, with newspapers for shoes, but I'm a better man for it!
    Angeline
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Had a blood test 2 weeks ago and saw the doc again today.  He questioned me closely about my sex drive (there but not much), erections (hit and miss, even with ED meds) etc. and then advised me that my T levels were actually lower than when I wasn't on any at all. I kinda figured that because I had to be on max dose (10mg Androgel) to get to 18 before.

    PSA levels up slightly but that's to be expected.  He wondered about urination problems but I found the occasional problems I had before resolved when I was at 10mg.

    We also discussed injections but those are out because he expected me to go to my family dr. every 2-3 weeks to get them.  He also mentioned another type of gel that you put on with a roller like deoderant, but we decided to stay with Androgel.

    He wanted to just bump me to 7.5 to see what happens but I convinced him that everything worked well at 10mg so we're going with that for 4 months and then another blood test.  

    I talked to him again about aromatase inhibitors and he said no for now, but has agreed to include estradiol levels on my next blood test.
    The man who gives his woman everything ends up with nothing. Not even the woman.
  • seriouslyseriously The mittenSilver Member Posts: 1,134
    Learning to do the injections yourself is the way to go.  Seriously.  I maxed out on androgel quickly and it was a hassle to deal with.  You won't regret it.  Besides the inconvenience of going in for injections, 2-3 weeks between is too long.  You'll be on a T roller coaster.  Up and down, up and down.  Twice a week injections of only 50 mg is my steady formula.  Keeps me nice and even.
    AngelineWheelManleoslayerJellyBean
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Went to the men's health clinic again today.  2 months ago doc increased Androgel to 10mg daily from 5mg, after 5mg showed zero change in my levels or libido.  Latest blood test #'s:

    PSA 2.2 (actually down)
    Testosterone 28 (range 6.0-27 nmol/l) so actually too high
    Estradiol 161 (range 0-172)

    Doc refused to put me on aromatase inhibitors because I'm showing no symptoms related to the relatively high E level.  Says I'm still in range.  He's cutting me back to 7.5mg Androgel daily because the T is too high.

    But here's a mini-triage and I'd like some input, please.

    55 yo, 5'11, 210 lbs. No problems with alcohol, most weeks nothing but one or two beer other weeks.  No drugs. No smoking except for 2 cigars since I got back from Cuba in January and nothing for 3 months before the Cuba trip.

    Beyond that, you'd think with those T numbers I'd be crushing it in the gym, but after a layoff of 6 weeks due to a couple of minor surgeries and even though I cut my weights back 40% I'm finding it very difficult to get back to what I was doing.  The workout seems extra tough now and instead of looking forward to it I'm starting to dread it.  AFA my weight, I got down to 195 lbs but after starting to lift heavier weights I went up to 210 and am stuck there.   I'm not cut but I'm not flabby. 36" waist but wear a 48" jacket.  Yeah, I've got big shoulders. I'm happy with my muscle development except for my biceps.  Just can't gain any traction with them.

    In other news, I'm just not motivated. Work is going very well, but my home life is just meh.  I've no interest in my hobbies or interest in keeping the house up.  I can't say I'm down or depressed, I'm not sleeping my time away, I'm not drinking or drugging, don't play video games or watch tv.  I just don't seem to give a damn about anything right now.

    Financially, I'm in pretty good shape.  Retirement savings on track.  Low(er) mortgage that I'm doing accelerated payments on but am carrying a line of credit that I'm having trouble getting rid of, mostly because I'm living for today.  Of anything in my life, the LOC is probably the biggest stressor, with #2 being my love life.

    On that note, I've had zero increase in my libido.  The woman I'm dating has been travelling and only been home 4 days since Feb. 6.  You'd think running those levels, that I'd be hot as a rabbit but I've had no urge to rub one out or anything else.  When she came home we had a couple hot days but I still had trouble maintaining erection and I wasn't going apeshit to get in her pants.  Viagra or Cialis only help about 20% of the time.

    I like sex, I want sex, but I'm not crazy about sex and that's not the guy I was 5 years ago (and that led to a lot of heartache).  I watch porn maybe once a month but as a diversion, not a sexual release.

    I'd objectively put myself about an 8 now.  The woman I'm dating is all I've ever wanted sexually.  But she's about a 6.5 where other women I've dated (and lost my mind over) are usually 7.5-8.   I like this woman but I'm not head-over-heels about her and only met one woman who brought that out in me and she was almost a mirror of my ex, physically.  I've also had a marked increase in IOI's recently but have had no interest in following up on them.  

    The woman I'm dating is definitely more into me than I am into her.  I'd like a relationship but have increasingly felt that they're just too damned much trouble for what I get out of them.

    So, seeking the wisdom of the collective, what do you think is up?  Has my red pill consumption simply pushed my "Don't give a damn" meter off the scale or could something else be going on?
    The man who gives his woman everything ends up with nothing. Not even the woman.
  • AngelineAngeline planting seedsCategory Moderator** Posts: 14,501
    The red pill consumption is something to consider if by that you mean a lot of time reading and spinning up over it.

    What do your sleep levels look like?
    What's something kinda scary you could do to get some enthusiasm going? Improv class? Open mike? Ride along with your local paramedic crew? 
    "Speak your truth." - Scarlet
    Remember to play!
    Do the right thing, whether anyone is watching or not.
    Be married, until you are not.

    Email address: angeline.greenwood@att.net
  • WheelManWheelMan North of SeattleGold Men Posts: 162
    Increased total T is not so useful if your body rapidly converts the free T to estrogen compounds. I would recommend obtaining a second medical opinion on the elevated E2, and get it before you acquire the (often not easily reversed) symptoms from all that excess estradiol/estrogen. Even if you have to travel to a US men's health clinic and pay their $100-250 initial consultation fee.
    AngelineSerenity
  • John3John3 SeattleSilver Member Posts: 1,396
    WheelMan said:
    Increased total T is not so useful if your body rapidly converts the free T to estrogen compounds. I would recommend obtaining a second medical opinion on the elevated E2, and get it before you acquire the (often not easily reversed) symptoms from all that excess estradiol/estrogen. Even if you have to travel to a US men's health clinic and pay their $100-250 initial consultation fee.


    This is exactly right.  Your symptoms are low T.  Your E2 is way too high.  Needs to be in the 20's, or the Estrogen hogs up all of the Testosterone receptor sites...so the T just floats in your blood stream but never gets used.

    I had loads of trouble when I saw the "best" endo in my area.  He also refused to use an AI.  The vast majority of his practice is diabetes, and really has no experience about HRT. I finally found a family practice guy who specializes in men, who has extensive experience.  He prescribed the AI before I even asked about.  A lot of men have difficulty with gels in the long run...they get less and less effective.  Injections (which are easy to do) are the most reliable.  I do two a week, and it keeps me steady day in and day out.

    I have also noticed longer than previous O times.  Years ago I had a PE on occasion...so not having to think about that is a nice bonus. 

    The woods are lovely, dark and deep.
    But I have promises to keep,
    And miles to go before I sleep,
    And miles to go before I sleep.
    AngelinemaverickSerenity
  • never_againnever_again CanadaSilver Member Posts: 1,372
    @angeline no, I don't get spun up.  I only visit here and NMMNG and have not joined the "he-man woman hating club" though I'm honest in that I'll never marry again.  Doesn't mean I don't want a relationship but I've already lost one fortune to a woman so won't do that again.

    I do have CPAP (15 years) and my sleep has always been spotty since puberty (40 years).  I've accepted that my body only needs about 5 hours a night to function fine.  My hobbies are shooting, motorcycle, hunting (spot and stalk so good exercise) and I've participated in my share of adrenaline filled activities the last few years (some have suggested I'm an adrenaline junkie.  I'm not but if I see something cool I want to try it.)

    @Wheelman and @John3 this is the third dr. I've seen but the first dedicated men's health dr.  He just doesn't think the AI's work.  He did say that if my libido isn't increasing then he may consider taking me off T altogether.  He said that the ED can be helped by drugs other than T.

    I had a good chat with my pharmacist today and he said there are very few men on AI in conjunction with T.  He did suggest that if my E levels are still high next time to bring it up to the dr. again.  He said the concern is trying to balance the hormones without it cascading into problems with other parts of my body.
    The man who gives his woman everything ends up with nothing. Not even the woman.
    Angeline
  • John3John3 SeattleSilver Member Posts: 1,396

    Figure 4

    Eur J Endocrinol. 2011 Nov;165(5):675-85. doi: 10.1530/EJE-11-0221. Epub 2011 Jul 13.

    Onset of effects of testosterone treatment and time span until maximum effects are achieved.

    The woods are lovely, dark and deep.
    But I have promises to keep,
    And miles to go before I sleep,
    And miles to go before I sleep.
  • John3John3 SeattleSilver Member Posts: 1,396

    So it takes some time (see chart) for T treatment to have an effect.  "Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3-6 weeks with a maximum after 18-30 weeks."

    There is a pretty decent (although a little dated) article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701485/  

    AI's do work ... http://www.peaktestosterone.com/Testosterone_Aromatase_Inhibitors.aspx.  Some men need them, so don't.  I believe there is a connection between belly fat and how efficiently T is converted to E2...apparently I'm really efficient, because my E2 climbs quickly if I don't take an AI.  Taking half an anastrozole every other day keeps mine in the low 20's.

    The woods are lovely, dark and deep.
    But I have promises to keep,
    And miles to go before I sleep,
    And miles to go before I sleep.
    WheelMan
  • BettermanBetterman United KingdomSilver Member Posts: 659
    You also need to see your SHBG levels.
    ENTJ, 8w7
    Don't wish she were different, wish you were better.
  • never_againnever_again CanadaSilver Member Posts: 1,372
    OK, got some issues with High Blood Pressure going on. I've always had great blood pressure, but last time I saw the TRT doc they took my BP and it was 150/90.  He didn't make a big deal of it so neither did I.

    A week later, I had a dental procedure and had some bleeding problems during the procedure (gum graft).  They took my BP and it was 165/95.  Not really unusually given the stress associated with dental surgery.  But enough of a concern that I've been monitoring it weekly.  

    Bought a BP monitor on EBay and waiting for delivery but have gone to get it checked on the machine at the pharmacy.  Consecutive weeks it's been 144/81, 141/80, 135/76 and 147/77.

    I'm going to make an appt. with my GP to get checked out.  I've also cut back on my Androgel from 3 pumps/side to 2 pumps/side, to see if that helps.  

    I've noticed over a few months that when I'm lifting heavy at the gym I turn really red-faced.  Some people have also mentioned how red my face gets when I'm laughing really hard.  Dunno if it's related.  No other symptoms, though.  I feel great.
    The man who gives his woman everything ends up with nothing. Not even the woman.
  • SerenitySerenity Senior Moderator** Posts: 11,358
    Are you monitoring your hemoglobin/hematocrit. T therapy usually elevates both, sometimes too much.

    In fact, it used to be a primary treatment for people with anemia.

    If it's high, you can just donate blood every few months. That's normally enough to resolve the problem.
    Mr_Brown
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Thanks, @Serenity. Unfortunately I have a blood disorder that disqualifies me from giving blood.

    But I have an appt. with my GP on May 2. Doctor's secretary did tell me not to take just one reading, but to take 3 or 4 consecutively as apprehension often raises the first reading and as I relax consecutive readings will probably be lower.
    The man who gives his woman everything ends up with nothing. Not even the woman.
  • SerenitySerenity Senior Moderator** Posts: 11,358
    This is a real concern to me.

    Getting red when you exercise can be a sign of elevated hematocrit/hemoglobin. 

    The increased blood pressure can also be a signal that your red blood count is elevated

    This is a problem because a combination of high estrogen and high hematocrit/hemoglobin can quite literally be deadly.

    For those guys who have had cardiovascular events while on T therapy, it's normally because of some combination of elevated estrogen and elevated red blood cells.

    Please have your doctor check these levels. And I would even go so far as to say to talk to your doctor about cutting back or discontinuing T therapy altogether until you know what these numbers are.

    T therapy is safe when administered correctly. I have concerns about whether your doctor knows how to administer it safely. 

    Please don't wait before addressing this. It really can be quite dangerous. :-/

    Thanks, @Serenity. Unfortunately I have a blood disorder that disqualifies me from giving blood.

    But I have an appt. with my GP on May 2. Doctor's secretary did tell me not to take just one reading, but to take 3 or 4 consecutively as apprehension often raises the first reading and as I relax consecutive readings will probably be lower.


    btw, L-Arginine is effective at lowering blood pressure (also helps erections). It's available at Amazon and is relatively cheap. It's not a complete solution, but it might be helpful.
    WheelManmaverick
  • never_againnever_again CanadaSilver Member Posts: 1,372
    Thanks again, @Serenity.  I've been getting my TRT from a Men's Health specialist, but he's refused to try to address my high Estrogen levels (posted elsewhere in this thread). 

    I will have to ask about my hematrocrit levels but in the meantime I have cut back to two pumps per side (from three) on my own and I'll look at the L-Arginine.
    The man who gives his woman everything ends up with nothing. Not even the woman.
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