Setting Expectations

Low testosterone issues, impacts on health & marriage, treatments, etc.
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be64
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Re: How high Estradiol is too high?

Postby be64 » Tue Jun 14, 2016 9:32 pm

Your testosterone is a little low and your estradiol is a little high. Your SHBG is on the lower end of the range which will give a better free t level but also will allow more free estradiol. Your symptoms sound like low T to me. I've had the same symptoms. I do daily SQ injections of both testosterone cypionate and HCG. I also use 5mg Cialis Daily.

I don't understand why your doctor would say that your insurance wouldn't cover SQ. Why would the insurance company need to know that information. Just have your doctor prescribe self injected IM then do SQ.
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Re: How high Estradiol is too high?

Postby SquarePants » Tue Jun 14, 2016 9:53 pm

I agree with everything that BE64 wrote. I'll add:

If your initial estradiol lab results were reported as "<20," then this leads me to suspect that your doctor did not order the "ultra sensitive" estradiol lab, which is the appropriate lab for measuring estradiol levels in men. The ultra sensitive lab test is able to measure levels below 5. If so, then your level of 33 may not be very accurate.

I'm not sure how your doctor defines "unproven," but there are multiple studies which showed that subq injections are equally effective when compared to IM injections. You can order smaller gauge syringes and do subq injections. Or go with IM injections, which is what many people do.

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Re: How high Estradiol is too high?

Postby be64 » Tue Jun 14, 2016 9:59 pm

I'm proof that SQ works. I inject 16mg per day testosterone and 70IU HCG per day and get a T level of about 1100. I'll add that I've been doing this for many years.
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Re: How high Estradiol is too high?

Postby justsomeguy » Tue Jun 14, 2016 10:36 pm

be64: what's the HCG & what's it's purpose?

Your T level sounds impressive! Was that the level your doc targeted, or the level you feel well again at? I'm a little disappointed my doc was totally fine with my current T level and didn't seem to want to set a higher level as a goal. I definitely felt better (not perfect tho) when the pellets peaked my T in the 800's.

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Physical or psychological?

Postby justsomeguy » Sat Jun 18, 2016 8:08 am

At the beginning of the year I was diagnosed with low T and started TRT (pellets) mid March. That helped (T peaked in the 800's), but did not fully alleviate my symptoms, and now my T is falling again (600's last lab test 10 days ago). Estradiol crept up a bit but not major.

Erections aren't my problem. I can always get one with a little coaxing. My major problem is sensitivity (low pleasurable feeling) and therefore an inability to finish, about 30 % of the time. But the pattern seems so strange as to when it happens. Last week I was able finish 4 days in a row. We took a day off (me: long cycle ride, she sore-more on that later) and then the following day I again experienced very low sensitivity (even given oral) and immediately knew it wasn't going to happen that night.

In all the mix this year we've had the biggest relationship challenge we've ever faced (all due to a colossal misunderstanding/ jumping to worst conclusion) that's thankfully behind us (but was excruciatingly stressful). And then the huge stressor: The day before Mother's Day we were cycling together and she was hit from behind by a car doing 60mph. Most traumatic thing I've ever experienced. She couldn't hear me (hard head impact, God saved her thru helmet) and she was convinced she was dying (not panicked, but convinced). Her eyes rolled back into her head & lost consciousness. She was airlifted out & the police immediately ordered a full forensic reconstruction- something they only do for fatalities. That's what their assessment was - she's going to die. But she didn't, all praise to Christ. Utterly miraculously she suffered no major internal injuries, no major broken bones, and no major head trauma. She "just" has a major concussion, some fractured bones and to-the-bone bruising all down her left side. All of which she's still dealing with on a daily basis.

Earlier this year she had an awakening & she's nothing but pro-sex and tells me the O's I give her really help with the pain (the endorphins released I assume). But I know there are times where I'm terrified at hurting her inadvertently - moving her suddenly or absent-mindedly grabbing her in a moment of passion that might inflict pain. It has happened a few times. I know I am very sensitive to seeing any woman in pain, especially in any kind of sexual situation. I can't bear to watch rape scenes on TV for example.

My guess is that I'm experiencing both physical & psychological challenges. My doc gave me some Ciallis samples to try but at age 47 my wife thinks "you don't need a pill". I hope she's right & I haven't tried them yet. On the other hand, my inability to always finish is affecting her as well.

So the big question is: do I visit the secular therapist recommended by my urologist?

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Re: Physical or psychological?

Postby Leah » Sat Jun 18, 2016 9:03 am

Maybe your doctor can recommend you to someone to explore the psychological side of it?
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Re: Physical or psychological?

Postby txtwindad » Sat Jun 18, 2016 9:13 am

At 47 you are smack dab in the age range where ED often begins.

But your symptoms sound more like high estrogen. Decreased sensitivity and trouble reaching orgasm. I had a lot of trouble with this a few years back. I found once we got my T injections dialed in and dealt with the estrogen issue all those problems gradually went away.

Are you being tested for estrogen levels with a high senitivity test?
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Re: Physical or psychological?

Postby justsomeguy » Mon Jun 20, 2016 9:29 am

Estradiol level is ok - 33 pg/mL (but risen since previous test). I'll need to ask whether the lab uses the high sensitivity test.

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Re: Physical or psychological?

Postby justsomeguy » Wed Jun 22, 2016 7:33 am

Ok here's what my doc said when I asked whether the lab is performing the "high sensitivity" estradiol check:

There has been a lot of substandard research done in the realm of estrogen and men. The estrogen that our lab does is considered sensitive, however, it is not able to detect levels below 20. I use estradiol (a form of estrogen) to help me calculate a ratio of testosterone to estrogen. I like this to be about 7-10 which has been agreed upon by most sexual medicine societies in the world. There are some theories that this ratio may help with some libido issues. Your ratios are 18.5 and well above the 10 limit. I am not concerned that there are other issues that we need to worry about. Much of the literature available on hormones for men and women are empirical and written from a vantage point of truth. The reality is that we don't have good strong evidence or clinical trials that prove the presumed truth in most cases.

I hope this helps.


So, according to him, estradiol is not a factor whatsoever with me. Do you agree?

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Re: Physical or psychological?

Postby Hoosier52 » Wed Jun 22, 2016 4:49 pm

From what I've read and learned, he is absolutely wrong - but most non TRT doctors are. I wish they'd just admit it. If you E2 is too low it can cause osteoporosis. Too high and it creates bloating, moodiness, etc. Both extremes effect your libido and ability to perform.

My current TRT doctor is about to be my former TRT for some of the same reasons. I'm going to go with Defy Medical, some of the top TRT doctors in the nation and on the cutting edge of HRT. Your hormones are too important to let some untrained doctor experiment with.

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Re: Physical or psychological?

Postby justsomeguy » Wed Jun 22, 2016 8:07 pm

He's at least checking for E2, and supposedly the sensitive test, but it seems he's only concerned about the ratio of T : E2 and not the precise E2 level.

This doc is a relatively young (guessing early 30's?) urological surgeon, but he's in the "Sexual Wellness" clinic of our HMO. According to him he sees a large number of patients for TRT. It seems his strategy is get the T up (either Testopel or IM self-injections) and then treat anything else with a menu of pharmaceuticals to address any other lingering symptoms. He said there's even one that you shoot up your nose and within seconds that will "get you over the edge". Something that goes right to the brain :?:

On the big plus side, most things he prescribes is covered by insurance, which is huge. My first Testopel procedure was nearly $3 grand :shock: (thankfully covered). That said, he did give me some Cialis samples to try but my wife hates that idea. I also got a bit wigged out by him describing "what could go wrong" (a 'permanent' erection that would end up being my last natural one ever) along with prescribing the 'emergency' pill should that happen ::xx

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Re: Physical or psychological?

Postby SquarePants » Wed Jun 22, 2016 8:48 pm

It doesn’t sound like your doctor is using a very sensitive E2 test. Even my old Labcorp standard E2 test from 2004 could measure levels down to 15. A test that can’t measure below 20 isn’t a very sensitive test. Both Labcorp and Quest Diagnostics have an “Ultrasenstive” test which is pretty standard for men getting their E2 levels checked. The Quest ultrasensitive test can measure down to 2. I’ve found examples where men ordered both the standard and ultrasensitive test for the same blood draw, and the reported results were dramatically different. If standard test returned a level of 33 and you are exhibiting symptoms that are consistent with high E2 levels, I would be suspicious of the results.

justsomeguy wrote:On the big plus side, most things he prescribes is covered by insurance, which is huge. My first Testopel procedure was nearly $3 grand :shock:

This may be the root problem. He may be prioritizing treatments by profit. His emphasis on pellets was my first suspicion. My wife got a single pellet inserted and it was only about $300-$400.

Having said that, you are nearing 50, so it’s possible that circulation issues are becoming a factor in your ED. That’s still not a psychological cause. However, if you recently were not having any problems, then I’d be inclined to believe that your elevated E2 may be the cause. As I probably mentioned earlier, you can try 50 mg Zinc. This may not help if you aren’t deficient in zinc, but it’s cheap and it probably won’t hurt.

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Re: How high Estradiol is too high?

Postby be64 » Fri Jul 01, 2016 10:52 pm

HCG mimics LH which stimulates the testicles to produce testosterone. By using this my body should be making some testosterone rather than the testicles just shutting down due to the presence of exogenous testosterone. The effect of this is that the testicles do not atrophy while on testosterone, but maintain their size if you are vain like me and don't want small testicles. HCG is also,supposed to help give a better sense of well being than just using testosterone.

My doctor is mostly just concerned that my testosterone level does not go over the top of the range, which it has at 1400. He has told me that my level is probably higher than 90 percent of men. My suggestion would be to get your level to the top of the range and see how you feel. If you don't feel better at 1000 than you do at 800 then it's not likely a benefit to be at the higher level. But if 1000 feels better then I see no reason why you shouldn't have a level of 1000 even if that is higher than most men.
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Re: Setting Expectations

Postby cev » Fri Jul 08, 2016 8:33 pm

Justsomeguy- How is your pellet therapy going? My DH had the pellets inserted three weeks ago with no noted improvement.

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Re: Setting Expectations

Postby justsomeguy » Sat Jul 09, 2016 10:46 pm

I'm very disappointed with the pellets. Doc said they could last up to 8 months. In less than 4 they were toast with me. Worse, there was only about a 3-4 week period in that 4 month window where I felt some improvement- maybe up to 75% of where I was just a year ago. I'm not looking to feel 18 or 25 or 35. I'd be excstatic to make it back to where I felt at 45 again.

This one pellet procedure billed my insurance for nearly $5k. And if it were up to him this would repeat every 4-5 months :shock: When I mentioned my continuing symptoms a month ago he gave me some Cialis samples (I'm torn about that and fear I could get dependent on C, high cost, side effects, etc). By email I've now told my doc I want injections instead so that's what I'm starting next week. Not loving the idea of a big IM needle multiple times per week but if it cures my low T symptoms I'll be very grateful.

Maybe pellets work for some but for me I'd say FAIL!

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Re: Setting Expectations

Postby mom210 » Sun Jul 10, 2016 6:44 pm

justsomeguy wrote:By email I've now told my doc I want injections instead so that's what I'm starting next week.

Are you getting them from your Dr or doing them at home? The shots I mean.... because you could do sub q....with a lot smaller needle.

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Re: Setting Expectations

Postby cev » Mon Jul 11, 2016 9:55 am

Mom210:
What is your DH currently using?


cev my dh is currently doing injections...he has done this for the last few years...he uses 100 mgs every 3.5 days...for a total of 200 mgs a week.
He does very well on this....good drive, energy, and health.
He is 57 now and is in his 4th year of a bachelor's degree at our local college, he works full time, and goes to the gym between 3 and 4 times a week. He has a lot of energy and is happy.

We have been incredibly fortunate in that he has had great drss too work with him.
We eventuality found ourselves at an anti clinic to get dh s dosing where we wanted it..but now have switched back to his primary Dr who is following the same dosing and method of delivery that the anti aging Dr used.

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Re: Setting Expectations

Postby justsomeguy » Tue Jul 12, 2016 1:27 pm

Got my first stab of T yesterday. He's given me 100mg of 200 mg/mL via IM once per week. Had to beg him to monitor Estradiol but that's in the lab order now.

I was Jones'n for a positive encounter with my wife so I took a 5mg Cialis Friday night and definitely felt a (positive) difference. But then most of Sunday I had strange leg aches. Doc doubted any connection. Since it looks like I'm now dependent on TRT for the rest of my life I REALLY don't want to become dependent on any additional pills too :?

On a positive note I feel a returning of some libido today :D

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Injection site soreness

Postby justsomeguy » Wed Jul 13, 2016 10:24 pm

Good news is I'm done with pellets. Bad news is my leg feels like I've been smacked by a baseball 2+ days after the IM injection. Since I'll be doing this once per week (alternating legs) I'm hoping my new reality won't involve constant muscle soreness. Does anyone have any tips for mitigating muscle soreness?

Not sure if it's relevant but I did a 50 mile ride (cycling) about 5 hours after the injection.

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Re: Injection site soreness

Postby Hoosier52 » Thu Jul 14, 2016 5:27 am

What size needles are you using and are you doing IM or SubQ injections? I do SubQ. I've had very little soreness but have had red, itchy bumps where I inject. A doc told me to massage the area after injecting. That seems to help.

SubQ with insulin needles is the way to go. Also, dividing the dose into two shots per week is the more up-to-date protocol.


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