Treatment options for Hypogonadism

3 days probably isn’t long enough. Dunno about nebido, but took about 8 or 9 days for me to feel my first Test Enan shot.

About 6 weeks to feeling somewhat normalized. Gradual process, bits and pieces came back over time. Continued to get better. Again do not know about nebido.

Remember that your testosterone has been suppressed for a pretty long time without treatment. Tissues are starving for it, but it is going to take a while for them to be saturated with it. It is going to take some time for you to feel 100% better.

Interesting.

Interesting. It took you 8 days? That`s encouraging. I have read different reports about when people notice the effects from Nebido and 3 days is too early to really feel anything from that alone, but I had fairly elevated testosterone levels already from the HCG, so I thought maybe I would start to notice something.

I have had 3 great days in the sun lately, so I don`t know if that`s it, but I think I`m feeling a little more rested for the last days and less fatigued.

I will just stick with the treatment and see what happens over the next weeks. I am a little worried though that the elevated E2 is a problem, so I think I may want to get blood work before the next shot. Maybe this week. Maybe the E2 levels stabilize in time naturally. I`ve heard that happen as well.

Did you ever use an AI?

With my free testosterone being that high, I`m not sure if the elevated E2 would block the benefit of elevated testosterone in some way?

Regards,

Renholder

Still not feeling much at all, if anything, one week after the Nebido shot.

Is time on my side or should I start getting worried? Where is the raging wood and urge to copulate with all the females on earth? :)

I had a few days where I possibly felt a little more rested, but it could just be random. I also had a day where I had very “full” wood. Strong and thick. Not sure if it actually was larger, but it is a feeling of fullness that makes you know things are like they should be. Only lasted for one day though.

Hey Renholder, sorry for not responding regarding my appointment, been a lot on the plate lately and I had to prospone getting it checked out.

Good to hear you actually got it though.

Regarding feeling the effects of the nebido don’t worry as it might take as long as 2- 3 weeks before you actually feel the effects of it, with enatathe it is written that it might also take 2- 4 weeks before you feel the full effect of it. Even with propionate which is the fastest ester of testosterone it can take as much as 1- 2 weeks before people feel the effects.

It was about ten days before I felt it kick in for me. Now that I inject weekly I notice it by the third day. I feel warmer and spontaneous erections are plenteous.

Appreciate the input guys.

I just wonder if I may really need an AI right now and if that could be the solution, since my testosterone levels already were fairly high on HCG alone.

I started using zinc, which I tested low range for, and it is supposed to have AI effects, at least with guys that are deficient.

Do you use an AI, Titleist? How long did it take for you to reach peak or feel maximum effects of TRT from you started? Did you feel shitty prior to TRT?

Regards,

Renholder

I’m not sure what an AI is? I was tested because I’ve always thought I might be low due to having only one good testical. I was about 400 on the scale so the doctor gave me a shot of a fairly high dose. It took a while for me to feel the affects.

Now that I inject regularly I sleep better, have more energy, thoughts are clearer and my libido/refractory period are like they were when I was in my twenties.

Armed with the info from here the doctor thought it would be best to do a weekly injection. He still thinks I should use HCG but my insurance doesn’t cover it.

AI = aromatase inhibitor.

It reduces elevated E2 which is an issue with many people on TRT treatment, but obviously there is a lot of people who don`t need it and that`s all the better. I don`t think Sta-Kool uses it either, if I remember correctly.

Please allow me blame my brainfog, if I keep repeating questions. :)

From what I`ve read, HCG is always a good idea on TRT, not just for testicular size, but there are other benefits as well since testosterone is not the only hormone produced in the testicles.

Is it really expensive in the US?

Here in Norway HCG is so cheap that I could pay out of my pocket for the rest of my life. 10$ for a month`s use. Usually, things are way more expensive here in Norway, so it`s the first time I`ve heard the opposite.

Glad to hear it`s working out for you.

Regards,

Renholder

My never-ending saga continues …

I haven’t seen my actual lab values yet, but I did have a discussion with my endocrinologist over the phone today. Apparently, my TSH, T3 and T4 were all fine, vitamin D was a little low, and the rest was just confusing.

My FSH was “very high,” and I think LH was also described as “high.” Based on that, the doctor would have expected to see low total T, but my total T was 562 ng/dl — pretty near the middle of the normal range, and significantly above either of my previous total T measurements. At the same time, my SHBG was high and my free T was scraping the bottom of the “normal” range. (My prior free T values ranged from below the lab reference interval, to just barely above the reference range when total T values were more 400 and 450ng/dl.

Anyway, the upshot is …
ANOTHER round of lab work, because the doctor thinks the total T value might be an error. In the meantime, he took pity on m and is going to send me a Cialis prescription along with the order for lab work.

I’m really glad he didn’t take the new total T result at face value, but it’s still discouraging not to have a resolution - again.

For other guys out there who think they may have low T issues, I’d say: you can’t always count on getting to the bottom of things in one or two doctor visits. Some patience may be required (not my long suit in the best of times), so don’t wait until you are completely frustrated/feeling hopeless before seeking a medical consult.

Just stick with it, meatbuilder.

It does not sound like you have secondary hypogonadism at least. Very high levels of FSH/LH could indicate primary hypogonadism. Unless you really feel bad, your total T does not look that bad IMO, but if SHBG is high it will lower your free testosterone. I believe there are ways to lower SHBG, but I`ve heard it`s not very easy.

Most important, how are you feeling? Did you get my PM about cialis?

EDIT: Are you supplementing with vitamin D? I`ve heard vitamin D mentioned time and again as a very important vitamin for proper endocrine function.

Quick update from me as well.

I got back from the doctor right now and got a renewed prescription of Nebido, HCG and Cialis. I was prepared to persuade him to write me a prescription of Arimidex, but my E2 was half of what it was last time and back in range, so I did not even dare to ask. I probably don`t need it either.

Bloodwork looked pretty much the same, with testosterone being 1 point lower (not significant). I think my thyroid looks good, but I will have to verify that later. Cortisol was fairly high and actually marked of as significant, but my doctor did not want to do anything about it for now.

As for how I feel, I do not notice any significant improvements in any area. I have imagined my elevated E2 to be an issue, but it seems like that is not the case after all provided I can trust the test (not a sensitive test). I am stronger in the gym lately, despite of being in a slight calorie deficit, so maybe something is happening.

I slept with a new girl this weekend, but my libido and EQ were not the best. That`s why I asked to get Cialis, which I intend on using 5 mg ED for one week and then EOD or 2,5 mg ED from there. Hopefully it will help.

Having read around about Nebido, there are guys who don`t experience the benefits until months after their first shot, so I`m just going to stick with it and don`t spend too much time thinking about it from here. Next shot is due at 6th of July and from there I think I will inject with a 9-10 week interval.

Regards,

Renholder

An interesting study on tadalafil.

J Sex Med. 2006 Jul;3(4):716-22.

Testosterone:estradiol ratio changes associated with long-term tadalafil administration: a pilot study.

Greco EA, Pili M, Bruzziches R, Corona G, Spera G,Aversa A.

Internal Medicine, Department of Medical Pathophysiology, University of Roma La Sapienza, Rome, Italy.
INTRODUCTION: It has been reported that lack of sexual activity due to erectile dysfunction (ED) may be associated with testosterone (T) decline. AIM: To investigate whether the known changes in sex hormones associated with resumption of sexual activity are sustained in the long term. MAIN OUTCOME MEASURES: Primary endpoints were variations from baseline of steroid hormones: total T, free T (f T), and estradiol (E). Secondary endpoints were variations of erectile function domain scores at International Index of Erectile Function-5 (IIEF-5). METHODS: In an open-label fashion, 20 patients (mean age 54.8 +/- 8.4 years) received tadalafil 10-20 mg on demand for 12 months. Exclusion criteria were those reported for phosphodiesterase inhibitors, including hypogonadism and hyperprolactinemia. RESULTS: Tadalafil assumption was safe and well tolerated (overall adverse effects in 15% of patients) and none discontinued medication. A significant decrease in E levels occurred at the end of the study (from 19.9 +/- 9.6 to 16.6 +/- 8.1 ng/dL, P = 0.042 vs. baseline), with parallel increase in the T:E ratio (26.3 +/- 15.3 to 32.6 +/- 17.7, P = 0.05), whereas no changes in T and f T serum levels were observed, respectively (411.4 +/- 131.4 to 434.2 +/- 177.1 ng/dL and 47.7 +/- 15.3 to 49.9 +/- 19.1 pmol/L, not significant). Interestingly, nonparametric subgroup analysis for related samples revealed that E decrease was detectable only in lean (N = 14) but not in obese (N = 6, body mass index > 27.5 kg/m2) subjects (17.8 +/- 10.1 vs. 13.5 +/- 6.8, P < 0.05). A net increase in IIEF-5 scores was observed at the endpoint (13.7 +/- 5.9 vs. 25.7 +/- 2.9, P < 0.0001).

CONCLUSIONS: Sustained improvement in sexual function after 12 months of tadalafil administration is associated with increased T:E ratio mainly related to reduction of E levels. We hypothesize that androgen-estrogen cross-talk and possible inhibition of aromatase activity during chronic exposure to tadalafil might have a role in the regulation of erectile function.
PMID: 16839328 [PubMed - indexed for MEDLINE]

From MD magazine.

Cialis Increases Testosterone ! Based on the research, acute dosages of Cialis do not have performance enhancing effects, but new research suggests that Cialis increases testosterone! Researchers had participants perform three 30 second “all out” sprints to exhaustion and measured testosterone and cortisol responses to exercise. They found that only after Cialis and exercise did increase testosterone however Cialis also increased cortisol levels as well. Cialis also lowered the DHEA to cortisol response. The study demonstrates that Cialis increases the “stress” response to the body but also has some testosterone enhancing effects as well. It’s interesting that a large dosage of caffeine which is a weak non-specific PDE inhibitor also caused an increase in testosterone and also an increase in cortisol21. So it seems that Cialis has both positive and negative effects on muscle. Cialis does not directly stimulate testosterone secretion per se, meaning it does not stimulate LH release or SHBG release directly. This is not the first study to find that Cialis raises testosterone:

In a study of 74 patients whom were treated on demand with 50 mg of Viagra or 20 mg of Cialis for 3 months in patients with erectile dysfunction. Basal level of total testosterone and free testosterone were at the bottom of the normal range that was reversed after treatment in both groups. Testosterone increase in Viagra-treated cases was significantly lower than in those treated with Cialis suggested to be due to the higher frequency of full sexual intercourse in the Cialis -treated group15.

Interesting, another study reported that the increase in testosterone from taking Cialis is mediated by a reduction in estrogen demonstration that Cialis may have anti-estrogen actions. It was found pointed out that T/estradiol ratio was changed associated with long-term Cialis treatment. There was no increase in LH levels from Cialis demonstrating that Cialis did not directly increase testosterone but indirectly increased testosterone by lowering estrogen16.

One of the primary reasons that many older men have problems “rising to the occasion” is that they have excess estrogen levels. Furthermore, in men with hypogonadism, a low dose of clomiphene citrate (Clomid ) is effective in improving Testosterone: Estrogen ratio, thus giving more long-term benefit for the management of erectile dysfunction in hypogonadal patients18. It seems that based on the current study Cialis has similar actions to Clomid by improving T: E ratios.

Interesting read, Renholder. Glad to hear your E2 is moving in the right direction. I also read somewhere that some guys don’t see all the benefits of Nebido for several months, so I think you’re right to give it plenty of time.

As for my total T levels, I was never at the “rock bottom” for that parameter, but the doctor questions the accuracy of my most recent results, which are hard to reconcile with my high FSH/LH levels and prior testing patterns. Thus, the new round of testing.

Feeling-wise, things are about the same. Fairly unfocused, hard to get and stay motivated for most things. EQ is all over the place — well, say between 0 and 4 or 5 on a 10 point scale. Bad sleep patterns continue. Still getting to the gym (long time gym rat habit), but I’m increasingly embarrassed by the quality of workouts I’m putting in.

Judging from limited sample pack experience, I’m hopeful Cialis will at least improve function (and all important confidence). If it does anything for T levels that would be a bonus. I don’t think my E2 levels were measured, so I have no info regarding T/E ratios.

Thanks for reminding me about the vitamin D. Considering what a sun-worshipper/abuser I am, I was surprised to come up even a little low in that area. I haven’t done anything about that yet, but I’ll pick up a supplement later today.

Wow, you got Nebido and HCG? I really need to meet up with your doc. My inferior beard growth frustrates me sometimes.

As for the Nebido I’m not surprised it takes that long for the true effects of it to set in as it’s a slow acting agent/ester. Some guys using testosterone for building purposes often don’t notice the effects of Test enanthate until the 6- 7th week and that is a faster ester than Nebido.