Hoping to get your opinion and perhaps referral to a doctor who would consult over the phone
I'm 35, male, 5'10 (178 cms), 155 lbs (70 kg), not obese or fat, of average fitness
2013, age 30
: No health problems. Got a regular check-up done. Nothing was flagged. Lab reports attached.2016, age 33
symptoms. Took Cialis 10mg
for the first time and it worked like a charm. Erection lasted 3 days! Great.2017, age 34
: ED worsened
. Upped to Cialis 20mg
. But effect would wear off in less than 24 hours
. Got concerned, went to a Urologist in Manhattan, New York
. He pulled Testosterone, Prolactin, E2 etc and said everything is normal and that everything is in my head. I need to relax and reduce stress. 2018 March, age 35
: Feeling low energy and reduced cognitive abilities. Like mental fog. Also in terms of ED: Cialis now completely stopped working for me. I took 30mg of Cialis (3x my dosage from 2016!) and effect would last only a couple of hours. And even then it'd be a semi erection.
I happened to be traveling to INDIA
where you can walk-in to labs and get any tests done without doctor's referral.
- Testosterone came out as 140!! Super low.
- Thyroid TSH : 5.75, higher than range
Went to an Endo in India and he said:
- -> You've subclinical hypothyroidism. Ordered test for antibodies and when that came out negative, he said, it is not an autoimmune disease, it is only slightly outside range so no medication needed.
- -> Testosterone: you've low T and I'll prescribe a single shot of Sustanon (Testosterone) 250mg.
I read forums and thought that wasn't a wise protocol. So, I didn't take it. Instead, I started self-medicating
- 1. Thyroxine 125mcg
- 2. Nolvadex 25mg EOD
I did this for 6 weeks until 2018 June
.June 2018, age 35
: Felt better energy, better mood, improved mental clarity. Figured because I'm self medicating, I should re-do labs to see if I'm dosing correctly.TSH was almost ZERO
. So, I reduced dosage to 100mcg
down from 125.Testosterone had improved to 400s
. But no changes in ED. Still dead penis.
I stopped Nolvadex. And instead, I added T-gel (1% Cernos)
to my routine. But it was too much (15ml) amndinconvenient. I did it for 2 weeks and got tested again. T had now increased to 700
+! GREAT NEWS. And My ED symptoms had reduced somewhat. I woke up with semi-erection. Some life was coming back to my penis and I thought that's progress.
Anyway, because it was inconvenient, I decided to take injections. And took a shot of 250mg Sustaon Testosterone.
Woke up next day with no morning wood and also feeling very drowsy, low energy
. I waited a couple of days and same thing, still fatigue.
So, I went and got tested again.July 2018, age 35, 3 days after T injection
: T had gone up to 800
+. Good news. But E2 had also gone to 47. So, perhaps that was causing ED. Cialis didn't help either. But this time I also got SHBG pulled. And it was LOW (13ish).I looked at my lab report from 2013 (that's the only other time I had gotten SHBG pulled) and it was 15
at that time too. But in 2013 I had no ED, no energy, mood or mental fog issues. I felt perfectly healthy.
and my T was only in 300s in 2013.
So, I kept reading forums and learned that low SHBG is NOT good for TRT protocol
. So, I'm now confused as to where to go next from here.
It seems like:
1. I should continue Thyroid medication of 100mcg
per day as that definitely did help with a lot of things.
2. But TRT - I'm unclear. Where to go next?Some options in my head but I don't feel confident taking any of the routes:Option 1
: Switch back to T gel daily. I can get compounding pharmacy prescription for a higher potency gel (say 5-10% potency) so I've to apply a lot less. Applying 3ml per day vs applying 15ml per day is a huge difference.Option 2:
Because I keep reading that injections is way to go, people feel better and gel stops working at some point, how about I inject a long ester T with some AI? For eg: Testosterone Undec 200mg every week + 25mg Aromasin E3D + HCG 250 iu injection E3D. (HCG to preserve fertility). Would that work?So, basically, it looks like my self-medication for Hypothyrodism is fine and I need to continue it. But I'm lost on TRT.
Summary of all labs attached.