What should I request in Blood work to look for cause of recent start of ED?

[halfape211]

Looking for suggestions on what blood work to get done that might help me figure out why now having ED problem. About three or four months ago, all of a sudden, ED. First time ever and it has not gone away. No blood tests were taken at start of problem. A month or so after the start of ED, my E2 was 45. I adjusted my A1 dose and my E2 went up to 160 a month later. I doubt this was the cause, but roughly around the start of the problem, I was put on Prednisone for a week or two. My desire for sex is strong, but my ability is weak. At the start of the problem, I was taking 150 mg of T per week and two half pills of A1. Since then my T has been increased to 225mg per week, with great results, except no improvement with ED. Been on TRT for about nine months. My doctor has taken very limited blood work. No hormone base line was taken at time of start of TRT except my E2 was 85 within the first few week of starting TRT (the next morning after taking my first half A1 pill.)

I am just looking at what tests to ask for in my blood profile as I think this is the cause, partly because it came on suddenly. I would ask my Doctor, but he really would only test the very basic items. Once I have the blood work done I will have to solve the problem with the help of this forum, because I know my doctor will not know enough to figure it out.

I assume I should get tests for: Estrodiol, TT, prolactin. DHEA, cortisol? SHBG?
Hopefully, someone can give me a list that should help figure this out.
Thanks

 

[Megatron28]

I think you already know the answer to the cause of your ED. It is your high E2. That is a classic side effect.

Which aromatase inhibitor are your taking and at what dose? How much test are you taking now? Are you taking anything else (e.g. hCG)?

By the way, it is AI, not A1 for Aromatase Inhibitor.

 

[halfape211]

I think you already know the answer to the cause of your ED. It is your high E2. That is a classic side effect.

Which aromatase inhibitor are your taking and at what dose? How much test are you taking now? Are you taking anything else (e.g. hCG)?

By the way, it is AI, not A1 for Aromatase Inhibitor.

Hey, Megatron,
Sorry, I should have mentioned I'm using Canadian measurements. So actually my E2 numbers were on the low side around this time. In Canadian numbers I was 45 and feeling pretty crappy. (Under 200 is considered normal). Some say E2 around 40 is a crashed level. Then I lowered my AI dose which increased my E2 to 160, a month later. And still no improvement at anytime between the 45 and 160.
I agree that high E2 will cause ED. But during my first few months I went from 85 down to 45; from working to not working; from normal to low. It was at a time closer to and just prior to the 45, that the problem started. It was almost like my problem is from low E2.

As I wrote before. I was on 150mg of T and .5 mg AI pill twice a week. After the problem started, I played around with the dose and did not find the sweet spot, even though my E2 went up to 160. So now I'm using 1mg Anastrozole per week, until I make an adjustment from my next blood work for the E2. I was on 150 mg T per week when the problem started and lately it's been increased to 225/week.

The only other variables was the Prednisone and I was getting lax on taking the 10 mg of Progesterone cream about the time this problem started. My doctor who is TRT specialist believes it is a hormone problem and not vascular, for a couple reasons. He will be doing blood work to try and figure it out, BUT honestly..., you guys know way more than even this specialist.

So, I would really appreciate it if you would head me in the right direction so I can ask for tests that might help me with this problem. I've never had any tests other than TT, free T and E2, so it might not hurt to get a more comprehensive blood work done anyways. I will also get whatever tests you recommend, just for my own health.

And I definitely will dial in my E2 over the next few months to the previous 85, by getting my E2 checked every couple weeks and adjusting my AI dose, but I do not think it is that simple. That's why I want to get a comprehensive Blood Test. I've had this problem for 5 months now, and want to do all I can to fix it ASAP.
The closest I have to my baseline before TRT was an 85. At the time of the 85, everything was working fine. I will try to get my E2 at that level again, just to cover all the bases.
Thanks

PS Not taking anything else, except Anastozole and not HCG. Going back on Progesterone (been off it for about 4 months). My natural HGH was checked and it's good without supplementing.

 

[Megatron28]

Check your Prolactin. High Prolactin can chase ED. Might not hurt to check your TSH for thyroid too as that can affect hormones.

How is your blood pressure? Getting low by any chance?

P.S. Including reference ranges with your blood work results is always helpful. Each lab is different with their ranges.

 

[halfape211]

Check your Prolactin. High Prolactin can chase ED. Might not hurt to check your TSH for thyroid too as that can affect hormones.

How is your blood pressure? Getting low by any chance?

P.S. Including reference ranges with your blood work results is always helpful. Each lab is different with their ranges.

Prolactin - check
TSH - check

Interesting you ask if my blood pressure is getting low. Low?? I just assumed blood pressure sometimes went higher with more T. Anyways, so far my blood pressure is stabile and usually around 120 over 68-70. (I run 10K a couple times a week to keep my ticker in shape.) A few months ago it occasionally dropped to 120 over between 58 to 60. I'll get the results in a few weeks and post them with reference ranges.

 

[Megatron28]

Prolactin - check
TSH - check

Interesting you ask if my blood pressure is getting low. Low?? I just assumed blood pressure sometimes went higher with more T. Anyways, so far my blood pressure is stabile and usually around 120 over 68-70. (I run 10K a couple times a week to keep my ticker in shape.) A few months ago it occasionally dropped to 120 over between 58 to 60. I'll get the results in a few weeks and post them with reference ranges.

Just because you ar on TRT doesn't mean you can automatically assume that TRT is the cuase. For example, maybe you just changed your blood pressure medication dosage and now you are getting ED because not enough blood is getting to your penis to sustain an erection. Sometimes ED is just ED.

 

[halfape211]

Just because you ar on TRT doesn't mean you can automatically assume that TRT is the cuase. For example, maybe you just changed your blood pressure medication dosage and now you are getting ED because not enough blood is getting to your penis to sustain an erection. Sometimes ED is just ED.

So true. But I hope to hell that this is fixable with some hormone adjustment.

 

[halfape211]

HAVE SOME RESULTS TODAY

TSH 2.03 (range 0.35 - 5.5) mlU/L
Prolactin 7.6 (range2.1 - 17.7) ug/L
Ferritin 79 (range 22-322) ug/L

For some reason the E2 results are not on the page. I inquired.

Anybody care to interpret these numbers??

Is the ferritin low? Does that mean anything?

 

[Megatron28]

HAVE SOME RESULTS TODAY

TSH 2.03 (range 0.35 - 5.5) mlU/L
Prolactin 7.6 (range2.1 - 17.7) ug/L
Ferritin 79 (range 22-322) ug/L

For some reason the E2 results are not on the page. I inquired.

Anybody care to interpret these numbers??

Is the ferritin low? Does that mean anything?

All those numbers look fine.

 

[halfape211]

All those numbers look fine.

Thanks very much Megatron. I will post my E2 numbers when I get them.

 

[halfape211]

E2 and DHEA numbers are in!! And these look more 'interesting'.

Estradiol is 133 pmol/L (Canadian) which equals 36.2 pg/ml (the American measurement) range is <205 pmol/L (which equals 55 pg/ml WHICH seems low!!??


DHEA is 1.17 umol/L range is 2.17 - 15.2 umol/L

Hopefully you have some thoughts on this.

 

[Alpin]

55 pg/ml for estradiol is not low.
How many days from shot is this estradiol ?
The 36.2 pg/ml seems ok'ish.

 

[halfape211]

Hi there APOLLON.

English is my first language, but sometimes I can be confusing!
55 pg/ml (American) is equivalent to 205 pmol/L (Canadian). Range in Canada as you probably know is anything less than 200 - 205 pmol/L. No exactly a very precise range. lol.

So my E2 at this time, is 36.2 pg/ml, at about two days after test injection. My E2 was about 45 pg/ml here a few months ago. And looking back, my E2 was only 23 two weeks into trt (nine months ago) and the morning after my first AI pill. I take a half Anastrozole pill when I take my injection twice a week.

Where the heck is the sweet spot and low spot for E2??

 

[Megatron28]

Most guys like to have their E2 between 20-40pg/ml. But everyone is different so you have to find what works best for you.

 

[Alpin]

Half tab of adex is a bit much. Over the long term you may lower your estradiol too much...Keep an eye on it.
That's quite an E2 range you have. The crappiest lab I dealt with had estradiol less than 172 pmol/l
And most were below 157 pmol/l.

 

[halfape211]

Most guys like to have their E2 between 20-40pg/ml. But everyone is different so you have to find what works best for you.

OK...., 20 - 40 pg/ml is Zone. I'll start lowering my E2 as I was not having any ED problems at 23 pg/ml level, but I was hurting real bad from low T. If I'm real lucky, it might help. But like Apollon says, I will have to keep an eye on it.

Thanks very much guys

I'll start a new thread on the DHEA and see what I can find out what that's doing to me, without reference to ED