Penile Implants

[Buddy Rich]

What are your total and free levels of testosterone as well as estrogen levels on the dose you currently use? It may not be any of that but it's s good place to start? From what little I know, I'm inclined to agree with those who suggested it may be a mental thing. Its tough to get too excited if your partner(s) are uninterested in sex themselves. Not saying that's your issue but as an example. Plus, have a problem one time and you start thinking about it, which makes it even worse.
.

My Endocrinologist ordered blood work for me in August. My total testosterone was 741.0 ng/dL. The Reference Range according to him is 221.0 ng/dL - 716.0 ng/dL, so he thinks my total testosterone “is a bit high.” My Primary saw that and nearly freaked the fuck out. Also mentioned something about my Globulin being too high at
3.7 gm/dL and my Hematocrit to high at 49.6%. The blood work didn’t include Free Testosterone or Estrogen. Also no SHBG. So you can see what some of the problems are. I’m not going back to either one of them. My next step is to contact Dr. Nichols at Tier1 and get some decent bloodwork drawn up. From everything I’ve heard, this guy knows his stuff.

No doubt there’s a mental aspect here also. Like you said. Have a problem one time and it seems to manifest, but I’m convinced if I can get the right protocol going…everything will fall into place.

I’ve already changed my diet for the better and I’m going to drop 20lbs (I’m currently at 240lbs).

[Smyth]

But do not let anybody cut on your dick.

I think we have a contender for the next t-shirt.

[Ray Gillenwater]

Ray, thanks for your advice in this thread. You’ve gone above and beyond.

Happy to help. It's hard to believe that this is the state of medicine in 2021 - having to get this sort of information from a strength training forum.

I also listened to the podcast with Rip and Dr. Nichols. I’m going to contact Tier1 for my testosterone. That seems like the place to go (much better than Defy) because I’ll never find an Endo locally who’s going to prescribe me more than 100mg/week.

Nichols is going to get a good laugh out of this.

Have you tried the daily scrotal cream? I just can’t see myself injecting every day, even if it is with a 27g 1/2” needle, but will if it comes to that. The cream just seems so much easier and from what I’ve read and heard can significantly influence the levels of DHT in the body.

The scrotal cream is tied with daily shallow IM injections in terms of the best delivery mechanisms, in my experience. Apparently it keeps your HDL levels higher than injections as well. The two downsides are you need to remember to apply it twice a day and you'll need to wash off your balls before making sweet sweet love - unless your lady friend doesn't mind a bit of transference and the bitter taste. Nichols will probably have you on 3-4 clicks, twice per day. This is probably equivalent to 210mg of cypionate. With free T at 40+ ng/dl, your total T will almost certainly be 1000+. Good doctors treat based on symptoms, not arbitrary reference ranges.

One other question. I won’t have a problem getting a daily Cialis script, but how would I go about getting a script for Flomax (if it comes to that) if I don’t have an enlarged prostate? Thanks again for all of your help.

Nichols can handle the Cialis script. I recommend holding off on flomax and changing one variable at a time. He may be able to prescribe it to you too, but if not, you'll need a GP or a urologist to do so.

My Endocrinologist ordered blood work for me in August. My total testosterone was 741.0 ng/dL. The Reference Range according to him is 221.0 ng/dL - 716.0 ng/dL, so he thinks my total testosterone “is a bit high.” My Primary saw that and nearly freaked the fuck out. Also mentioned something about my Globulin being too high at
3.7 gm/dL and my Hematocrit to high at 49.6%. The blood work didn’t include Free Testosterone or Estrogen. Also no SHBG.

Once you get sorted out on your new regimen, you're going to look back at this conversation with even more contempt. Curious to see what happens with you if you wouldn't mind reporting back once your levels are dialed in.

[Buddy Rich]

But do not let anybody cut on your dick.

I think we have a contender for the next t-shirt.

Sounds like a winner to me! I’ll personally send out a free “Do Not Let Anybody Cut On Your Dick” T-shirt to everybody who helped me on this Forum.

Once you get sorted out on your new regimen, you're going to look back at this conversation with even more contempt. Curious to see what happens with you if you wouldn't mind reporting back once your levels are dialed in.

I have every intention on doing just that. I really hit rock bottom but now have hope for better things to come. Thanks again, Ray! Also everybody else who contributed. I will not let anybody cut on my dick!!

[dalan]

My Endocrinologist ordered blood work for me in August. My total testosterone was 741.0 ng/dL. The Reference Range according to him is 221.0 ng/dL - 716.0 ng/dL, so he thinks my total testosterone “is a bit high.” My Primary saw that and nearly freaked the fuck out. Also mentioned something about my Globulin being too high at
3.7 gm/dL and my Hematocrit to high at 49.6%. The blood work didn’t include Free Testosterone or Estrogen. Also no SHBG. So you can see what some of the problems are. I’m not going back to either one of them. My next step is to contact Dr. Nichols at Tier1 and get some decent bloodwork drawn up. From everything I’ve heard, this guy knows his stuff.

Good plan. Think I'll check him out myself.

References ranges vary from lab to lab but 716 is the lowest upper end number I've ever seen. I don't know if it's a reflection on our society today or what but that's ridiculous. It's usually either 800 and something or around 1100 depending on the lab. Doctors, and especially GP's go by these arbitrary numbers like they're from the mouth of God and it's absolutely stupid. 741 is pretty good for 100mg, btw.

Just a personal note - I've used flomax and I hated it. Orgasms were, shall we say, less than satisfying. Your mileage may vary and it sounds like it works for some people.

Anyway, sounds like you have s plan of attack and keep us updated if you don't mind.

[J. Keith Nichols MD]

Buddy,
Rip and Ray have provided you with some great advice. They both have amazing insight and should have been in the medical field.
As previously stated, if you have morning erections the plumbing works. A penile implant would be a mistake and if you have a complication and it had to be removed you would NEVER be able to have an erection again. Look at the American urology associations guidelines on ED for insight into other causes like performance anxiety for one. If you can get an erection and are able to masturbate then you know you are dealing with psychological issues (anxiety for one).
As far as your levels go...they are nowhere near optimal in my world (listen to Ray). Follow the free testosterone for treatment. I personally like to see the free above 30ng/dl and really closer to 50 ng/dl if needed. Thats going to typically correlate with a total of 1000-2000 ng/dl (maybe more in some). The cream and injections both work. When starting injections I recommend starting at 30mg daily. From a clinical standpoint I think that a daily application of Cream or injection works best.
What is also missing in your treatment is optimizing all the hormones not just testosterone. They all have beneficial effects and they work synergistically. Our clinical success is really due to understanding that men need enough testosterone to exert a response (most like you have never gotten enough) as well as knowing you need to optimize all the other hormones (especially thyroid)

[Mark Rippetoe]

Thanks to Dr, Nichols for this post. He will be on a podcast with me very soon.

[Smyth]

Doc, when I had blood work done, under Total Testosterone. The ref range was listed as 86.98-780.10 ng/dl. Is this the number that you suggest we want around 1000? Am I understanding that right?

[Mark Rippetoe]

That's his suggestion.

[Buddy Rich]

Buddy,
Rip and Ray have provided you with some great advice. They both have amazing insight and should have been in the medical field.
As previously stated, if you have morning erections the plumbing works. A penile implant would be a mistake and if you have a complication and it had to be removed you would NEVER be able to have an erection again. Look at the American urology associations guidelines on ED for insight into other causes like performance anxiety for one. If you can get an erection and are able to masturbate then you know you are dealing with psychological issues (anxiety for one).
As far as your levels go...they are nowhere near optimal in my world (listen to Ray). Follow the free testosterone for treatment. I personally like to see the free above 30ng/dl and really closer to 50 ng/dl if needed. Thats going to typically correlate with a total of 1000-2000 ng/dl (maybe more in some). The cream and injections both work. When starting injections I recommend starting at 30mg daily. From a clinical standpoint I think that a daily application of Cream or injection works best.
What is also missing in your treatment is optimizing all the hormones not just testosterone. They all have beneficial effects and they work synergistically. Our clinical success is really due to understanding that men need enough testosterone to exert a response (most like you have never gotten enough) as well as knowing you need to optimize all the other hormones (especially thyroid)

Thank you, Dr. Nichols for taking the time to post in this thread. I’ll be contacting Tier1 this week. I live in Upstate NY, so I’ll have to do it via telemedicine. That’s certainly going to be better than any in person Doctor I’ve been dealing with in the last year.

My first visit with a Urologist was a disaster. I wasn’t in the exam room for more than a few mins and after giving me the “once over” and checking my prostate, he explained what he called the “3-Tier Approach” to ED. 1st is pills, then injections and when those stop working it’s onto the 3rd tier. Penile Implants. He said his patients have a 90% success rate and are happy with them. Sounded more like a sales pitch and that frightened me. He never once looked at my numbers or offered any suggestions on raising my testosterone or optimizing hormones. I left the exam room pissed of and dejected. Just how much money do these guys make with Penile Implants I wonder?

I have another appointment with a Urologist in Syracuse, NY, but I’m going to skip that and deal with your clinic first. Again, thank you. Look forward to the next podcast you have with Rip.