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How Long Does It Take To Recover After Taking Testosterone Injections?

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Posted on Thu, 15 Oct 2015
Question: Hi Doctor,

I would like to brief on my problem.

I am 31yr, 95 Kg and 185 cm and was on Anabolic Steroid for almost 2 years on and off way back in 2013 & 2014. Last steroid (testosterone injection) injected around 6 months ago. Never run Post cycle therapy which usually runs by bodybuilders after Steroids.

3 Months ago, I have started HCG with a mild dose (of total 8000IU in 4 weeks) but it failed to increase T level (may be due to pre-mixed injection HUCOG are used instead of using mixing powder with bacterio static water, other possible cause as I was on high dose of pain killer after tooth extraction) -----> Then, I suspected ‘Primary hypogonadism’ or Testicular failure. Now, confusion is clear after surge in T level with oral medicines like Clomid and Nolvadex. Also, testicle size seems normal to me.
Then started with SERM (Nolva+Clomid) for 4 more weeks and as I was expecting it increases my T level to 565 ng/dl from 214 ng/dl, E2=78 (Reference Range = 0 – 39 pg/ml) with high LH. But, still I found difficulty in getting Erection.

To reduce Estrogen, I have started aromatase inhibitors (AI) Aromasin along with Clomid for around 3 Weeks and lab results says T level = 486 ng/dl, E2=48 with normal LH & FSH. But, Still I can’t see any improvement in Erection, I used to have great erection before and when I was on AAS cycle.
Labs Results with (SERMS) - Clomid ED & Nolvadex for 4 Weeks
Testosterone-->564.6 ng/dl (Ref. Range is 241 - 827 ng/dl)
E2-------------->74.4 (Ref. Range is 0 - 39.8 pg/ml)
LH-------------->14.01 (Ref. Range is 1.5 - 9.3 mIU/ml)
FSH------------>6.92 (Ref. Range is 1.4-18.1 mIU/ml)


Labs Results with (SERM’s+AI) –Clomid with Aromasin for 4 Weeks


Testosterone-->486.6 ng/dl (Ref. Range is 241 - 827 ng/dl)
E2--------------->48.5 (Ref. Range is 0 - 39.8 pg/ml)
LH-------------->6.89 (Ref. Range is 1.5 - 9.3 mIU/ml)
FSH------------>4.87 (Ref. Range is 1.4-18.1 mIU/ml)

3 Weeks ago T level drops to 419 ng/dl and as I am not on any medicine so it seems like it drops further.

I took consultation of a doctor, he suggested for MRI, I have had an MRI on my Pituitary and nothing out of the ordinary was noted then he asked for semen analysis and results are not as bad my problem of erection. Personally, I feel very few doctors are aware how to restart HPTA after prolong use of AAS and they simple suggest tadalafil/cialis for recovery and I know this will not going to work. I have problem with erection. Less than a year ago I have got married and thanks to my wife she understands my situation, also I want kids so TRT is not an option.

I have gone under all possible tests that could be done by blood diagnosis and I don’t have any Heart, BP, thyroid, Sugar, Cholesterol, Prolactin and Cortisol problem except Vit-D deficiency. I am non-smoker and occasional drinker.

Doctor, I am going through worst phase of my entire life and feeling like dying every day and I can’t even describe in detail how terrible things have been. This nightmare is running from last 6 Months after last steroid induced and I have tried ‘everything I know’ to bring HPTA back to the normal. Still I didn't lose hope for recover. I am excited to get your input on this problem.

Please suggest best possible solution if it is related to diet, exercise or weight loss. Now, I have started going to the Gym followed by a healthy diet.

Intercourse frequency is once in a week but suddenly lost erection due to performance anxiety and negativity running in brain. Intermittently, I am getting morning wood but erection does not sustain for long.
Best Regards,
doctor
Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Early mornings better than night

Detailed Answer:
Good Day Mr.XXXX,
Noted your concern. It takes several months for the HPG axis to recover after using Testosterone injections. So kindly be patient. In the meanwhile, it is great to see your Testo levels have improved to normal range with Clomiphene + Aromatase inhibitor treatment. hCG in a dose of 1500 to 2000 units thrice weekly is another option which can also be injected subcutaneously ( though it is written as Intramuscular in the leaflet).

Your testosterone levels are normal and still you do not have erection. There are few possibilities
1) Anxiety and /or depression.
2) Venous leak in the penile blood vessels.

You could try Cialis every alternate days and keep yourself calm and quiet. Try going for a small vacation for few days with your partner away from city. This helps to relax yourself and erection returns to many people with in few days if testosterone levels are good.

If you still fail to have erections, then please get a penile Doppler study to assess competency of penile veins.

Please understand that, pituitary secretes LH in a time dependent pulsatile manner and the levels of Testosterone is maximum in the early mornings, not at night. So you could try to have intercourse at early mornings.

Regarding performace anxiety. Do you get erections when watching something erotic when you are alone? Are you able to masturbate until ejaculation in those situations?

Regards'
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (2 days later)
Hello Dr. XXXXXXX
Many Thanks for noticing my concern!
     
I understand, pituitary recovery will take time and it depends on individual response. But, on the basis of your experience can you tell me how much time HPTA generally take to restore normal functioning? Last testosterone injected around 6-7 months ago.

SERM + AI raise my testosterone level, on these medicines T level raise to 560ng/dl but on reducing dose it was 419ng/dl. Now, I have completely eliminated any SERM & AI from last one month. But, it seems like T level reduced further.

In response to your question:
I have used Cialis & Sildenafil in past but now I don’t want to use these PDE5 inhibitors because it will create tolerance and sometime dependency also and I have seen that on low testosterone these medicine doesn't work.

I have some difficulty to get erection while on bed but two days ago I had successful intercourse with my wife. Also, I can get erection easily by watching porn & I can masturbate easily with ejaculation.

If I get erection then mostly it’s difficult to maintain erection for a successful intercourse, what actually happens, suddenly a negative pulse come from brain with a feeling that I can’t do it & erection goes next moment. Possibly, I have ‘psychological’ problem along with ‘physiological’.

I will surely work on provided guidelines. Please suggest what should I do from here.
Regards,
doctor
Answered by Dr. Binu Parameswaran Pillai (30 hours later)
Brief Answer:
Psychology consult

Detailed Answer:
Sincere apologies in the delay .
In my expreience it takes anywhere between 3 months to 1 year for the pituitary gonadal axis to recover based on the dose of testosterone used and the duration.


In your case, there is an element of performance anxiety involved. That is an issue. You are able to maintain an erection and ejaculate which rules out a structural or hormonal problem.

Your tesosterone levels are reasonably good now. In my opinion, you may surely benefit with a psychology counselling. In the meanwhile a small dose of Cialis may help
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1439 Questions

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How Long Does It Take To Recover After Taking Testosterone Injections?

Brief Answer: Early mornings better than night Detailed Answer: Good Day Mr.XXXX, Noted your concern. It takes several months for the HPG axis to recover after using Testosterone injections. So kindly be patient. In the meanwhile, it is great to see your Testo levels have improved to normal range with Clomiphene + Aromatase inhibitor treatment. hCG in a dose of 1500 to 2000 units thrice weekly is another option which can also be injected subcutaneously ( though it is written as Intramuscular in the leaflet). Your testosterone levels are normal and still you do not have erection. There are few possibilities 1) Anxiety and /or depression. 2) Venous leak in the penile blood vessels. You could try Cialis every alternate days and keep yourself calm and quiet. Try going for a small vacation for few days with your partner away from city. This helps to relax yourself and erection returns to many people with in few days if testosterone levels are good. If you still fail to have erections, then please get a penile Doppler study to assess competency of penile veins. Please understand that, pituitary secretes LH in a time dependent pulsatile manner and the levels of Testosterone is maximum in the early mornings, not at night. So you could try to have intercourse at early mornings. Regarding performace anxiety. Do you get erections when watching something erotic when you are alone? Are you able to masturbate until ejaculation in those situations? Regards' Binu