Sidegra, Kamagra, Viagra and Cialis - yet another update and a happy ending?

[Mister Fixit]

I have written about this in a number of previous threads but I wanted to update people with how things have been going at the Andropause clinic I have been attending.

Readers of previous threads will know I had been having testosterone shots every 3 weeks since 2015 and after a visit to the endocrine clinic, they referred me to the andropause clinic.  At the same time, I started fortnightly shots of 250 grams of testosterone enanthate – here are the dates so far.

7 May              Saw endocrine doc, started fortnightly shots

20 May            13 days

4 June              15 days

17 June            13 days

1 July              14 days

16 July            15 days

29 July            13 days

Next shot should be 12 August.

 

I have noticed quite a difference in 3 months – my beard is much stronger (I could get away with not shaving daily, but not now), my pubic hair has grown thicker (but I trim it short it for hygiene reasons - in the past I have been prone to bouts of tinea cruris - jock or dhobi itch), my short term memory is somewhat better and I have managed to have sex successfully at least once a week (although still using an ED med).

So we have managed.  Sex can be temperamental – I still find that erections can fade away and return, sometimes 3 or even 4 times, but we always end up with an orgasm one way or another.  Twice we have had a real good old ding dong session without any fading away.  When it does fade away and we can’t be bothered to keep trying, we have developed a technique where we can still satisfy each other.

 

I first went there on 15^th June after I had started on the fortnightly testosterone shots.  The very nice doc there said too high a dose could affect haematocrit so he ordered blood tests.  I went back 2 weeks later on the 29^th and haemoglobin and haematocrit were both fine, a touch low perhaps. 

Then he bought in a colleague and they had a long confab, resulting in them suggesting that I try Nebido at 6,300 baht a pop every 3 months! AND there will need to be a series of shots while they titrate the dosage. 

 

At the time, I still had about 12 or more testosterone enanthate ampoules at home, so we left it that I would use those up first and then talk again.  I have 7 left so at one every 2 weeks will take 14 weeks so we still have 3½ months to get organised. 

 

Then we returned 2 weeks later and he finally tested my oestradiol after I’d asked him previously.  Having this tested had been mentioned by a few people in previous threads.  I attach a copy of the report.  I am pleased to see that my PSA still remains well below 4.  My testosterone was  OK at 9.36 with an upper limit of 14.90 ng/mL.  That seems fine to me and he thought so too. 

 

In terms of the oestradiol, it says 46.90 pg/mL, but there is no range mentioned.  I have Googled and had conflicting results – Healthline says 10-40 pg/ml so mine is somewhat high. 

Then I read a study abstract here https://pubmed.ncbi.nlm.nih.gov/7614406/ which said 10-82 pg/ml was normal – quite a difference! 

Then I read on a website that levels were ‘Normal total estradiol levels in men are somewhere between 20–55 pg/mL (2.0–5.5 ng/dL) and 10-40 pg/mL (1.0-4.0 ng/dL), depending on whom you ask.’  https://tctmed.com/estrogen-in-men/

 

So, which is it?  Does my figure look normal or too high?

 

Another thing I have learnt.  I am now starting to believe that the pharmacy where I get my ED meds are selling, not necessarily fakes, but not true potency. 

I used to use Sidegra but found it wasn’t as potent as Kamagra which I had always used before.  I stopped the Sidegra and moved back on to Kamagra but found I was having to increase the dose to 1.5 tablets (or a 100 ml gel and half a 100 mg tablet which seems to work better) to get anything like a decent lasting erection, but even they were patchy.

 

I even bought a pack of supposedly ‘genuine’ Cialis from there, but the first one I took wasn’t much good, but the second was amazing.  Really worked well and no problems.  So I wonder if there are QC issues with what they sell or something. 

Even more interesting was the doc suggesting I try Sidegra.  I told him it had stopped being as effective and I’d stopped 18-24 months ago, but he suggested I tried again and got it from the hospital pharmacy so it will be authentic.  I did and that night – wow!  We were at it for getting on an hour and not a hint of a droop until about 45-50 minutes in. 

 

Any comments on attached test results?

[ezzra]

I go my the true and tried motto that says: W*ank, W*ank keep the money in the bank...

[Mister Fixit]

On 8/10/2021 at 6:15 PM, ezzra said:

I go my the true and tried motto that says: W*ank, W*ank keep the money in the bank...

I am married, don't need to w@nk

[Mister Fixit]

@WaveHunter @rcuthbert @jackdd 

 

Just wondered if you guys have any comments on my figures above, seeing how you helped out so much in the past?

 

 

[spidermike007]

Walked away from the big pharma poison pills years ago. Since then used either Bali Mojo, or Gracku. The latter is amazing. Please do not start with the FDA warnings. They are total nonsense. The FDA is one of the most corrupt organizations in the world, and one of their sole purposes is to support the drug companies and deny the benefits of anything natural. They are basically a drug company mafia, as we have seen with the Covid vaccines.

 

 

 

 

[mikecha]

where can you buy this

[Tarteso]

Moved to Things of Sex forum

[MarkyM3]

Hi Misterfixit....

 

I have been on TRT in the UK for the last 3 years so have some experience of the highs and lows of it.  I am currently using Nebido (have also done gels, which are a PITA ultimately and gave me skin problems). Fortunately, it's laid on free via the UK NHS (public health service) though I pay plenty of taxes so quid pro quo! 

 

Some of the indicators your endo should be monitoring are not on that list. For example, to calculate free testosterone (i.e. available to bind to androgen receptors), it's done using raw testosterone plus SHBG and Albumin figures iirc. Can't see either of the latter 2 on there. 

 

E2 (oestrogen),  PSA (possible indicator of prostrate issues ahead) and haematocrit ratio (blood thickness), are important and can see those there. If E2 gets too high, Anastrozole can be introduced to lower it (but can cause problems). Prolactin should be on there but isn't. 

 

Your figures are all in imperial measurements so I'd need to translate to the reference ranges I see when I do my bloods.

 

Also - not sure of your age and this may not matter but be prepared to see your balls shrink and ejaculate reduce. This apparently can be counteracted by HGC but isn't offered in the UK NHS. Am thinking of using a private doctor to get this looked at because I'm 50, unmarried and still might want to have kids in the next couple of years. 

 

Shoot me a PM if you like and I can fish out my previous results to see if there's anything else to mention.

[Mister Fixit]

On 8/14/2021 at 3:42 PM, spidermike007 said:

Walked away from the big pharma poison pills years ago. Since then used either Bali Mojo, or Gracku. The latter is amazing. Please do not start with the FDA warnings. They are total nonsense. The FDA is one of the most corrupt organizations in the world, and one of their sole purposes is to support the drug companies and deny the benefits of anything natural. They are basically a drug company mafia, as we have seen with the Covid vaccines.

 

 

 

 

Tried this once, complete rubbish for me.  All it did was give me indigestion which put me off sex.

Also I would say it didn't give me a full erection, maybe a 75% to 80%-er and it didn't last long.

[Mister Fixit]

On 8/14/2021 at 3:56 PM, mikecha said:

where can you buy this

Any pharmacy, maybe even 7/11.  

[rott]

Which hospital pharmacy sells these magical Cialis as described in the OP.? 

[Mister Fixit]

2 hours ago, rott said:

Which hospital pharmacy sells these magical Cialis as described in the OP.? 

I didn't buy the Cialis from there, I got them from a small pharmacy near Nana.  I said that in the OP.  

But Phramongkutklao, the Army hospital near Victory Monument have them but they cost 472 baht each and as you can buy them at pharmacies around Nana for 2,000 baht for a strip of 4, so just go there.  Much easier.

 

I doubt you'd get in to the Army hospital.  I was wangled in by an old girlfriend, an Army nurse there about 11 years ago.  Then a few years later, an old student who happened to be a nurse there heard my ancient knees cracking and got her husband, also a doctor there, to refer me to the orthopaedics department.  I am very happy with my treatment there in all  the departments I have been to. 

[Mister Fixit]

On 8/16/2021 at 5:03 AM, MarkyM3 said:

Hi Misterfixit....

 

I have been on TRT in the UK for the last 3 years so have some experience of the highs and lows of it.  I am currently using Nebido (have also done gels, which are a PITA ultimately and gave me skin problems). Fortunately, it's laid on free via the UK NHS (public health service) though I pay plenty of taxes so quid pro quo! 

 

Some of the indicators your endo should be monitoring are not on that list. For example, to calculate free testosterone (i.e. available to bind to androgen receptors), it's done using raw testosterone plus SHBG and Albumin figures iirc. Can't see either of the latter 2 on there. 

 

E2 (oestrogen),  PSA (possible indicator of prostrate issues ahead) and haematocrit ratio (blood thickness), are important and can see those there. If E2 gets too high, Anastrozole can be introduced to lower it (but can cause problems). Prolactin should be on there but isn't. 

 

Your figures are all in imperial measurements so I'd need to translate to the reference ranges I see when I do my bloods.

 

Also - not sure of your age and this may not matter but be prepared to see your balls shrink and ejaculate reduce. This apparently can be counteracted by HGC but isn't offered in the UK NHS. Am thinking of using a private doctor to get this looked at because I'm 50, unmarried and still might want to have kids in the next couple of years. 

 

Shoot me a PM if you like and I can fish out my previous results to see if there's anything else to mention.

Sorry for the delay in replying to your post and PM.  There's been too much going on.

 

Not too sure about them being Imperial measurements, which are UK.  Thai hospitals tend to use US measurements.  But I'm not familiar enough yet with all of them to be 100% sure of what's what.

 

I don't have a range for the E2 so I don't know if what is in that report above is high, low or average.  It just says 46.90 pg/mL (which suggests a metric measurement).  Do you know what the range should be?  I have read conflicting reports. 

 

How did you find the Nebido injections?  I have heard they take up to 4 minutes to do!  ????

 

And I'm 72.   I'll reply to your PM later.   Maybe better to keep it that way because I've asked about this quite a lot over the last few months and I'm probably boring people by now!  ????

 

 

[rott]

10 minutes ago, Mister Fixit said:

I didn't buy the Cialis from there, I got them from a small pharmacy near Nana.  I said that in the OP.  

But Phramongkutklao, the Army hospital near Victory Monument have them but they cost 472 baht each and as you can buy them at pharmacies around Nana for 2,000 baht for a strip of 4, so just go there.  Much easier.

 

I doubt you'd get in to the Army hospital.  I was wangled in by an old girlfriend, an Army nurse there about 11 years ago.  Then a few years later, an old student who happened to be a nurse there heard my ancient knees cracking and got her husband, also a doctor there, to refer me to the orthopaedics department.  I am very happy with my treatment there in all  the departments I have been to. 

I do beg your pardon it was the Sidegra that caught my attention, they are the ones that came from a hospital pharmacy. 

[Mister Fixit]

Just now, rott said:

I do beg your pardon it was the Sidegra that caught my attention, they are the ones that came from a hospital pharmacy. 

No problem.  ????

 

Yes, Sidegra are 250 baht at the Nana pharmacy I use, but at the hospital they were only something like 152 baht.  They worked well too!  ????

[worgeordie]

What are you going to do , when all of these things

no longer work ,it will happen.will you be able to accept it.

regards Worgeordie

[Mister Fixit]

2 hours ago, worgeordie said:

What are you going to do , when all of these things

no longer work ,it will happen.will you be able to accept it.

regards Worgeordie

Nowt really te dee wi' ye, is it, wor kid?  

It's been gannin' alang for a geet few months noo, marra, 'n' Aa've pretty well accepted what's gannin' on by noo.  

Just is lang as Aa kin get a bit uh legower once a week, Aa'm happy.  Ye canna change gettin' owld, but ye kin at least try t' slow things doon.  

 

[rott]

17 hours ago, worgeordie said:

What are you going to do , when all of these things

no longer work ,it will happen.will you be able to accept it.

regards Worgeordie

I would imagine that instead of devoting 90% of his spare time to doing good works amongst the deserving poor he will increase that to 100%.

 

I would make so bold as to suggest that he assists me in a few projects such as giving cello lessons to the disadvantaged and to long term prisoners. Also teaching expats that there is no apostrophe in a plural and that could of and should of should be could have and should have. 

When one door closes in life, another opens. 

Time for my pill. 

[Mister Fixit]

On 8/20/2021 at 9:02 AM, rott said:

I would imagine that instead of devoting 90% of his spare time to doing good works amongst the deserving poor he will increase that to 100%.

 

I would make so bold as to suggest that he assists me in a few projects such as giving cello lessons to the disadvantaged and to long term prisoners. Also teaching expats that there is no apostrophe in a plural and that could of and should of should be could have and should have. 

When one door closes in life, another opens. 

Time for my pill. 

I just carry on doing my bits of part time teaching English and hence assist Thais in bettering their life.  

If I could play the cello, maybe I would help you with that too.

[mokwit]

Disclaimer: I am not medically qualified. I have sat through lectures on the male endocrine system at undergraduate level, which means I probably know more than most commenting on the internet, but I do NOT have the broad base of a medical degree. Also, this stuff is complex when it is not straightforward - most of the time for most people it is straightforward and that is why people get by treating themselves without deep knowledge - to understand what is happening when it is not a straightforward case, you really need a lifetime of study - see my example about having to understand the assays and what they measure.

 

If your Estradiol was tested here then probably the range is 25.8 - 60.7 it actually depends on which lab you use and which reagent kits they use - it would also depend on whether it was "sensitive" (i.e. mass spectrometer measured) or immunoassay which is much less accurate, but as far as I know only immunoassay is available here." If as I think, they are using US reagent kits then the range is standardised against US population not Thai. As an aside, a number from a sensitive assay is probably not comparable with an immunoassay number because this also likely picks up Estrone and 2 other estradiol derivatives. You really have to know it in this level of understanding to really analyse it.

 

Thai Lab reference range I have for Estradiol is 25.8 - 60.7 pg/ml - the higher your number the less likely it is to be accurate with immunoassay - male estradiol levels are at the edge of detection with this technology.  Mine came in at 52.1 and I was told that probably corresponds to a real level in the range 20-30.

 

The fact that your testosterone is given in nmol/L not Ng/ml suggest yoir lab might not be the same as mine/not using the same reagent kits - which muddies the waters. I don't know how many labs there are in Thailand - you mention Nebido - is this from Bumrungrad? They were talking before of setting up their own lab. To be sure about your Estradiol levels you really need to know the reference range of the Lab that tested your sample - it is strange it is not given.

 

Key point is that you need good estrogen levels for bone mineral density, erections in particular and other things.

 

A level of less than 15 is often found with people with osteoporosis, but you can't extrapolate a level of 15 as causative from the data we have. An experienced practitioner has stated that a level above 80 shuts off the male sex drive - key point is that you seem to have libido - most people expect too much from testosterone WRT to erections  - it doesn't really do that much unless your levels of Testosterone are below 250 ng/dl. What action it has is more on nocturnal erections than sexual ones. Proviron [Mesterolone] a DHT derivative possibly would have better effect on ability to maintain an erection that Testosterone - this seemed to be my experience, also volume of ejaculate at doses of 250mg/day which is higher than is recommended but it seems not to have this benefit at lower doses. I have posted on Proviron elsewhere here - search under my name and that and you should find it - if not come back to me.

 

So on the estrogen side, if you are in the range and not having any obvious estrogemn related side effects like gynocomastia it is not something you should be focused on too much. At your age more might be better than less due to it's action on maintaining bone mineral density.

 

I am reluctant to make any comment on your testosterone levels as you give it in nmol/L and I am used to working in ng/dl. A very rough conversion is to multiply the nmol/L figure by 29 as a ratio assuming a linear relationship. If we come at it from this angle your 9.36 translates to 271 ng/dl which is around the level where you might expect erectile problems, but the 0.02-14.9 x 29 does not correspond to a usual ng/dl range 300-1200 (recently adjusted to 200-1100) OR a Thai lab range I have as 249-836 ng/dl for men under 50 and 193-740 for men over 50., so if your Doctor who is used to figures in nmol/L says it is OK one assumes he knows. That said, they found as far back as the 1940's that to get the subjective benefits of exogenous Testosterone you needed a total T level of above 800 ng/dl which across a population probably translated to a free Testosterone level in the upper part of the range 5-15 ng/dl WHICH brings us to another point others have made that you really might be better knowing what your FREE Testosterone levels are as the protein it binds to in the blood (SHBG) increases with age leaving less free to bind to receptors and most importantly cross the blood brain barrier to exert an affect in the CNS where it is needed ("sex is in the mind" is something you understand better with age. SO next time enquire about having your Sex Hormone Binding Globulin [SHBG] levels checked, from which with total Testosterone level; also you can calculate free Testosterone.

 

One point about Nebido that has been made is that you spend most of the three months between injections at around 600 ng/ml which is not the 800 plus needed for maximum/subjective benefits.

 

HTH feel free to ask if you need further info/clarifications.

 

 

[thaitom]

On 8/14/2021 at 4:06 PM, Tarteso said:

Moved to Things of Sex forum

There's a sex forum ?

[MarkyM3]

On 8/19/2021 at 8:26 AM, Mister Fixit said:

Sorry for the delay in replying to your post and PM.  There's been too much going on.

 

Not too sure about them being Imperial measurements, which are UK.  Thai hospitals tend to use US measurements.  But I'm not familiar enough yet with all of them to be 100% sure of what's what.

 

I don't have a range for the E2 so I don't know if what is in that report above is high, low or average.  It just says 46.90 pg/mL (which suggests a metric measurement).  Do you know what the range should be?  I have read conflicting reports. 

 

How did you find the Nebido injections?  I have heard they take up to 4 minutes to do!  ????

 

And I'm 72.   I'll reply to your PM later.   Maybe better to keep it that way because I've asked about this quite a lot over the last few months and I'm probably boring people by now!  ????

 

 

Hi...Mokwit has quoted a lot of useful info so I won't repeat that. Suffice to say, I do repeat that your blood tests are missing some of the things an endocrinologist should be monitoring. Saying that, my experience has been many endos are not particularly clued-up with TRT and some of the advice I received in the past was plain wrong! There is a lot of information out on the internet so becoming self-educated is essential imo (though your endo may not like it!).

 

I just had a Nebido injection this week - no great issue, it takes a minute or so into the buttock. It's a little bit tender for an hour or so afterwards but that fades quickly enough. Someone who hasn't got experience of doing the injections properly is more of a menace than anything. 

 

Mokwit mentioned SHBG levels - as per my comments, this stuff helps determine how much of the testosterone binds to androgen receptors and is bio-available. That plus albumin determine the free testosterone calculation and your endo should be looking at that, not just a raw testosterone figure. Personally, my SHBG is usually at the low end of the acceptable range and this means my free testosterone level is boosted. However, low SHBG isn't necessarily a great thing - mine hovers around .18 nmol/L but I'd be happier with a figure of around 30 as that, apparently, is more typical of younger men.

 

I request a blood panel just before I have my next jab to see my trough figure for testosterone. After a while on Nebido, I am finding my trough is still towards the upper end of the free testosterone range if I stick to around 11 weeks between jabs (they recommend 12-14). Thankfully. my endo and GP give me reasonably free reign on what I want.

 

The advantage of Nebido is the convenience. However, I don't believe it's used much in the US (not sure if it's licensed for use there). 

 

I would concur with Mokwit in saying I'm not sure TRT necessarily makes a big difference to erections. It didn't turn me into a sex god (sadly..!), I feel the effects are reasonably subtle and it's more about boosting general energy. I've been prescribed Viagra and Cialis via UK NHS as an adjunctive and did find it helped in that area, but I found benefits with those prior to doing TRT too. I understand my experience isn't unusual but everyone is different. Some have dramatic benefits, others quit because it does nothing, some in-between. 

 

The background to my use of TRT is that I've got epilepsy. Whilst it's fully controlled, research shows the drug I use (Epilim) apparently screws up the endocrine system by suppressing LH production amongst other things. Had I known that, I might well have tried HCG instead of TRT first. However, your situation sounds very much like a classic age-related TRT case. 

 

As it is, I just had a yearly review with my endo and I've asked to have a fertility test done (yes, I'll have to jack off into a canister no less an hour before my appointment!). If it shows (as I expect) that I'm largely infertile as a result of TRT (I believe it typically shuts down sperm production), then I'm told HCG may be prescribed as an adjunctive to my TRT (though I had previously been told it would only be given if I withdrew from TRT). In the US, endos don't seem to have an issue doing HCG and TRT at the same time - hence I thought I'd have to use a private doctor here in the UK for the HCG. I will see. 

 

To recap, here are the key things your endo should be monitoring and my UK reference ranges (metric, use online converter app to switch to imperial):

 

SPA (Serum Prostrate Ag level): 0-1.99ug/L

 

Free Testosterone - calculated of:

 - Serum Testosterone (8 - 26.1 nmol/L)

 - Serum Albumin (done as part of at liver function test, 35 - 50g/L)

 - SHBG (0.17 - 0.73nmol/L)

 

Oestradial - UK doesn't use the better "sensitive" test Mokwit mentions, our range is stated to be 0 - 145 pmol/L. My research indicates it's better to stay at upper end if possible. 

 

Serum Prolaction  - 45 - 375 miu/L

 

Serum Cortisol - 9am, 140 - 690 nmol/L

 

Full Blood Count - get your haematocrit ratio here, range 0.4 - 0.54 ratio

 

My endo also asks for some other things e.g thyroid testing (I have a slow thyroid), renal profile, bone profile

[Mister Fixit]

@mokwit  @MarkyM3

 

Many thanks for your technical contributions, chaps and when I've re-read them about 6 more times I will respond!  ????

I have tried half a dozen times or more to get my free testosterone checked in Thailand and have been told the same number of times that they don't test for it here, only total testosterone.   I read something above about calculating it from total test, but I speed-read both posts and only got the gist.

 

The thing is, I am due to see the andropause doc again on Tuesday next week, the 31st, so I would like to get some ducks in a row beforehand.  

 

What's a 'must test for' that I haven't already had?  (It's probably been mentioned in one of your posts, but could we make a list of what else to check?

 

The other interesting thing is the mention of bone density because I was told about 11 or 12 years ago that I have osteopenia, and take 1500 mgs calcium and Vit D twice daily.

I had a back X-ray the other week and that has deteriorated since the last one 3 years ago, but that's mainly cartilage thinning - but even I immediately noticed my spine was now not straight and has started to curve to the right slightly.  I did have the L5 vertebra slightly misplaced 3 years ago but that has now expended to the L4 and the L2 and L3 are going too.
I don't have a lot of back pain though.  A twinge here and there, but then again I've lost a total of about 55 kgs in the last 4 years which must have helped, at least somewhat.

 

Let me digest all the stuff you've sent and thanks again for your help.