TRT one month in, first lab results, positive changes but little sex drive

[hdrider]

Hey guys, starting my second month on TRT. I am a lean, healthy and very active 53 year old male. So far, the main changes have been:

-Better mood
-More energy
-more positive outlook
-physically a little stronger. Seeing some gains on my lifts in the gym
-better sensitivity in genitals, and better orgasms
-seems to be a slight decrease in fasting blood glucose, which remains a concern

My concern at this point is no increase in sex drive, which is still very low. It has perhaps even dropped a little. Also, little if any improvement in ED.

Surprisingly, free T seems to be high. That's good news, right?

Before TRT:

T total 333 (ref 250-1100)
T Free 51.3 (ref 35-155)
DHEA Sulfate 291.7 (ref 71.6 - 375.4)
LH 5.0 (ref 1.7 - 8.6)
Estradiol, Sensitive 13.6 (ref 8.0 - 35)
C-reactive Protein, Quant. <.3 (ref 0-4.9)

My protocol is 100 IU HCG subq injection daily, and 1 ml of 100 mg/ml compounded T gel daily.

I also take about a dozen supplements daily, primarily vitamins, minerals, herbs, and creatine. Can post specifics if relevant.

Current labs below. I have a consult scheduled with my doc for later this week, but any ideas, thoughts, or advice from you guys here? Thanks!

Ordered Items
CBC With Differential/Platelet; Comp. Metabolic Panel (14); Lipid Panel w/ Chol/HDL Ratio; Testosterone,Free and Total; DHEA-Sulfate;
TSH; Prostate-Specific Ag, Serum; IGF-1; Estradiol, Sensitive; Venipuncture; Cardiovascular Report
TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
CBC With Differential/Platelet


WBC 3.1 Low x10E3/uL 3.4 - 10.8 01
RBC 4.73 x10E6/uL 4.14 - 5.80 01
Hemoglobin 14.5 g/dL 12.6 - 17.7 01
Hematocrit 42.9 % 37.5 - 51.0 01
MCV 91 fL 79 - 97 01
MCH 30.7 pg 26.6 - 33.0 01
MCHC 33.8 g/dL 31.5 - 35.7 01
RDW 12.9 % 12.3 - 15.4 01
Platelets 162 x10E3/uL 150 - 379 01
Neutrophils 41 % 01
Lymphs 44 % 01
Monocytes 10 % 01
Eos 4 % 01
Basos 1 % 01
Neutrophils (Absolute) 1.3 Low x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1.4 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.3 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 110 High mg/dL 65 - 99 01
BUN 16 mg/dL 6 - 24 01
Creatinine, Serum 0.81 mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 102 mL/min/1.73 >59
eGFR If Africn Am 118 mL/min/1.73 >59
BUN/Creatinine Ratio 20 9 - 20
Sodium, Serum 140 mmol/L 134 - 144 01
Potassium, Serum 4.5 mmol/L 3.5 - 5.2 01

Chloride, Serum 103 mmol/L 97 - 108 01
Carbon Dioxide, Total 23 mmol/L 18 - 29 01
Calcium, Serum 8.7 mg/dL 8.7 - 10.2 01
Protein, Total, Serum 6.4 g/dL 6.0 - 8.5 01
Albumin, Serum 4.3 g/dL 3.5 - 5.5 01
Globulin, Total 2.1 g/dL 1.5 - 4.5
A/G Ratio 2.0 1.1 - 2.5
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase, S 44 IU/L 39 - 117 01
AST (SGOT) 20 IU/L 0 - 40 01
ALT (SGPT) 24 IU/L 0 - 44 01
Lipid Panel w/ Chol/HDL Ratio
Cholesterol, Total 172 mg/dL 100 - 199 01
Triglycerides 45 mg/dL 0 - 149 01
HDL Cholesterol 76 mg/dL >39 01
Comment 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 9 mg/dL 5 - 40
LDL Cholesterol Calc 87 mg/dL 0 - 99
T. Chol/HDL Ratio 2.3 ratio units 0.0 - 5.0
Please Note: 01
T. Chol/HDL Ratio
Men Women
1/2 Avg.Risk 3.4 3.3
Avg.Risk 5.0 4.4
2X Avg.Risk 9.6 7.1
3X Avg.Risk 23.4 11.0
Testosterone,Free and Total
Testosterone, Serum 834 ng/dL 348 - 1197 01
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 30.4 High pg/mL 7.2 - 24.0 02
DHEA-Sulfate 230.8 ug/dL 71.6 - 375.4 01
TSH 1.660 uIU/mL 0.450 - 4.500 01
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 1.9 ng/mL 0.0 - 4.0 01
IGF-1
Insulin-Like Growth Factor I 164 ng/mL 61 - 200 02
Estradiol, Sensitive 34.8 pg/mL 8.0 - 35.0 02

 

[Vince Carter]

It takes awhile, sometimes that is our number one complaint is that sex drive and/or ED matters don't resolve when everything else does. I only looked at your T and E numbers and they look fine. I'd suggest higher DHEA numbers but I don't believe that's where the issue is, it could be, and will benefit you. But I didn't read every test you posted.

 

[ERO]

Yes, the lack of improvement in ED and libido is, sadly, a common complaint with TRT, myself included.

Your glucose (I am assuming it was a fasting glucose test) is a bit high at 110, which is in the "Pre-Diabetes" range of 100 - 125. I would maybe get a second test to rule out a "one off" reading and if it is still that high, look at ways to lower via diet, etc...

 

[hdrider]

I've been attacking my blood glucose level for the last 2 years with everything I've got, and everything I can find out. Low carb diet, no processed food, supplements, plenty of exercise, no excess weight, and now TRT.

It has come down, but not sure what else to do. My a1C is at 5.2 right now, which is okay, but could be better.

 

[Nelson Vergel]

Your blood work is nice. Your glucose if obviously slightly elevated. Have you tried metformin?

It would be nice to see what your DHT is.

Ask the compounding pharmacy is the T cream formulation has any alcohol or not. If not, you may want to apply to testicles if your DHT is low. You could also change the HCG dose to 500 IU twice per week (total weekly dose: 1000 IU) instead of the 100 IU per day (total weekly dose: 700IU)

 

[hdrider]

Thank you, Nelson.

I am aware of Metformin, but have not tried it for two reasons. First, some of the diabetes forums I follow suggest side effects, some possibly unknown, since the mechanism is not well understood. Second, my regular doctor would not be open to prescribing it, since he has indicated that my blood glucose level is not of concern because it's not at diabetic level. His exact words to me two years ago "Don't worry. You're not diabetic, and if you develop diabetes, we'll just put you on medication." Can you believe it?

I will discuss other options with my TRT doc, and in the meantime will educate myself on DHT. What is the theory behind changing the HCG dose from daily to twice weekly?

Also, thank you for your great work with this forum. To say that it has changed my life is not an overstatement.

 

[Vince]

hdrider, I been on metformin for a long time, never had any side effects. I think you should give it a try. https://www.excelmale.com/forum/sho...y-explores-anti-aging-properties-of-metformin

 

[Gene Devine]

Cabergoline increased my libido significantly and swear by the stuff.

It's a well known Dopamine agonist and taken in low doses like .25 mg twice weekly has helped many men and women increase libido like it has mine.

You can't take it if your Prolactin levels are low as it's a Prolactin inhibitor.

There are a number of Doctor's who are aware of these benefits and will prescribe it where indicated.

 

[hdrider]

Thank you, Vince. I will keep it on my radar. Right now my priority is to get a satisfactory TRT protocol dialed in, then see how my blood sugar responds to that. Once that stabilizes, I'll see what the next step is.

 

[hdrider]

Thank you, Gene. I will research Cabergoline, and mention it to my doc when we talk.

 

[hdrider]

I checked my pre-TRT labs from my regular doc, and found that my prolactin level is (or was) on the high end: 12.2 (ref 2.6 - 13.1). So unless maybe TRT has brought it down, this could possibly be part of the problem, and therefore Cabergoline a potential solution.