Libido issues still - 8 months - Labs - Need help

[SilverSurfer]

Thank you in advance for your help. I started TRT a little over 8 1/2 months ago. My main complaint was libido, but also had ED, no morning wood, lost muscle mass, and mental fogginess. My opening TRT was 200 mg every 2 weeks. This solved all my secondary complaints but didn’t do anything to help my libido. Since then I have added HCG to no effect except restore my shrinking balls. I’ve also upped my dose a couple of times, went to weekly, then every 3 days, but nothing helps with libido. In fact, I feel no different from 200 mg every 2 weeks (100 mg week) to 100 mg E3D (200 mg week) I can’t feel a difference. I’m currently on 150 mg once per week. The prior 2 days to injection I use 350 iu HCG, so the labs are my peak blood levels.

I am a recovering Fentanyl addict of 16+ years, so still take a medication called Suboxone (partial opiate agonist) which creates some of my problems but I cannot stop taking it for another 6+ months minimum. I haven’t touched a drop of alcohol or used any drugs for almost a year. I’m 50 years old and only take Cialis, Viagra, and Campral in addition to the Suboxone. I’m 5’9” and weigh 207 lbs. (Was 284 lbs, lost 93 lbs fat and gained 16 lbs muscle since 11 months ago). I still need to lose 17 lbs and working on it. Walk/jog 5 days a week for 75 mins and lift weights 4 times per week for 1 hr each. Diet good, could be better.

Results - Peak #s (normal range #s)

SHBG - 50.4 (19.3 - 76.4)
PSA - 1.2 (0.0 - 4.0)
TSH - 3.87 (0.45 - 4.5)
T4 - 7 (4.5 - 12)
T3 - 30% (24% - 39%)
Free Thyroxine- 2.1 (1.2 - 4.9)
Hemocrit - 48

Testosterone - 1,429 (264 - 916)
Free T - 26.8 (7.2 24)
Estradiol - 86.1 (7.6 - 42.6) **Not sure if sensitive test, but rqst it - 6% of Testosterone
Prolactin - 25.4 (4.0 - 15.2)
DHT - 79 (No range given, but internet search says normal range) approx 5.5% of Test

All my other blood work normal or very good. Ie, lipids, vitamins, glucose, BP

I asked about my high prolactin which is a side effect of the Suboxone and my doc said it wasn’t that high to try any medications as he’s seen #s in the mid-hundreds. Also, my estrogen is a bit high, but given my testosterone is so high and test followed on day 3 and 4 of HCG this doesn’t seem abnormal does it? No gyno, no AI, no side effects except mild back acne at higher T doses. Again, on all doses and frequencies (with or without HCG) I feel the exact same. No anxiety, no depression, never been medicated for such. 7+ hrs sleep per night.

Any thoughts or ideas? My doc did give me an RX for T gel that I could fill but haven’t. I had thought maybe my DHT was low, and gels raise DHT, but after getting test back that doesn’t seem to be an issue does it?

 

[wsj357]

Prolactin is high. I’ve read many times high prolactin causes ED issues. There is a way to lower this value. I’ll let the community back that thought up because I’m not 100% sure, I am fairly confident it is. I would google that.

I had super high t levels and my labido sucked. I lowered it down and it came back. I believe estrogen and too many hormones were causing this issue. How long as you goinf between dose changes? What were your pre trt labs.

The cream has helped a ton as well.

I am on suboxone and that’s why I started trt. Similar addiction issues but not as long. Suboxone does cause some erectile dysfunction because it lowers the petiutary function. Now that your T is fine, the suboxone is not as big an issue.

I’ve found with suboxone less is more. What dose are you currently taking? I went from 16mg three years ago to 3mg today. The drop was easy. I was able to go from 16 to 8 overnight. 8 to 4 in 2-3 months and I’ve stayed at 3 to 4 for a year or two.

 

[SilverSurfer]

I asked my doc about Cabergoline and he said no, to deal with my prolactin so I would need to order from an overseas pharmacy I guess. I wasn’t sure if my prolactin was that high that it would affect libido, but it’s about the only thing I can see that might work.

I saw on Reddit they mentioned a B6 vitamin supplement called P5P, and am not sure if anyone has had success with it.

My T was low 400s when I started TRT. However, I started getting my testosterone tested every 5 years starting at age 25, and it was consistently 900 - 1000 all the way up to age 45 even with my early opiate addiction. I’m currently taking 3 mg of Suboxone per day. I was inducted at 12 mg a year ago. I tried to get down to 2 mg and my cravings came back, so I’m on 3 mg for at least July before I can try to get down to 2 mg.

 

[Gman86]

I would imagine that your high prolactin is probably the main issue. I would definitely try to get your hands on some cabergoline if I were you.

You’re also very hypothyroid. Definitely get that treated.

 

[SilverSurfer]

Hypothyroid? Why do you say that? My numbers are all seemingly in the normal range and my doc said my thyroid numbers looked “good”? My addiction doc pulled thyroid tests about 6 months ago and said similar. I’m not disputing it, just trying to understand what to look at which indicates it. Thanks.

 

[Systemlord]

Hypothyroid? Why do you say that? My numbers are all seemingly in the normal range and my doc said my thyroid numbers looked “good”? My addiction doc pulled thyroid tests about 6 months ago and said similar. I’m not disputing it, just trying to understand what to look at which indicates it. Thanks.

No, your thyroid labs aren't normal, the reference ranges aren't normal. Your libido problems are related to the Suboxone, narcotic pain relievers are notorious for killing libido. TRT will not work well when there are thyroid problems and sometimes labs can look good and thyroid problems can still exist.

Optimal VS Normal Thyroid Levels for all Lab Tests & Ages

Reference ranges for TSH and thyroid hormones

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH.

 

[Gman86]

Hypothyroid? Why do you say that? My numbers are all seemingly in the normal range and my doc said my thyroid numbers looked “good”? My addiction doc pulled thyroid tests about 6 months ago and said similar. I’m not disputing it, just trying to understand what to look at which indicates it. Thanks.

Ya anytime man, it’s a learning process for all of us. But it’s so sad that two different guys, with actual licenses to practice medicine, that went to school for 7+ years to learn about these things, are that blind to such obvious signs of hypothyroidism. The medical system is so broken. And I’m a nurse. It’s so discouraging for me. Thought about getting out of the medical field many times because of how broken it is, and how patients usually always get worse, or at best continue with their original problems. I’ve never had a patient with a chronic illness get better, ever. It’s so sad.

But anyways, best advice I can give to you is ditch those doctors asap. They clearly have no clue what they’re talking about in regards to thyroid. So who knows what else they have no clue about. Any TSH over 2.5 is a clear sign of hypothyroidism. Plus your free T3 is extremely low. Like ridiculously low. It should be at least 3.5. Most good doctors will like free T3 around 3.7 or higher to be optimal. And they didn’t even test you for total T3, free T4, or reverse T3, which are all absolutely necessary to accurately assess someone’s thyroid. Let alone testing for thyroid peroxidase and thyroglobulin antibiodies. But bottom line, you’re so clearly hypothyroid its not even funny. No exaggeration. It’s mind boggling that a doctor actually looked at your labs and said “they look good”, let alone two doctors!

 

[Vince Carter]

When you run Prolactin had you not had sex/orgasmed in the ~24hrs prior...these can influence that test.

Cabergoline is widely avail as a research chemical. Will that fix something...I don't know.

 

[CoastWatcher]

For future reference, your doctor failed to order the proper estradiol test (the reference range is a dead giveaway). The standard test that was ordered for you is unreliable when men use it.

 

[wsj357]

Ya anytime man, it’s a learning process for all of us. But it’s so sad that two different guys, with actual licenses to practice medicine, that went to school for 7+ years to learn about these things, are that blind to such obvious signs of hypothyroidism. The medical system is so broken. And I’m a nurse. It’s so discouraging for me. Thought about getting out of the medical field many times because of how broken it is, and how patients usually always get worse, or at best continue with their original problems. I’ve never had a patient with a chronic illness get better, ever. It’s so sad.

But anyways, best advice I can give to you is ditch those doctors asap. They clearly have no clue what they’re talking about in regards to thyroid. So who knows what else they have no clue about. Any TSH over 2.5 is a clear sign of hypothyroidism. Plus your free T3 is extremely low. Like ridiculously low. It should be at least 3.5. Most good doctors will like free T3 around 3.7 or higher to be optimal. And they didn’t even test you for total T3, free T4, or reverse T3, which are all absolutely necessary to accurately assess someone’s thyroid. Let alone testing for thyroid peroxidase and thyroglobulin antibiodies. But bottom line, you’re so clearly hypothyroid its not even funny. No exaggeration. It’s mind boggling that a doctor actually looked at your labs and said “they look good”, let alone two doctors!

Your dealing with the sick care system in western medicine.

They work by lab ranges. Lab ranges are skewed and the organizations and research behind the creation of these ranges are biased.

They widen the gap of ranges so that less folks are covered under insurance. For instance thyroid tsh is ranged between 1-5 I believe. Insurance won’t cover therapy unless your at 6. Any doc who is educated knows that anyone at 2 t 5 is needing some help with thyroid.

Find a private care doc like Nelson Virgil or defy or dr Nichols and they will tell you a different story. Take the same lab to a insurance slave doc and they’ll say your fine. Have fatigue! Here take this pill. Have Ed here take viagra. Have sdepression or anxiety here take this. Never “your thyroid and low t are the culprit here”. Hope that helps. Surprised more folks haven’t figured this out .

 

[wsj357]

Ya anytime man, it’s a learning process for all of us. But it’s so sad that two different guys, with actual licenses to practice medicine, that went to school for 7+ years to learn about these things, are that blind to such obvious signs of hypothyroidism. The medical system is so broken. And I’m a nurse. It’s so discouraging for me. Thought about getting out of the medical field many times because of how broken it is, and how patients usually always get worse, or at best continue with their original problems. I’ve never had a patient with a chronic illness get better, ever. It’s so sad.

But anyways, best advice I can give to you is ditch those doctors asap. They clearly have no clue what they’re talking about in regards to thyroid. So who knows what else they have no clue about. Any TSH over 2.5 is a clear sign of hypothyroidism. Plus your free T3 is extremely low. Like ridiculously low. It should be at least 3.5. Most good doctors will like free T3 around 3.7 or higher to be optimal. And they didn’t even test you for total T3, free T4, or reverse T3, which are all absolutely necessary to accurately assess someone’s thyroid. Let alone testing for thyroid peroxidase and thyroglobulin antibiodies. But bottom line, you’re so clearly hypothyroid its not even funny. No exaggeration. It’s mind boggling that a doctor actually looked at your labs and said “they look good”, let alone two doctors!

He said it. This guys on the money. Believe him and take charge of your health.

 

[fifty]

A lot of doctors are just like “cool your numbers are in range. Case closed. Maybe I’ll have time for lunch today.”

 

[wsj357]

A lot of doctors are just like “cool your numbers are in range. Case closed. Maybe I’ll have time for lunch today.”

More like your fine it can’t be that. Here take this script and fill it. Come back next month for more. Lolllzzz ffs mind boggling where our medical care system is headed.

 

[Systemlord]

Bioidentical hormones are is the prevention and treatment for countless diseases, it's no wonder why bioidentical hormones are so difficult to get prescribe.

 

[SilverSurfer]

I called my addiction doc where I had my TSH levels taken right before I started TRT, and it was 2.1. Can TRT be the cause of why my TSH is now 3.87. While I have gained muscle on TRT, which is great, my fat loss started stalling out at the end of the year. I figured I had to work through a plateau or something.

 

[Systemlord]

I called my addiction doc where I had my TSH levels taken right before I started TRT, and it was 2.1. Can TRT be the cause of why my TSH is now 3.87. While I have gained muscle on TRT, which is great, my fat loss started stalling out at the end of the year. I figured I had to work through a plateau or something.

Going from low testosterone to optimal testosterone can expose a thyroid that was already on the brink, TRT is attempting to restore metabolic rates and it's the thyroids job to increase metabolism and is now struggling.

We see this often.

 

[SilverSurfer]

I’m going to step down my testosterone dose given the peak is pretty high, and my libido is not helped or further hurt one way or another by doseage, then retest my thyroid in 90 days. In the meantime I’m going to try to find a source for Cabergoline to see if lowering my prolactin helps at all.

 

[SilverSurfer]

While I wait on getting Cabergoline from overseas I decided to try P5P which is a bioavailable form of B6. There was plenty of “bro-science” touting its effects, but I did find a medical study that validates the claims. It appears to be about 80% as effective as Cabergoline, without the side effect profile, according to this study: https://www.researchgate.net/profile/Suha_Witwit/publication/328137742_The_role_of_vitamin_B6_in_reducing_serum_prolactin_in_comparison_to_cabergoline/links/5bbb0350299bf1049b749819/The-role-of-vitamin-B6-in-reducing-serum-prolactin-in-comparison-to-cabergoline?origin=publication_detail

I’ll update any results in 2 or 3 weeks when I receive my Cabergoline. If unsatisfied with the results I’ll try the Cabergoline for a few weeks. By then it will be time for a follow up on my thyroid retest.

 

[Vvs1]

There's an herb Vitex that can lower prolactin when taken at high dosages, 1200-1600mg.

I just want to warn you that low doses increase prolactin and the herb is known as a libido reducers for monks, or for women.

There are studies out there, that back both claims. I just wanted to warn you about it first before you experimented. Some of the PFS guys have used it to recover, and that's the only few real world claims I've seen.

 

[SilverSurfer]

Vvs, thanks for the info, I have never heard of Vitex. I’ll have to check that out and read up on it. So far my experiment with P5P seems to be working, although only 5 days in, my libido the past 1.5 days seems better, and certainly I’ve gotten some random erections during the day when sex crosses my mind. But it could be a natural cycle or placebo, so I’ll evaluate it at the end of 30 days.