Libido good pre/post TRT- Years later crashes

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I've read thru so many threads on this forum and others about libido issues on TRT. but nothing entirely similar to my story and I'd be grateful for guidance on how to chase down what the issue is.

Prior to TRT even with medical issues, adrenal fatigue, and low hormones my libido and sexual performance was amazing. Getting on TRT/HRT (I do test, adex, hcg, HGH) made my life return to normal thankfully and the entire time for 7 years my libido and sexual performance remained awesome. Then eventually little by little by little my libido and at times sexual performance declined. Like what the hell? My labs have remained consistent so my docs say it's not the hormones. But I've read plenty of times it's not as simple as my T, estrogen and IGF levels staying same. That libido is complex. But what else then should I have them check on labs? I've had prolactin and progesterone and lots of other things checked. All remain in good or optimal ranges.

I've tried all sorts of supplements to see if they'd help, herbs, adaptogens, all the dopamine precursors and nada.

Just weird not to have a strong libido, and also when I do have sex it not be as intense as it used to be, orgasms aren't as pleasurable, and are harder to achieve.

Again I never had issues prior to TRT/HRT which is nearly 9 years ago I started. On TRT/HRT if remained fantastic. Just 2 years ago or maybe a little longer my libido started going downhill and then even the sensations, pleasure and intensity of orgasms.

I've read some guys go to Dr Mariano and he sorts out all kind of labs as well as if it's any mental issue I guess since he is a psychiatrist by training.

I'm in great shape. Low bodyfat. Not having adrenal fatigue issues. Exercise properly at gym, plus yoga and meditation, balance life stressors etc. clean pale/cyclical keto eating.

Is this just the difference between mid 30s and creeping in the early 40s?!?!

I was gonna try Viagra until i saw prices. But that's not supposed to help libido or orgasm intensity. I could try all these online places many threads talk about BUT I'd like to get to the root cause whatever it is.

Some say over time adex can create issues??
 
Defy Medical TRT clinic doctor

CoastWatcher

Moderator
Welcome to Excelmale.

Can you give us some context? How old are you? Details of your protocol? Your most recent labs, with reference ranges, and any trends in those labs (something trending up or down)? Your medications/supplements, and any change in medical situation? Are you sleeping well, might you be dealing with apnea?

The conversation will open up with this to jumpstart it. We're looking forward to hearing more from you.
 

madman

Super Moderator
I've read thru so many threads on this forum and others about libido issues on TRT. but nothing entirely similar to my story and I'd be grateful for guidance on how to chase down what the issue is.

Prior to TRT even with medical issues, adrenal fatigue, and low hormones my libido and sexual performance was amazing. Getting on TRT/HRT (I do test, adex, hcg, HGH) made my life return to normal thankfully and the entire time for 7 years my libido and sexual performance remained awesome. Then eventually little by little by little my libido and at times sexual performance declined. Like what the hell? My labs have remained consistent so my docs say it's not the hormones. But I've read plenty of times it's not as simple as my T, estrogen and IGF levels staying same. That libido is complex. But what else then should I have them check on labs? I've had prolactin and progesterone and lots of other things checked. All remain in good or optimal ranges.

I've tried all sorts of supplements to see if they'd help, herbs, adaptogens, all the dopamine precursors and nada.

Just weird not to have a strong libido, and also when I do have sex it not be as intense as it used to be, orgasms aren't as pleasurable, and are harder to achieve.

Again I never had issues prior to TRT/HRT which is nearly 9 years ago I started. On TRT/HRT if remained fantastic. Just 2 years ago or maybe a little longer my libido started going downhill and then even the sensations, pleasure and intensity of orgasms.

I've read some guys go to Dr Mariano and he sorts out all kind of labs as well as if it's any mental issue I guess since he is a psychiatrist by training.

I'm in great shape. Low bodyfat. Not having adrenal fatigue issues. Exercise properly at gym, plus yoga and meditation, balance life stressors etc. clean pale/cyclical keto eating.

Is this just the difference between mid 30s and creeping in the early 40s?!?!

I was gonna try Viagra until i saw prices. But that's not supposed to help libido or orgasm intensity. I could try all these online places many threads talk about BUT I'd like to get to the root cause whatever it is.

Some say over time adex can create issues??

Libido starts in the brain and neurotransmitters play a huge role as one can have healthy testosterone levels/thyroid levels/adrenal glands and still suffer low libido due to imbalance in neurotransmitters especially dopamine. Same applies to erections as hormones can be in balance but one still suffers from ed whether mild-moderate-severe due to poor endothelial/vascular health/poorly functioning nitric oxide pathways. Libido/ed can be very complex issues as many factors can contribute. Dopamine manipulation is also very difficult as it cannot constantly remain elevated. Something to think about is when one starts trt everyone experiences the honeymoon period where the brain is flooded with dopamine due to the increase in testosterone but it is short term and I think eventually there are mechanisms which cause one to be less sensitive to the effects of dopamine over the long run on trt especially when levels reach a CONSTANT steady state as oppose to the natural daily fluctuations of the circadian rhythm.The testosterone patch as oppose to gels/injections most closely mimics the natural circadian rhythm.
 
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To parse out libido and the physical ability to act on the desire...which is it for you? We talking strictly ED arena or are you losing basic interest in sex....I like to separate the two issues.
 
Thanks for the responses. I'll have to get out labs and take time to type them up later. They've been consistent for 8+ years basically. Doing more soon too so if there are any libido specific lists of things to ask my doc to check please enlighten me.

It's libido first, I don't generally have an interest in sex. Which is WEIRD after being a typical horny guy my entire life. However when I do have sex, my performance isn't up to par so feels like I may have ED too. But is ED related to not easily achieving orgasm and orgasm not being super intense or as pleasurable as it was my entire previous life? So maybe it's not even considered ED If I can get it up but just not achieve orgasm or when I do it's lame. Like whatever that didn't even feel good.

I'm in my early 40s. Been on same protocol for entire time once I got my E2 dialed in to low 20s. TT usually in 800-1100 range depending on day I draw blood. 200mg Test a week, 1mg adex 3x week, 250iu hcg 3x per week, 3iu HGH daily. Due to severe chronic pain I've had insomnia issues so take Xyrem (GHB). As far as I know Xyrem boosts libido and dopamine,
My doctors have said so. In past I experienced it as well that stuff used to make me wanna get it on when a girlfriend was spending night. Only other Med is sometimes periods of vicadin for chronic pain. Can vicadin mess with libido and pleasure? No apnea as I've done sleep study and come out fine.

What's strange is when I started this protocol I was in awful shape due to a host of medical issues (which led to the need for HRT). Yet back even when I was in horrible shape and on tons and tons of harsh meds, I was still horny as a teenager and had a great sex life with my partner. For many years on the above protocol my libido and sexual performance remained high if not got higher for a period of time especially when I got back into shape and over the big medical hurdles.

But that's scary if being on a constant HRT plan is going to essentially desensitize me to dopamine ? Am I reading that right? But if so wouldn't other guys on long term HRT lose their libido and ability to orgasm or feel intense pleasure from it too?

Supplements - I take a lot of anti-aging, longevity type supplements from my doctors. That I've researched greatly and they've been consistent on suggesting. I see 2 different functional medicine doctors primary care plus cardiologist who is also a HRT doc and uses supps with patients, to always have more than one opinion on anything I do medically, after what's happened to me in past I do my own research and also have multiple docs review my labs and give suggestions just to be safe before I use any medication or supplements. It would be a long list so if there is something specific you're asking for I should be on or any libido killers I'm unaware of please ask. I'd generally say a lot of the types of supplements Life Extension magazine markets and does articles on, im probably on. I'm not on supplements to get yoked or ripped or things like that. Probiotics, Vit D, fish oil, curcumin/turmeric, TMG, acetyl l carnitine, Krill oil, digestive enzymes, uniquinol, resveratrol, PQQ, NAC, mushrooms blend, creatine, ALA, Alpha GPC, bacopa, tart cherry, blueberry extract, Huperzine, vinpocetine, ginseng, ginkgo, rodeola rosea, MCT, C, ashwaganda, olive leaf extract, taurine, theanine, before bed 5 HTP/melatonin/calcium magnesium Zinc, for joints MSM Chondoiton Glucosamine, pre workout tyrosine + beta alanine + citraline + arginine, post workout whey protein or if not in mood a handful of BCAA and 5g glutamine, that's generally off top of my head. Could be others especially in products that have multiple ingredients. Eating generally paleo. Wanna get back on cyclical keto sort of Mauro DiPasquale style which in past has gotten me to sustain 7-10% BF via dunk tank Or dexa scan. Maybe I'm 11-12% right now not my best but certainly not bad for a guy in his 40s.

I've seen threads on other forums of guys doing hard core cycles and certain steroids losing libido but I am not doing any of that. Just doctor prescribed HRT.

My docs don't advise anything else said I can try viagra or cialis but it's so damn expensive and doing the online thing is a roll of dice from what I've read for quality of product or credit card scams. Plus those don't help libido and orgasm so not sure it would help anyhow. Some Florida clinics have a ton of other sexual boosters and I think maybe even oxytocin but come on should I need to he slamming all sorts of ****tails into my body or getting to root cause to correct and have a normal sex life without spending tons of money on auxiliary stuff. I've tried mucuna, Maca and muira puana with no luck in boosting libido.


Thanks guys.
 
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madman

Super Moderator
Thanks for the responses. I'll have to get out labs and take time to type them up later. They've been consistent for 8+ years basically. Doing more soon too so if there are any libido specific lists of things to ask my doc to check please enlighten me.

It's libido first, I don't generally have an interest in sex. Which is WEIRD after being a typical horny guy my entire life. However when I do have sex, my performance isn't up to par so feels like I may have ED too. But is ED related to not easily achieving orgasm and orgasm not being super intense or as pleasurable as it was my entire previous life? So maybe it's not even considered ED If I can get it up but just not achieve orgasm or when I do it's lame. Like whatever that didn't even feel good.

I'm in my early 40s. Been on same protocol for entire time once I got my E2 dialed in to low 20s. TT usually in 800-1100 range depending on day I draw blood. 200mg Test a week, 1mg adex 3x week, 250iu Hcg per week, 3iu HGH daily. Due to severe chronic pain I've had insomnia issues so take Xyrem (GHB). Only other Med is sometimes periods of vicadin for chronic pain. Can vicadin mess with libido and pleasure? No apnea as I've done sleep studies and come out fine.

What's strange is when I started this protocol I was in awful shape due to a host of medical issues (which led to the need for HRT). Yet back even when I was in horrible shape and on tons and tons of harsh meds, I was still horny as a teenager and had a great sex life with my partner. For many years on the above protocol my libido and sexual performance remained high if not got higher for a period of time especially when I got back into shape and over the big medical hurdles.

But that's scary if being on a constant HRT plan is going to essentially desensitize me to dopamine ? Am I reading that right? But if so wouldn't other guys on long term HRT lose their libido and ability to orgasm or feel intense pleasure from it too?

I've seen threads on other forums of guys doing hard core cycles and certain steroids losing libido but I am not doing any of that. Just doctor prescribed HRT.

Thanks guys.
1 gram arimidex 3 times week my god could that be your issue having in the low 20s may not be good for you maybe need higher with total 800-1000? Desensitization to dopamine regarding trt hard to say as there is no concrete evidence but is there a possibility?
 

JakeH

Member
1 gram arimidex 3 times week my god could that be your issue having in the low 20s may not be good for you maybe need higher with total 800-1000? Desensitization to dopamine regarding trt hard to say as there is no concrete evidence but is there a possibility?

When I was on clomid and AI, and thus blocking estrogen, I lost all desire and orgasams were weak. It felt like I had a rubber penis in fact.
 
Thanks guys. Still getting hang of this forum so I apologize for any delays or mishaps. I'm so grateful for the quick responses. Yes higher arimidex than most. Back when I started we started .5 2x week to 3 x week. It seemed to keep me good for I forget what period of time a year or a year and a half, then E2 krept up so had to keep upping adex. But it's been years on that high a dose and like I said for a long time I was like 16 again, couldn't pass a good looking girl without popping a tent in my shorts. So let's say 6 years generally at 1mg adex 3 times a week and libido sky high...would there be a reason it took so long to drop my libido if it partly is cause?

As for E2 I've always read 22-27 or something in That range is sweet spot no? It seemed to work for me for years.

Also I just edited in many of my supplements. Just a side note the herbs and some of the mental supps I cycle and do not stay on year round.

My docs conclusion - stress. But damn I've had stress before and seem to manage it well (yoga, meditation, massage, acupuncture). As someone said they say libido is a complicated beast. Not black and white on labs.
 

madman

Super Moderator
Thanks guys. Still getting hang of this forum so I apologize for any delays or mishaps. I'm so grateful for the quick responses. Yes higher arimidex than most. Back when I started we started .5 2x week to 3 x week. It seemed to keep me good for I forget what period of time a year or a year and a half, then E2 krept up so had to keep upping adex. But it's been years on that high a dose and like I said for a long time I was like 16 again, couldn't pass a good looking girl without popping a tent in my shorts. So let's say 6 years generally at 1mg adex 3 times a week and libido sky high...would there be a reason it took so long to drop my libido if it partly is cause?

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I would try cutting back on your ai to see if you notice any improvements and a 22-27 number is not a given regarding e2. Estradiol is tricky and some can actually run higher numbers with a higher total t and feel well. Also if your e2 test was the standard assay which tends to overestimate e2 and not the sensitive assay which is more accurate than your e2 levels may very well be too low. You need to explain your exact protocol and post lab work so members can give further insight!
 
Protocol
200mg t weekly
250iu hcg 3x week
1mg adex 3x week
3iu HGH daily.

Most recent labs :
TT 826, FT 225, Estradiol 30 (highest its ever been that I recall)

Next most recent :
TT 833, FT 253, Estradiol 25

One before that :
TT 947, FT 198, Estradiol 21

how do I tell which estrogen test I've had done?
 

madman

Super Moderator
Protocol
200mg t weekly
250iu hcg 3x week
1mg adex 3x week
3iu HGH daily.

Most recent labs :
TT 826, FT 225, Estradiol 30 (highest its ever been that I recall)

Next most recent :
TT 833, FT 253, Estradiol 25

One before that :
TT 947, FT 198, Estradiol 21

how do I tell which estrogen test I've had done?

I live in Canada and unfortunately we only have the standard assay. Most members on EM are US based and use Labcorp or Quest for blood work so hopefully other members will let you know what the test coding is and what is stated on your paper work for the sensitive assay.
 
I'm gonna see my doc to get new labs done in a week, hoping to find a list of what's most thorough to have checked while the insurance will pay for it. Then if I can't figure this out maybe I need to do a consult with Mariano or Crisler. I can't keep going on living like this.
 

JPB

Member
Can you clarify, is your issue a lack of desire for sex, or ability to get it up and orgasm, or both? I do think cutting back on the AI is a good start. Something to keep in mind, the long-term shutdown of LH output can compromise sexual function eventually. I know the theory that HCG can help alleviate this, but YMMV. Also, while high T consistently helps libido for most, it does not seem to help resolve or eliminate ED for many. Thus the addition of daily Cialis to the protocol, by the way, which also helps with many other age-related cardiovascular and circulatory / NO related declines.
 
It's lack of desire for sex (and other previously enjoyable things like MMA or hard core heavy lifting that I've been Doing for 30 years- so some of it I thought might just be being in my 40s but now I wonder if it's dopamine desensitization).

So I lack the desire for sex, and when in in a situation I can sometimes get it up and get job done but hard to reach orgasm and even if I do there is hardly any pleasurable feeling to it. Like weird an orgasm not feeling crazy intense good?!

Mind you pre TRT libido was awesome. For approx 7 years on TRT my libido was awsome, orgasms intense, and I felt like a rock star in bed. So why years later with my labs being consistent to when libido was good, now libido is horrible? Organs don't feel good?
 

JPB

Member
As I mentioned previously the shutdown in LH can lead to issues ...eventually. I think the dopamine connection sounds logical too.
 

draftsman

New Member
You take a lot of different supplements. I would suggest changing/reducing or just stopping the supplement protocol for a few weeks and see how you feel. I've also heard low(er) carb diets reduce libido as well as over training.
 
Hi, I have done periods of weaning off supplements to see if it has any effect with no change in libido. The only supplements I probably never go off of even when trying to “fast” from them for a few weeks, is fish oil and probiotics. I never heard of them negatively impacting libido.

Still here we are many months later no change at all...I was so curious to see if anything would work that I haven’t tried so paid a lot for legit oxytocin troches, and a nasal spray too just for giggles. Nothing.

This summer when I have time to travel I’ll just have to hope a doctor like Mariano perhaps can sort it out. It’s damn depressing and frustrating to lose libido or the sensation of pleasure and orgasms. It’s weird to say the least.
 
Oh god no!! Sorry I didn’t realize I didn’t put changes in this thread as I had one on another forum. I did a long period (maybe 3 months ?) of lowering T to 150mg week and no AI and continued HCG. Felt no changes in sexual desire or performance or pleasure. Did labs and my E2 has climbed to 39. At no point did I really feel differences in morning wood which I thought was the unwritten rule that if you had crashed E2, then get off AI, as it rose you’d know perhaps you were close to sweet spot when morning wood returned. So after no AI for months and E2 39, I resumed adex at 1mg week total, doing .5mg on same day I inject T (twice weekly for 150mg total).

I’ve since had some morning wood here and there, and sexual desires, but as someone else posted it feels like I have a “rubber penis”. No sensation and no feelings of pleasure even if I do orgasm. No fireworks at all so to speak.
 
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