27 Yr Male on TRT, Zero Libido

[Admired]

27, 5'9" 155 lbs, great shape, run quite a lot.

Been on TRT since April of 2018 @ 100mg/week (1 injection). First few weeks and month went well with libido good and erections pretty solid. Then the last month or month and a half libido plummets and erections are non existent and even very challenging to achieve when I masturbate. Spoke to endo and got the following bloodwork.

Lab:Estradiol (LC&Q)

[TD="width: 50%, align: left"]Estradiol[/TD] [TD="width: 10%, align: left"]25.1[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]7.6-42.6 - pg/mL[/TD]

[TD="width: 50%, align: left"]ESTRADIOL[/TD] [TD="width: 10%, align: left"]25.1[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]7.6-42.6 - pg/mL[/TD]

Lab:Testosterone, Free and Total (includes SHBG) (LC&Q)

[TD="width: 50%, align: left"]Testosterone, Total[/TD] [TD="width: 10%, align: left"]1083[/TD] [TD="width: 10%, align: left"]H[/TD] [TD="width: 30%, align: left"]- ng/dL[/TD]

[TD="width: 50%, align: left"]Testosterone, Free[/TD] [TD="width: 10%, align: left"]227[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]- pg/mL[/TD]

[TD="width: 50%, align: left"]Testosterone, % Free[/TD] [TD="width: 10%, align: left"]2.1[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]- %[/TD]

[TD="width: 50%, align: left"]Sex Hormone Binding Globulin[/TD] [TD="width: 10%, align: left"]48.7[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]- nmol/L[/TD]

Lab:CBC, Platelet; No Differential (LC&Q)

12.3-15.4 - %

[TD="width: 50%, align: left"]WBC[/TD] [TD="width: 10%, align: left"]11.0[/TD] [TD="width: 10%, align: left"]H[/TD] [TD="width: 30%, align: left"]3.4-10.8 - x10E3/uL[/TD]
[TD="width: 50%, align: left"]RBC[/TD] [TD="width: 10%, align: left"]5.19[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]4.14-5.80 - x10E6/uL[/TD]
[TD="width: 50%, align: left"]Hemoglobin[/TD] [TD="width: 10%, align: left"]15.4[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]13.0-17.7 - g/dL[/TD]
[TD="width: 50%, align: left"]Hematocrit[/TD] [TD="width: 10%, align: left"]48.0[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]37.5-51.0 - %[/TD]
[TD="width: 50%, align: left"]MCV[/TD] [TD="width: 10%, align: left"]93[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]79-97 - fL[/TD]
[TD="width: 50%, align: left"]MCH[/TD] [TD="width: 10%, align: left"]29.7[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]26.6-33.0 - pg[/TD]
[TD="width: 50%, align: left"]MCHC[/TD] [TD="width: 10%, align: left"]32.1[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]31.5-35.7 - g/dL[/TD]
[TD="width: 50%, align: left"]Platelets[/TD] [TD="width: 10%, align: left"]296[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]150-379 - x10E3/uL[/TD]
[TD="width: 50%, align: left"]NRBC[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"][/TD]
[TD="width: 50%, align: left"]RDW[/TD] [TD="width: 10%, align: left"]13.1[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]	[/TD]

Lab:Thyroxine (T4) Free, Direct, S (LC&Q)

[TD="width: 50%, align: left"]T4,Free(Direct)[/TD] [TD="width: 10%, align: left"]1.39[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]0.82-1.77 - ng/dL[/TD]

Lab:TSH (LC&Q)

[TD="width: 50%, align: left"]TSH[/TD] [TD="width: 10%, align: left"]1.600[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]0.450-4.500 - uIU/mL[/TD]

Lab:Triiodothyronine,(T3) Free (LC&Q)

[TD="width: 50%, align: left"]Triiodothyronine,Free,Serum[/TD] [TD="width: 10%, align: left"]3.2[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]2.0-4.4 - pg/mL[/TD]

[TD="width: 50%, align: left"]This is a big improvement in TT and FT. Previous bloodwork just prior to TRT was TT= 559, FT=89 and SHBG= 46.8 E2=29.9 In reality I shouldn't have really been on TRT with these numbers but I was feeling lethargic most of the day and sub part erections. The only thing that jumps out at me is the fact that the E2 number did not rise with the testosterone increase, other than that the numbers look great to me but I can't for the life of me determine why I feel so impotent despite positive results. E2 seems right in the range but it could be I am hyper sensitive to it? Any help would be greatly appreciated.[/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 10%, align: left"][/TD] [TD="width: 30%, align: left"]2.0-4.4 - pg/mL [/TD]

Here are the testosterone ranges btw

[TD="class: nopadding, colspan: 2"]	[/TD]
[TD="class: sections no-bot-border med-text, colspan: 2"]Clinical Information:C[/TD]

 

[Vince]

It's strange you do not have any libido, especially at your age. I recommend the proper estrogen test, the sensitive one for men. You had the wrong E2 labs, you may want to check your thyroid even though you're free T3 looks good. You could check the reverse T3 and antibodies just to make sure your thyroid is good. That's all I can think of hopefully others will chime.

 

[Gman86]

Ya it is odd, you would think that with those numbers all within range that you would feel amazing, and have no problems with libido or erections. Have you thought about adding HCG to your protocol? I've been on HCG since I started TRT, so I don't have any experience with TRT not using it. But I have heard of people having issues with libido and erections, then adding HCG, and it resolving the issue.

 

[Systemlord]

You may want to inform your endo that he's ordering the wrong estrogen test, the range is a dead give away and is for females. You need the LC/MS/MS method, E2 is expected to be lower than stated, that would explain lack of erections and ejaculations. The symptoms your describing is low E2, common when below 20 pg/mL.

Yes you should have been put on TRT, having Total T midrange with SHBG near the top of the ranges was the problem. SHBG binds up testosterone, when elevated it binds up more and more testosterone, choking your free testosterone.

 

[Gman86]

Are you on an AI? How is it possible for your total testosterone to almost double, yet E2 actually went down? I don't think I've ever seen that before.

 

[Admired]

You may want to inform your endo that he's ordering the wrong estrogen test, the range is a dead give away and is for females. You need the LC/MS/MS method, E2 is expected to be lower than stated, that would explain lack of erections and ejaculations. The symptoms your describing is low E2, common when below 20 pg/mL.

Yes you should have been put on TRT, having Total T midrange with SHBG near the top of the ranges was the problem. SHBG binds up testosterone, when elevated it binds up more and more testosterone, choking your free testosterone.

Thanks for your reply, shouldn’t E2 raise with a subsequent rise in testosterone as what was seen, a nearly double increase in test with a small decrease in E2, this makes no sense. Doesn’t high and low E2 have the same symptoms? So basically get E2 retested with the LC/MS/MS method whatever that is?

 

[Admired]

No I’m not on AI, I’m as confused with the results as you.

 

[Admired]

No I’m not using hcg but I will mention it to my endo.

 

[Systemlord]

Thanks for your reply, shouldn't E2 raise with a subsequent rise in testosterone as what was seen, a nearly double increase in test with a small decrease in E2, this makes no sense. Doesn't high and low E2 have the same symptoms? So basically get E2 retested with the LC/MS/MS method whatever that is?

Occasionally I see men who have low E2 even with a high Total T, it just means you are an under converter probably do to a low number of aromatase enzyme and or your liver clears out excess estrogen too well. Low and high E2 are similar and easily confused, some men need estrogen above 30 to feel well. There is no office range for estrogen, some need more and some less.

Yes LC/MS/MS known as E2 sensitive or ultrasensitive designed for men, the standard test isn't sensitive enough to give accurate readings because it's designed for females who have more estrogen tha men.

Low Estradiol Symptoms:

• Fatigue along the lines of sleepiness
• hypersomnia (sleeping too much and too often)
• strong erections but limited sensitivity
• loss of erections
• osteoporosis and osteopenia
• joint pain, clicking or popping joints
• eye fatigue (eyes seem more tired despite adequate sleep, dark circles)
• loss of libido (interest in sex)
• difficulty retaining water (constant urination)
• anxiety, depression, irritability

High Estradiol Symptoms:

• Soft erections, inability to maintain an erection
• water retention (less frequent urination), leading to excessive sweating, blood pressure spikes or high blood pressure (from the water retention)
• insomnia
• hot flushing (flushing around the ears or on the face)
• night sweats (from estradiol lowering, causing loss of water retention)
• bloating; brain fog (like your head's in a bubble)
• testicles seem smaller than usual

 

[Admired]

Occasionally I see men who have low E2 even with a high Total T, it just means you are an under converter probably do to a low number of aromatase enzyme and or your liver clears out excess estrogen too well. Low and high E2 are similar and easily confused, some men need estrogen above 30 to feel well. There is no office range for estrogen, some need more and some less.

Yes LC/MS/MS known as E2 sensitive or ultrasensitive designed for men, the standard test isn't sensitive enough to give accurate readings because it's designed for females who have more estrogen tha men.

Low Estradiol Symptoms:

• Fatigue along the lines of sleepiness
• hypersomnia (sleeping too much and too often)
• strong erections but limited sensitivity
• loss of erections
• osteoporosis and osteopenia
• joint pain, clicking or popping joints
• eye fatigue (eyes seem more tired despite adequate sleep, dark circles)
• loss of libido (interest in sex)
• difficulty retaining water (constant urination)
• anxiety, depression, irritability

High Estradiol Symptoms:

• Soft erections, inability to maintain an erection
• water retention (less frequent urination), leading to excessive sweating, blood pressure spikes or high blood pressure (from the water retention)
• insomnia
• hot flushing (flushing around the ears or on the face)
• night sweats (from estradiol lowering, causing loss of water retention)
• bloating; brain fog (like your head's in a bubble)
• testicles seem smaller than usual

Ok thank you very much, so I guess I should just get a retest with the sensitive measurement. Now say my E2 is lower than it should be, how can one increase E2? Based on symptoms i could have either high or low but I would say more so low.

 

[CoastWatcher]

Where does your prolactin sit? Out of range prolactin levels can hammer libido. And your DHT?

 

[Admired]

Where does your prolactin sit? Out of range prolactin levels can hammer libido. And your DHT?

Haven't had DHT tested and prolactin before starting TRT was

L

[TD="class: red"]Prolactin[/TD] [TD="class: red"]1.9

[/TD] [TD="class: red"]4.0-15.2 (ng/mL)[/TD] [TD="class: red"]MB[/TD]

How does prolactin play a role in libido? I don't know where it sits now however.

 

[Vince]

Haven't had DHT tested and prolactin before starting TRT was

L

[TD="class: red"]Prolactin[/TD] [TD="class: red"]1.9

[/TD] [TD="class: red"]4.0-15.2 (ng/mL)[/TD] [TD="class: red"]MB[/TD]

How does prolactin play a role in libido? I don't know where it sits now however.

Men's Sexual Problems Linked to Low Prolactin Levels

https://www.excelmale.com/forum/sho...exual-Problems-Linked-to-Low-Prolactin-Levels

 

[Admired]

Ok,

i'm going to go to LabCorp monday and get the following tests

E2 Sensitive Test
DHT (Which one?)
Prolactin
IGF-1



Anything else I should test for? I want all bases covered so I know what is the underlying issue. Do I have to get authorization from my doctor to get these tests or can I just walk in and get them done independent of my physician?

 

[madman]

Ok,

i'm going to go to LabCorp monday and get the following tests

E2 Sensitive Test
DHT (Which one?)
Prolactin
IGF-1



Anything else I should test for? I want all bases covered so I know what is the underlying issue. Do I have to get authorization from my doctor to get these tests or can I just walk in and get them done independent of my physician?

For DHT get the Equilibrium dialysis (HPLC/MS-MS) test

 

[Admired]

For DHT get the Equilibrium dialysis (HPLC/MS-MS) test

Ok thanks, any other tests I should consider? DHEA?

 

[madman]

Ok thanks, any other tests I should consider? DHEA?

DHEA is definitely good to know as it relates to the health of the adrenals and you should get your ferritin/serum iron tested.

 

[Admired]

For DHT get the Equilibrium dialysis (HPLC/MS-MS) test

Would you happen to know if the DHT test on discountedlabs is the Equi dialysis? It doesn't say. Is there even a test for HCG and since i'm not even on HCG would this test be irrelevant?

 

[madman]

Ok,

i'm going to go to LabCorp monday and get the following tests

E2 Sensitive Test
DHT (Which one?)
Prolactin
IGF-1



Anything else I should test for? I want all bases covered so I know what is the underlying issue. Do I have to get authorization from my doctor to get these tests or can I just walk in and get them done independent of my physician?

Also understand that even though your TT/FT are at the higher end of the reference range, seeing as your e2 was taken with the wrong test you will not know where your e2 truly sits until you have it done using the sensitive assay so I would not stress out over whether you may think your e2 is too high or too low until you have the proper e2 test done.

As far as libido it is complex and even if one had healthy TT/FT levels along with e2 in a healthy range and prolactin, DHT levels were also in range one can still experience issues with libido as lack of quality sleep, excess stress, neurotransmitter health also play a role.

When one first starts trt it is common for many to experience an increase in libido due to a surge in dopamine and the overall stimulatory effects of testosterone which most would call the honeymoon period and as the body eventually adapts to the new testosterone level libido levels off and as long as overall hormone are in a healthy range one will experience an overall improvement in libido but it may not be as intense as when first starting trt.

It is also common to experience increase in libido when one changes their protocol and increase testosterone dose but it is temporary as the body will eventually adapt to these new levels and again libido can level off and as long as overall hormones are in a healthy range one should have a healthy libido.

There are many men who are always chasing this so called raging libido thinking it should be present 24/7 on trt when in fact having healthy levels of sex hormones one should have a healthy functioning libido.

In your situation as well as many others e2 levels whether too low or high can definitely cause negative effects regarding libido/erections.

 

[Admired]

Also understand that even though your TT/FT are at the higher end of the reference range, seeing as your e2 was taken with the wrong test you will not know where your e2 truly sits until you have it done using the sensitive assay so I would not stress out over whether you may think your e2 is too high or too low until you have the proper e2 test done.

As far as libido it is complex and even if one had healthy TT/FT levels along with e2 in a healthy range and prolactin, DHT levels were also in range one can still experience issues with libido as lack of quality sleep, excess stress, neurotransmitter health also play a role.

When one first starts trt it is common for many to experience an increase in libido due to a surge in dopamine and the overall stimulatory effects of testosterone which most would call the honeymoon period and as the body eventually adapts to the new testosterone level libido levels off and as long as overall hormone are in a healthy range one will experience an overall improvement in libido but it may not be as intense as when first starting trt.

It is also common to experience increase in libido when one changes their protocol and increase testosterone dose but it is temporary as the body will eventually adapt to these new levels and again libido can level off and as long as overall hormones are in a healthy range one should have a healthy libido.

There are many men who are always chasing this so called raging libido thinking it should be present 24/7 on trt when in fact having healthy levels of sex hormones one should have a healthy functioning libido.

In your situation as well as many others e2 levels whether too low or high can definitely cause negative effects regarding libido/erections.

Thank you for the very informative information. I realize it is very complex and I just want to try to eliminate as many variables as possible and just have a normal functioning libido. Can you further clarify what you mean by neurotransmitter health, how does one even make sure it remains in a healthy state?

I'm also wondering if my overconsumption of zinc is the culprit for my possible low E2. I ingest about 100mg/day for the last few weeks with copper. Not sure but I am going to eliminate it for a while.

Thanks again