33 yo w/ Free T/SHBG of an 85 yo guy & no libido for 2 years - help!

[corvetteguy]

Hi everybody!

Stefan here - longtime reader and fan of this forum and web site.

I've got some real puzzling libido/testosterone issues and have reached an impasse about what to do next.

I'm 33 years old, married, have kids and would like more. Body fat somewhere between 15% and 20%.

Main issue: Total T is ok but I have the free T and SHBG of an 85+ YO man. Zero libido for 2 years (nothing turns me on but I do wake up with erections) Difficulty sleeping (wake up easily and also have frequent urination during the night even with moderate to low liquid consumption during the day). I usually wake up 3x to urinate. Inconsistent energy during the day. Increased anxiety. Simple tasks take lots of effort. Very little desire to interact with others, take on ambitious goals.

(will post bloodwork and labs in subsequent message)

Just a brief background:

I've had higher anxiety and below avg sleep for many years but libido was ok until 2 years ago.
2 years ago I started losing a lot of fat.
I was statistically obese so I went from about 35% to 10% body fat but it was gradual (took about 1 year.)
I lost most of the weight w/ 16/8 intermittent fasting but also later did one meal a day and alternate day fasting.
For the better part of the last two months I have done only regular meals, no fasting.

IF has worked wonders for my body fat but it may have been at least the catalyst to my issues.
There is emerging evidence that if someone has higher baseline cortisol, chronic fasting will accelerate HPA axis issues.

But I've quit all the fasting and nothing is improving.

No drugs or roids ever.
Alcohol is maybe an avg of 5 drinks/week (have gone weeks w/ zero alcohol and no difference.)
Caffeine is zero to 4 cups/day. (have gone weeks w/ zero caffeine and no difference.)
I'm almost always in bed for 8 hrs but sleep quality blows so I still am tired w/ erratic energy during the day.
Diet is mostly clean and whole foods.
Stress is average to low. Just the usual ups and downs of a job and family life but nothing out of the ordinary.

I've tried just about everything from a natural standpoint and nothing is improving.

Earlier this year, I had a TSH of 6 so I thought my issues where hypothyroid but I've corrected that and TSH has been under 2 for months now and still no change.

I'm seeing a functional medicine doctor who is pretty good and is ready to prescribe me 100 mg cypionate/week + HCG. I'm ready to go for it at this point as I have tried everything else and am tired of feeling awful but I wanted to get advice from all you guys or see if I may be overlooking something.

I am very grateful for any advice or feedback! (I'll post more specific bloodwork/labs in a message to follow).

 

[corvetteguy]

SHBG = 78 (reference range: 16.5 to 55.9)
Free T = 5.5 (reference range: 8.7 to 25.1)
Total T = 540

So only about 1% of my T is available for use.

See how bad my SHBG and Free T is according to the chart I am attaching
(disregard the red circles)

TSH = 1.15
AM Cortisol = 11.2 (see attachment for saliva cortisol results;
they are lowish in the morning and highish at night.)

All other important numbers are optimal or within range
(Eg: vitamin D, iron, zinc, blood sugar, etc)

Thank you in advance for the help!

 

[fifty]

Do you have any LH blood test? When i was a little younger i had similar values to yours and got good results using clomid. My lh was like 1.5 though.

Any dhea-s numbers?

 

[corvetteguy]

Hi fifty,

Thank you so much for such a prompt reply.

I have really comprehensive chem and metabolic bloodwork but I
couldn't convince my doc until recently that there was a T issue.

I was the one who had to request Free T and SHBG bloodwork in
addition to total T and the results were a real eye opener to her.

I'll be honest - I'm sort of burnt out on many waves of bloodwork
this year and am just ready to feel better but if you guys insist
on LH, DHEA or any other ones before taking the next step, I
will go ahead and do it.

 

[fifty]

I understand. If you want to do trt that’s fine i am just saying there are other possible things you could look at. Sleep apnea? Low dhea? For example sleep apnea will often cause your body to wake up so you don’t go too far into oxygen debt. Low dhea can make you tired. So can thyroid issues.

It’s too bad bloodwork is so expensive and cumbersome. One day you’ll probably just be able to scan your wrist with your iphone20 and get full panel results in 5 seconds.

 

[corvetteguy]

I guess I always ruled out sleep apnea since I don't have most of the symptoms or signs (snoring, gasping for air, headaches in the morning, waking up with dry mouth) but perhaps I might still have it?

I'll definitely get more blood work and take a sleep test if this may prevent me from getting on TRT prematurely.

 

[corvetteguy]

Fifty, and anyone else here with experience ...

What if I have low DHEA and LH before starting TRT?
What would you suggest I do at that point, hypothetically speaking?

 

[fifty]

I am just saying clomid is sometimes an option for "trt" if LH is low. It will tell the body to produce more testosterone. It works for some, it's cheap ($15/mo), and it's easy to take (1 pill per day usually at 25mg or 12.5mg). It will usually also raise E2 and SHBG some though so some don't like it. I always liked it though when I used it in the past even though I am a high SHBG guy.

DHEA helps some people in the realm of sex drive. It is also cheap (~$10/mo for tablets...start at 5mg tablet twice a day and can go up from there). I remember at one point one of the pharmacies that TRT docs use was making a test cyp/dhea mixture to inject. Some reports of "hyper-sexuality" using that...it was thought to be the injectable dhea causing that "side effect". Some people find good benefits with a combination of dhea and pregnenolone.

There are many on this board who know way more than me. Maybe they will chime in on the above. Some people like that stuff and some people hate it.

If I were you I would just do a bit of research on clomid, dhea, and pregnenolone. Would also consider a sleep study if insurance covers it or it's not too expensive where you're at. Those are things a doctor can advise you on as well. Clomid is the only one of those that is a prescription med.

TRT is always an option but it's much more of a commitment than the options I listed above. You will have to inject test and hcg probably 2-3x /week. If your hematocrit gets too high from the injections, you will have to donate blood several times per year. Fertility can become an issue as TRT will shut you down. Many people when trying to have kids will come off TRT for a while (and add clomid) to get their sperm count back up to a normal/high level. Some even donate sperm to freeze before starting TRT just to be on the safe side.

 

[fifty]

If sex drive is a primary concern, definitely look at dhea and pregenolone. I had crazy high sex drive last year when I had tried that combo. I believe I was taking only 5mg dhea twice per day and 10mg pregnenolone once per day using sublingual tablets. I stopped because I felt that combo increased my hair shedding/fallout some. I am prone to male pattern baldness though.

 

[corvetteguy]

Fifty,

I just ordered some DHEA and pregnenalone. I know I should probably get bloodwork first but it's either this or TRT and I'm almost sure I'm low in both so I'll see what happens between now and bloodwork two months from now.

I see guys here making dosing suggestions all over the place so I'll have to figure that out.

I'm sorry to hear about your hair experience. Tons of thick hair are one of my few genetic strengths so I'll take my chances, haha

 

[Systemlord]

Fifty,

I just ordered some DHEA and pregnenolone. I know I should probably get bloodwork first but it's either this or TRT and I'm almost sure I'm low in both so I'll see what happens between now and bloodwork two months from now.

I see guys here making dosing suggestions all over the place so I'll have to figure that out.

I'm sorry to hear about your hair experience. Tons of thick hair are one of my few genetic strengths so I'll take my chances, haha

I tried 30mg pregnenolone without any lab work and for 6-8 hours I paid for it, heart was racing and it wasn't fun. Try sleeping through that.

 

[fifty]

As with anything, start low and then can increase once you see how you respond.