Detailed Labs of 42yr old healthy with some recent sexual symptoms

[ResearchIt]

42 years old
6'1" 190lbs
Never smoked, don't drink, no drugs, no medication, no accidents, no porn, no surgeries, good health, eat clean, don't work out a lot but pretty active.

First sexual symptom ever was age 37 when I noticed a little bit of decreased sensitivity because it took a few more thrusts and effort to orgasm when wearing a condom. At this age of 37 I also lost a little bit of hair around my crown and I got a tiny bit of extra fat on my chest and lats and waist. But not a big deal. Still no issues ever with libido, erections, or orgasm until about age 41.

At age 41 I began to feel some real changes. I still have a strong interest in sex, but I don't feel horny all the time like I used to. I used to feel a high sexual tension that needed to get released frequently, and then when released it was gone and I felt relaxed. I don't feel that tension like I used to. I developed a few gray hairs. My penis seems a bit more shriveled when flacid and less full of life. Erections are usually ok, but not like before. It now requires more stimulation and even some days it doesn't get up very well. Nocturnal erections still happen, though not as much. Morning erections and spontaneous erections are rare now. Erections solely from sexual thoughts are very difficult to achieve. Penis and genital area sensitivity is noticeably lower than before - not numb but not great. Less sensation around penis, scrotum, testicles, perenium, anus, and pubic bone. Orgasms used to be explosive, not as strong now. My scrotum seems looser and saggier as well. I haven't been sleeping as well, two or three nights out of the week I will wake up at 2am wide awake and can't fall back asleep for an hour or two. Sleep isn't as satisfying as it used to be.

I have started to use a 2.5mg Cialis an hour before sex just in case it is one of those days when a great erection won't happen. I don't need it every time but just use it as an insurance policy.

I have also used 5 to 15mg of Yohimbine and/or 750mg of Maca which has helped with sensitivity and achieving orgasm.

In addition to my labs, I had a complete cardiovascular exam - EKG result was great, calcium hardness score was checked and it was zero meaning no plaque. I had the penile doppler ultrasound done and have great blood flow and no venous leakage. I also had a sleep study and don't have sleep apnea.

My main current issues are lower libido, inferior erections, less sensitivity, more time and effort to orgasm, and less satisfying orgasms.

I would like to figure out what changed in me and how I can get my previous sexual self back without the assistance of Cialis or Yohimbine/Maca supplements. Unfortunately I don't have any labs from the past, but I had some detailed labs done recently (I think they missed doing the Estradiol Ultrasensitive though).

I have a feeling low free T is the issue, with my SHBG as the main culprit and my high free estradiol and mediocre total T levels being the second cause. I am new to this so any feedback, context, or insight would be appreciated, thank you so much!

 

[Systemlord]

The attachments are unreadable.

haven't been sleeping as well, two or three nights out of the week I will wake up at 2am wide awake and can't fall back asleep for an hour or two. Sleep isn't as satisfying as it used to be.

Low-T can cause poor sleep, before I was diagnosed with low-T I used to lie awake at night staring at the ceiling.

You should also get a sleep study done because if you have sleep apnea it can shorten your life.

 

[ResearchIt]

The attachments should be readable now, thanks!

 

[ResearchIt]

Low-T can cause poor sleep, before I was diagnosed with low-T I used to lie awake at night staring at the ceiling.

You should also get a sleep study done because sleep apnea can shorten your life.

I know what you mean, it is very frustrating laying awake at night staring at the ceiling. I had two sleep studies done, one at-home and one in-lab. Both confirmed I do not have sleep apnea. Unfortunately they didn't have guidance on what else might be the issue, though I suspect it is Low-T.

 

[Systemlord]

though I suspect it is Low-T.

It's not even a close call, you are clearly dealing with low-T.

Another thing, Cialis can't work if you don't have enough testosterone.

 

[Cataceous]

Although not dramatically low, your free testosterone is in a borderline area below the healthy normal range. Some men will have problems there. A relatively safe way to see if raising your testosterone would help is to run a trial with a testosterone nasal gel, such as Natesto. This method of testosterone delivery minimizes the disruption of other hormones that would occur with traditional TRT.

 

[ResearchIt]

Thank you for the comments. I'll have to try that Natesto to see if it makes a difference to my symptoms. Nice that there is a low risk way to somewhat trial TRT with that.

One thing I am curious about is whether my symptoms are "normal" for my age and whether their onset (seemed like most of the change happened over 1 year from 41-42) is "normal" as well?

 

[sammmy]

Your symptoms are not normal for your age. Boosting your testosterone may improve penis sensitivity, orgasm, and erection but this may just cover up the real cause, which may lie in the nervous system/neurotransmitters. Libido may not be improved at normal TRT levels of testosterone.

Another fast and cheap way to boost temporarily free testosterone is Anastrozole. It may boost sexuality but make you feel bad overall so it is a just a quick test if a testosterone boost covers up the symptoms. It is not a useful solution in the long run due to the side effects of Anastrozole - fatigue, joint pains, feeling unwell, even insomnia.

Last, your labs show low platelets and boundary low lymphocytes. Maybe some kind of infection was going on. These have to be retested and monitored.

 

[MarcoFL]

You are low on Vit D. I would get on that asap!

 

[ResearchIt]

Thanks again, very helpful. I agree, I would first like to try to figure out the root cause rather than forever bandaid the effects with Cialis, herbs, or even hormone adjusters. I do need to vitamin supplement better. And maybe ultimately I will need a direct hormone adjustment, but I would like to rule out anything else first. It's interesting there are approaches like Natesto and Anastrozole that can be trialed without the committment of TRT. Dipping your toe in the water to see gauge benefits before jumping in.

Another question, my SHBG is on the higher end of the range, and if it were lower my free testosterone would be higher. I have read on the forums that there isn't a direct way to lower SHBG, but sometimes it can be lowered by treating something else, for example high estradiol. Any ideas about manipulating my SHBG, given my labs?

 

[Systemlord]

I have read on the forums that there isn't a direct way to lower SHBG, but sometimes it can be lowered by treating something else, for example high estradiol.

No because estradiol has a minimal impact on SHBG.

SHBG is one of the most difficult hormones to change. In some cases the high SHBG is the direct result of low-T, because the body is trying to scavenge T on the decline.

This is the body's way of trying to balance all the hormones and sometimes makes things worse.

 

[MarcoFL]

Thanks again, very helpful. I agree, I would first like to try to figure out the root cause rather than forever bandaid the effects with Cialis, herbs, or even hormone adjusters. I do need to vitamin supplement better. And maybe ultimately I will need a direct hormone adjustment, but I would like to rule out anything else first. It's interesting there are approaches like Natesto and Anastrozole that can be trialed without the committment of TRT. Dipping your toe in the water to see gauge benefits before jumping in.

Another question, my SHBG is on the higher end of the range, and if it were lower my free testosterone would be higher. I have read on the forums that there isn't a direct way to lower SHBG, but sometimes it can be lowered by treating something else, for example high estradiol. Any ideas about manipulating my SHBG, given my labs?

My doctor recommended Life Extension Mens Ultra Prostate formula to lower SHBG. Really helps with urine flow and dropped my SHBG by 15-20 points!

 

[Golfboy307]

Agree with System Lord. My SHBG dropped from 50 to 30 after I started on Test Cyp.

 

[Cataceous]

No because estradiol has a minimal impact on SHBG.
...

Incorrect. Estrogens are strong drivers of SHBG production in the liver. Guys who take Clomid often see SHBG skyrocket due to the estrogenic zuclomiphene component. In the other direction, when I had estradiol fall to undetectable levels, SHBG dropped to single digits from my normal around 30 nMol/L.

You are low on Vit D. I would get on that asap!

If it's in ng/mL then it's fine. The range should start at 20, but was changed without scientific justification. In addition, there may be problems with higher levels. Highest natural testosterone levels are associated with vitamin D in the mid 30s ng/mL.

Vitamin D: The Dangers of High Levels

Now it is pretty well-known in the men's health community that correcting a Vitamin D deficiency can increase testosterone, something...

www.peaktestosterone.com

 

[ResearchIt]

Thank you - very helpful feedback! I used a Free T calculator (Free & Bioavailable Testosterone calculator) and entered some sample Total T, Albumin, and SHBG values to check what corresponding Free T levels would be:

Example 1

Example 2

Am I right to think that the lower range Free T results in my labs are possibly the cause of the change I felt this last year? Or do you think it could be the higher free estradiol?

Given my age, background, and labs, what do you think would be good Total T, Albumin, SHBG, Free T, and Estradiol targets for me for the purpose of getting my sexual symptoms improved and back to normal?

 

[Cataceous]

I view the healthy normal range for that Vermeulen free T calculator as about 10-20 ng/dL. Your value is 8.2 ng/dL So it is possible that this is contributing to your problems. But be aware that some guys function perfectly well at this level, so you shouldn't make assumptions until you have more information. Your ratio of total estradiol to total testosterone is 0.48%. This is nicely within the normal range. Your calculated free estradiol of 0.5 pg/mL doesn't correspond very well with the measured value of 0.68, primarily because of the different ranges. For the calculated value the range is about 0.3-1.3 pg/mL. For the measured value this lab wants it below 0.45. I don't think either method is inherently more trustworthy, so I would consider free estradiol to be uncertain at this point. Normally with high SHBG such as yours the level of estradiol is considered to be less of a problem.

I've argued that when we don't know our hormone levels from our prime years we might target average levels for healthy young men. These would be total testosterone of 600-700 ng/dL, SHBG of 30 nMol/L, Vermeulen free T of 15 ng/dL and estradiol of 25-30 pg/mL.

Because your natural numbers aren't that bad I'd encourage you to limit initial treatments to testosterone nasal gel or enclomiphene. These can raise your testosterone without causing too many other problems, unlike regular TRT.

 

[ResearchIt]

Thank you for the excellent feedback.

 

[ResearchIt]

What do you guys think about this?

With a little bit of exercise and effort on my part, I can keep my total T levels around 600 plus a few points. So while my natural T isn't super high, it's not really low either. My free T is low and my SHBG is high. Interestingly, my DHT and Free Estradiol are high.

There were mentions above of estrogens being strong drivers of SHBG production as well as possibly trying Anastrozole to reduce estrogen levels.

This got me thinking that perhaps my body is converting too much T into DHT and Free Estradiol and, since SHBG binds to DHT and Estradiol (albeit less so than T), that maybe my body is producing more SHBG than normal to try to constrain my high DHT and Free Estradiol levels. If that is the case, unfortunately the increase in SHBG production is lowering my Free T as well. If this theory is correct, then I should explore why my body converts too much T into DHT and Estradiol.

Is there any merit to the theory above? If so, and I know we all have issues unique to us, but is this a common pattern with some guys and are there common solutions to it?

 

[Cataceous]

A counterpoint is that androgens have the opposite effect of estrogens on SHBG, tending to drive it down. Additionally, in another thread we've been discussing the effects of reducing SHBG. I'm starting to believe that this in isolation has minimal influence on the free hormone levels. However, if you were inclined to experiment then it's possible that micro-dosing an AI would push you in the desired direction, with higher free testosterone and at least relatively lower free estradiol. In absolute terms your free and total estradiol levels aren't actually very high, so you'd have to be very cautious with AI dosing. In the case of anastrozole I would start with only 15-20 mcg per day or so.

Our bodies regulate testosterone production via the levels of free androgens and, more importantly, free estrogens. As an aromatase inhibitor starts to reduce production of estradiol the body compensates with increased testosterone production, raising free testosterone. Via aromatization the higher testosterone prevents estradiol from dropping so much, but you've still accomplished the goal of raising testosterone relative to estradiol. This may also reduce SHBG to an extent. It may seem paradoxical, but lower SHBG reduces the total hormone levels. So you shouldn't be disappointed if total testosterone doesn't move or even goes down. You have to instead look at what the free hormones are doing.

 

[ResearchIt]

Thank you, that's very helpful!!