Diminished sexual function after starting TRT

[radman]

I have recenlty started TRT with HCG for low T at age 62. My total testosterone level has been gradually dropping over the past few years:
Feb 2019 401
Feb 2024 386
May 2025 296
Sep 2025 322
Oct 2025 249
Nov 2025 334

When I saw the level of 249 I decided I should try TRT since, while fit, I have had low muscle mass, fatigue, poor sleep, and apathy. But my sexual function has been pretty much unchanged since a young age - no problems at all with erections or libido.

Started TC 50 mg SQ twice a week, beginning on Nov 7. I am also concurrently doing HCG 250 IU SQ twice a week, primarily to avoid testicular atrophy and to allow for a quicker recovery of normal testicular function should I decide to stop.

I have noticed a definite impact on my sexual function. Erections are slow and not as rock hard as before. Orgasms are OK, but lack the intensity they had a few weeks ago.

I didn't have any particular thoughts about sexual function since I didn't have any problems, but I would have thought that it would be a favorable impact if anything.

Here are my labs just prior to starting TRT/HCG:
(I started heavy resistance training in October which may have had an impact on TT)

Total Testosterone: 334 ng/dl (Oct was 249)
Free Test (equilibrium dialysis): 56.5 pg/ml (Oct was 45)
SHBG: 23 nmol/L
LH: 4.2 mIU/ml
Estradiol (ultrasensitive): 28 pg/ml (normal <29)

So I'm confused. The estradiol level was borderline high at baseline based on the labs reported normal of less than 29 (Quest), even though most authorities consider 10-40 within normal range. Also the T:E ratio of about 12 is pretty normal.
Since that was the only clue, I took .25 mg of Anastrazole to see if I notice any impact.

Has anyone else had this type of experience?
Any thoughts on cause or plan of action?

Thanks for any help

 

[Systemlord]

HCG 250 IU SQ twice a week, primarily to avoid testicular atrophy and to allow for a quicker recovery of normal testicular function should I decide to stop.

I have noticed a definite impact on my sexual function. Erections are slow and not as rock hard as before. Orgasms are OK, but lack the intensity they had a few weeks ago.

The cause is hCG, which is common to see sexual function degrade in some men. The LH receptors weren't meant to be stimulated in a near constant state, LH receptors are meant for pulsatile stimulation.

The half-life of LH is 20 minutes, the half-life of hCG is 24-36 hours. Big difference!

Some men report positive benefits cycling hCG every other week.

 

[Systemlord]

I have recenlty started TRT with HCG for low T at age 62. My total testosterone level has been gradually dropping over the past few years:
Feb 2019 401
Feb 2024 386
May 2025 296
Sep 2025 322
Oct 2025 249
Nov 2025 334

Hard to tell if your T levels are actually on a steady decline over this period of time. Many things contribute to T production, diet, sleep and even overtraining which will effect T negatively. Your hormones are constantly changing day to day, you'll never repeat the same test twice, because hormones production isn't linear. Your T levels will fluctuate every day.

Too much cortisol is a testosterone killer. Overtraining can suppress T. Lab testing isn't 100% accurate. Lab testing can vary 50-75 ng/dL in either direction. Split one blood sample into two, you get two different results but in reality both are the same value.

Total T is a function of SHBG, high SHBG, higher Total T. Free T is what matters.

 

[radman]

The cause is hCG, which is common to see sexual function degrade in some men. The LH receptors weren't meant to be stimulated in a near constant state, LH receptors are meant for pulsatile stimulation.

The half-life of LH is 20 minutes, the half-life of hCG is 24-36 hours. Big difference!

Some men report positive benefits cycling hCG every other week.

Thanks, that is very helpful. I was suspicious about HCG as well. I have read that HCG causes increased intratesticular estrogen production and assumed that could be a cause of the diminshed sexual function. However, I have not heard that the constant stimulation of the LH receptors could be a cause. If I dont' notice an impact from the low dose anastrazole, I'll discontinue it promptly and then discontinue the HCG to see if that fixes the problem.
I like the idea of cycling HCG. In fact, I've been wondering about longer cycles - ie. no HCG for a month or so and then maybe a week at somewhat higher dose HCG, like 500 mg three times a week for a couple weeks, then off again.
I am not concerned about fertility, just want to avoid testicular atrophy and hopefully allow for more rapid recovery of normal testicular function. I don't know how much or how often the testes need stimulation in order to prevent atrophy.

 

[Systemlord]

I have read that HCG causes increased intratesticular estrogen production and assumed that could be a cause of the diminshed sexual function.

AI's can't affect estrogen produced within the testicles, Ai's only affect E2 outside the testicle environment.

Some men have struggled to lower estrogen while on hCG.

 

[radman]

Hard to tell if your T levels are actually on a steady decline over this period of time. Many things contribute to T production, diet, sleep and even overtraining which will effect T negatively. Your hormones are constantly changing day to day, you'll never repeat the same test twice, because hormones production isn't linear. Your T levels will fluctuate every day.

Too much cortisol is a testosterone killer. Overtraining can suppress T. Lab testing isn't 100% accurate. Lab testing can vary 50-75 ng/dL in either direction. Split one blood sample into two, you get two different results but in reality both are the same value.

Total T is a function of SHBG, high SHBG, higher Total T. Free T is what matters.

I think looking back over the years the testosterone has continued to gradually decline, as is pretty much expected. Of course, it isn't a straight line decline. More like the graph of the S+P 500 during a bear market!

 

[Systemlord]

I am not concerned about fertility, just want to avoid testicular atrophy and hopefully allow for more rapid recovery of normal testicular function. I don't know how much or how often the testes need stimulation in order to prevent atrophy.

I've been on TRT on and off for 10 years, on the longest for solid 6 years, came off and HPTA rebooted very quickly, within 4.5 weeks after stopping injections and 7 days on short acting oral testosterone.

Permanent atrophy is unlikely.

 

[radman]

AI's can't affect estrogen produced within the testicles, Ai's only affect E2 outside the testicle environment.

Some men have struggled to lower estrogen while on hCG.

Yeah, but I think the estrogen produced in the testes is partially leached into the systemic circulation causing a rise in serum E2. If true, this rise in E2 would add to the E2 formed via aromatization of the exogenous TC. Net result of the elevated E2 could impact sexual function (either good or bad effect depending on T:E ratio and other factors).
A short course of low dose anastrazole with attention to changes/improvement in symptoms could inform the cause of the sexual dysfunction being related to high E2. I'll check E2 level at my next blood draw in a few weeks, but would like to sort things out sooner.
That's my thinking anyway.
The complicated nature and inter-relation of the various hormones in the system makes definite inferences of cause and effect difficult. In that setting, a little trial and error may be helpful (anastrazole first, discontinue HCG second, recheck labs w/T:E ratio in a few weeks.

 

[radman]

I've been on TRT on and off for 10 years, on the longest for solid 6 years, came off and HPTA rebooted very quickly, within 4.5 weeks after stopping injections and 7 days on short acting oral testosterone.

Permanent atrophy is unlikely.

Thank you, very helpful information. I've seen different things written on time to recovery vs. duration of TRT vs age, etc.
Your experience makes me wonder whether the HCG is worth it. If recovery of the natural HPTA happens quickly, then the only value of HCG for me is to avoid temporary atrophy. I mean, I suspect most guys looking for a testosterone boost are like me and don't like the idea of it shrinking your cojones. But maybe I'm too skittish about it.